1
|
Toale C, Morris M, Gross S, O'Keeffe DA, Ryan DM, Boland F, Doherty EM, Traynor OJ, Kavanagh DO. Performance in Irish Selection and Future Performance in Surgical Training. JAMA Surg 2024; 159:538-545. [PMID: 38446454 PMCID: PMC10918576 DOI: 10.1001/jamasurg.2024.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024]
Abstract
Importance Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity. Objective To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments. Design, Setting, and Participants This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022. Exposures Selection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview. Main outcomes and measures Assessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses. Results Data were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (β = 0.31; 95% CI, 0.14-0.48) and simulated environments (β = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (β = 0.55; 95% CI, 0.22-0.87). Conclusions and Relevance In this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.
Collapse
Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sara Gross
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara A O'Keeffe
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Donncha M Ryan
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eva M Doherty
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oscar J Traynor
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | |
Collapse
|
2
|
Anton NE, Doster D, Choi JN, Ritter EM, Stefanidis D. Neuropsychological Differences Between Surgery Interns and Age-Matched Adults. JOURNAL OF SURGICAL EDUCATION 2023; 80:1641-1647. [PMID: 37634978 DOI: 10.1016/j.jsurg.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/23/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE The purpose of this study was to assess how neuropsychological factors differ between general surgery interns and normative data from age-matched adults in the general population. DESIGN Participants completed a comprehensive neuropsychological assessment battery. Neuropsychological factors assessed included: executive function (Behavioral Rating Inventory of Executive Function, BRIEF), working memory (Wechsler Adult Intelligence Scale, or WAIS, digit span), psychomotor speed (WAIS coding, Trails A and B), selective attention (D2 Test of Attention), and problem solving (Tower of London, TOL). Data for all measures was compared to previously published normative data for age-matched, healthy adults in the general population using one-sample t-tests. SETTING This study was completed at Indiana University School of Medicine in Indianapolis, IN, which is a large academic healthcare training institution. PARTICIPANTS Postgraduate year 1 general surgery residents (PGY1s) voluntarily participated in this study. RESULTS Twenty-six general surgery PGY1s completed all measures. We found that PGY1s had significantly better behavioral inhibition, working memory, selective attention, problem solving, and psychomotor speed than their counterparts in the general population (Table 1). Conversely, we found that PGY1s had significantly lower cognitive flexibility (p = 0.02) and ability to monitor task progress (p = 0.006) than the general population. CONCLUSIONS The results from this study indicate that there are several neuropsychological factors that may help explain the high achievement of general surgery PGY1s. Assessment of these factors could aid general surgery programs in the selection and training of high-caliber residents. However, there are indicators that PGY1s struggle from cognitive inflexibility and task monitoring compared to the general population. These skills are needed to manage the complex and dynamic nature of surgical performance, so educators should consider methods to enhance junior residents' development of these characteristics.
Collapse
Affiliation(s)
- Nicholas E Anton
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Dominique Doster
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer N Choi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - E Matthew Ritter
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
3
|
Dasci S, Schrem H, Oldhafer F, Beetz O, Kleine-Döpke D, Vondran F, Beneke J, Sarisin A, Ramackers W. Learning surgical knot tying and suturing technique - effects of different forms of training in a controlled randomized trial with dental students. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc48. [PMID: 37560044 PMCID: PMC10407582 DOI: 10.3205/zma001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 08/11/2023]
Abstract
Objective The acquisition of surgical skills requires motor learning. A special form of this is intermanual transfer by transferring motor skills from the nondominant hand (NDH) to the dominant hand (DH). The purpose of this study was to determine the learning gains that can be achieved for the DH by training with the DH, the NDH, and by non-surgical alternative training (AT). Methods 124 preclinical (n=62) and clinical (n=62) dental students completed surgical knot tying and suturing technique training with the DH, with the NDH, and an AT in a controlled randomized trial. Results A statistically significant learning gain in knot tying and suture technique with the DH was evident only after training with the DH when compared to training with the NDH (p<0.001 and p=0.004, respectively) and an AT (p=0.001 and p=0.010, respectively). Of those students who achieved a learning gain ≥4 OSATS points, 46.4% (n=32) benefited in their knot tying technique with the DH from training with the DH, 29.0% (n=20) from training with the NDH, and 24.6% (n=17) from an AT while 45.7% (n=32) benefited in their suturing technique with the DH from training with the DH, 31.4% (n=22) from training with the NDH, and 22, 9% (n=16) from an AT. Conclusions Training with the DH enabled significantly better learning gains in the surgical knot tying and suturing techniques with the DH.
Collapse
Affiliation(s)
- Sükran Dasci
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Harald Schrem
- Medical University of Graz, General, Visceral and Transplant Surgery, Graz, Austria
| | - Felix Oldhafer
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Oliver Beetz
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Dennis Kleine-Döpke
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Florian Vondran
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Jan Beneke
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - Akin Sarisin
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Wolf Ramackers
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| |
Collapse
|
4
|
Rahimi AM, Hardon SF, Uluç E, Bonjer HJ, Daams F. Prediction of laparoscopic skills: objective learning curve analysis. Surg Endosc 2023; 37:282-289. [PMID: 35927349 PMCID: PMC9839814 DOI: 10.1007/s00464-022-09473-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Prediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box. METHODS Surgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency. RESULTS A total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses. CONCLUSION The learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.
Collapse
Affiliation(s)
- A. Masie Rahimi
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD Amsterdam, The Netherlands
| | - Sem F. Hardon
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
| | - Ezgi Uluç
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
| | - H. Jaap Bonjer
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Tafelbergweg 47, 1105 BD Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC – VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
5
|
El Boghdady M, Ewalds-Kvist BM. The innate aptitude's effect on the surgical task performance: a systematic review. Updates Surg 2021; 73:2079-2093. [PMID: 34564821 PMCID: PMC8606384 DOI: 10.1007/s13304-021-01173-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
Surgery is known to be a craft profession requiring individuals with specific innate aptitude for manipulative skills, and visuospatial and psychomotor abilities. The present-day selection process of surgical trainees does not include aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We aimed to scrutinize the significance of innate aptitudes in surgical practice and impact of training on skills by systematically reviewing their significance on the surgical task performance. A systematic review was performed in compliance with PRISMA guidelines. An initial search was carried out on PubMed/Medline for English language articles published over 20 years from January 2001 to January 2021. Search strategy and terms to be used included ‘aptitude for surgery’, ‘innate aptitude and surgical skills, ‘manipulative abilities and surgery’, and ‘psychomotor skills and surgery’. MERSQI score was applied to assess the quality of quantitatively researched citations. The results of the present searches provided a total of 1142 studies. Twenty-one studies met the inclusion criteria out of which six citations reached high quality and rejected our three null hypothesis. Consequently, the result specified that all medical students cannot reach proficiency in skills necessary for pursuing a career in surgery; moreover, playing video games and/or musical instruments does not promote skills for surgery, and finally, there may be a valid test with predictive value for novices aspiring for a surgical career. MERSQI mean score was 11.07 (SD = 0.98; range 9.25–12.75). The significant findings indicated that medical students with low innate aptitude cannot reach skills necessary for a competent career in surgery. Training does not compensate for pictorial-skill deficiency, and a skill is needed in laparoscopy. Video-gaming and musical instrument playing did not significantly promote aptitude for microsurgery. The space-relation test has predictive value for a good laparoscopic surgical virtual-reality performance. The selection process for candidates suitable for a career in surgery requests performance in a simulated surgical environment.
Collapse
Affiliation(s)
- Michael El Boghdady
- Department of General Surgery, Croydon University Hospital, London, UK.
- St Georges University of London, London, UK.
| | | |
Collapse
|
6
|
Beattie KL, Hill A, Horswill MS, Grove PM, Stevenson ARL. Aptitude and attitude: predictors of performance during and after basic laparoscopic skills training. Surg Endosc 2021; 36:3467-3479. [PMID: 34370121 PMCID: PMC8351236 DOI: 10.1007/s00464-021-08668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Background Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on. Purpose To assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training. Method Thirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures. Results The statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks. Conclusion By focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.
Collapse
Affiliation(s)
- Kirsty L Beattie
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Andrew Hill
- School of Psychology, The University of Queensland, Brisbane, Australia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia
- Minerals Industry Safety and Health Centre, Sustainable Minerals Institute, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| |
Collapse
|
7
|
Mason EM, Deal MJ, Richey BP, Baker A, Zeini IM, Service BC, Osbahr DC. Innate Arthroscopic & Laparoscopic Surgical Skills: A Systematic Review of Predictive Performance Indicators Within Novice Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2021; 78:178-200. [PMID: 32591323 DOI: 10.1016/j.jsurg.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To query the literature for predictive factors for performance on arthroscopic and laparoscopic surgical simulators in novice surgical trainees. These predictive factors may prove a valuable tool in identifying certain innate potential to becoming a future skilled surgeon that could benefit both surgical residency candidates and program directors alike, while also improving patient care. DESIGN Systematic Review. RESULTS The initial searches yielded 249 articles. After screening titles/abstracts and implementing inclusion and exclusion criteria, 36 studies were included in the final systematic review. CONCLUSIONS Current literature suggests that video game experience/frequency, psychomotor and visuospatial aptitude, and perceptual ability are among the most promising predictive indicators of baseline simulator performance. Study limitations include utilization of different standards for characterizing predictive factors. Future studies should aim to utilize standard guidelines for accurate quantification of innate predictive factors. Future research should also focus on utilizing standardized simulator platforms and aptitude tests to allow for more accurate cross-study comparisons and meta-analyses with larger sample sizes.
Collapse
Affiliation(s)
- Eric M Mason
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Bradley P Richey
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alexandra Baker
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Benjamin C Service
- Sports Medicine Division, Orlando Health Orthopedic Institute, Orlando, Florida
| | | |
Collapse
|
8
|
Kalun P, Dunn K, Wagner N, Pulakunta T, Sonnadara R. Recent evidence on visual-spatial ability in surgical education: A scoping review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e111-e127. [PMID: 33349760 PMCID: PMC7749687 DOI: 10.36834/cmej.69051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Understanding the relationships between structures is critical for surgical trainees. However, the heterogeneity of the literature on visual-spatial ability (VSA) in surgery makes it challenging for educators to make informed decisions on incorporating VSA into their programs. We conducted a scoping review of the literature on VSA in surgery to provide a map of the literature and identify where gaps still exist for future research. METHODS We searched databases until December 2019 using keywords related to VSA and surgery. The resulting articles were independently screened by two researchers for inclusion in our review. RESULTS We included 117 articles in the final review. Fifty-nine articles reported significant correlations between VSA tests and surgical performance, and this association is supported by neuroimaging studies. However, it remains unclear whether VSA should be incorporated into trainee selection and whether there is a benefit of three-dimensional (3D) over two-dimensional (2D) training. CONCLUSIONS It appears that VSA correlates with surgical performance in the simulated environment, particularly for novice learners. Based on our findings, we make suggestions for how surgical educators may use VSA to support novice learners. Further research should determine whether VSA remains correlated to surgical performance when trainees move into the operative environment.
Collapse
Affiliation(s)
- Portia Kalun
- Department of Surgery, McMaster University, Ontario, Canada
| | - Krista Dunn
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Natalie Wagner
- Department of Surgery, McMaster University, Ontario, Canada
- Office of Professional Development & Educational Scholarship, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | | | - Ranil Sonnadara
- Department of Surgery, McMaster University, Ontario, Canada
- Department of Surgery, University of Toronto, Ontario, Canada
| |
Collapse
|
9
|
Pelizzo G, Cardinali L, Bonanno L, Marino S, Cavaliere C, Aiello M, Bramanti P, Mazzon E, Soddu A, Calcaterra V. Training Skills in Minimally Invasive, Robotic and Open Surgery: Brain Activation as an Opportunity for Learning. Eur Surg Res 2020; 61:34-50. [PMID: 32585673 DOI: 10.1159/000507766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The advantages of the robotic approach in surgery are undisputed. However, during surgical training, how this technique influences the learning curve has not been described. We provide a tentative model for analyzing the learning curves associated with observation and active participation in learning different surgical techniques, using functional imaging. METHODS Forty medical students were enrolled and assigned to 4 groups who underwent training in robotic (ROB), laparoscopic (LAP), or open (OPEN) surgery, and a control group that performed motor training without surgical instruments. Surgical/motor training included six 1-h sessions completed over 6 days of the same week. All subjects underwent functional magnetic resonance imaging (fMRI) scanning sessions, before and after surgical training during. RESULTS Twenty-three participants completed the study. The 3 surgical groups exhibited different learning curves during training. The main effects of the day of training (p < 0.01) and the group (p < 0.01) as well as a significant interaction of day of training group (p < 0.01) were observed. The performance increased in the first 4 days, reaching a peak at day 4, when all groups were considered together. The OPEN group showed the best performance compared to all other groups (p < 0.04). The OPEN group showed a rapid improvement in performance, which peaked at day 4 and decreased on the last day. Similarly, the LAP group showed a steady increase in the number of exercises they completed, which continued for the entire training period and reached a peak on the last day. However, the participants training in ROB surgery, after a performance initially indistinguishable from that of the LAP group, had a dip in their performance, quickly followed by an improvement and reaching a plateau on day 4. fMRI analysis documented the different involvement of the cortical and subcortical areas based on the type of training. Surgical training modified the activation of some brain regions during both observation and the execution of tasks. CONCLUSIONS Differences in the learning curves of the 3 surgical groups were noted. Functional brain activity represents an interesting starting point to guide training programs.
Collapse
Affiliation(s)
- Gloria Pelizzo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy, .,Department of Pediatric Surgery, "Vittore Buzzi" Children's Hospital, University of Milano, Milan, Italy,
| | - Lucilla Cardinali
- CMoN, Cognition, Motion and Neuroscience Unit, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Carlo Cavaliere
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Marco Aiello
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | | | - Andrea Soddu
- Brain and Mind Institute, Department of Physics and Astronomy, Western University, London, Ontario, Canada
| | - Valeria Calcaterra
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,Pediatric Unit, "Vittore Buzzi" Children's Hospital, Milan, Milan, Italy
| |
Collapse
|
10
|
Thomaschewski M, Laubert T, Zimmermann M, Esnaashari H, Vonthein R, Keck T, Benecke C. Efficacy of goal-directed minimally invasive surgery simulation training with the Lübeck Toolbox-Curriculum prior to first operations on patients: Study protocol for a multi-centre randomized controlled validation trial (NOVICE). Int J Surg Protoc 2020; 21:13-20. [PMID: 32322765 PMCID: PMC7171180 DOI: 10.1016/j.isjp.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 11/29/2022] Open
Abstract
Laparoscopic surgery (MIS) requires additional psychomotoric skills (basic skills) Acquisition of MIS basic skills by the video box trainer Lübecker Toolbox. Simulation of laparoscopic demands outside the operation room. MIS training outside the operation room prior to first operations on patients. Implementation of MIS training into the surgical residency curriculum.
Background Minimally invasive surgery (MIS) procedures require special psychomotoric skills. Learning of these MIS basic skills is often performed in the operating room (OR). This is economically inefficient and could be improved in terms of patient safety. Against the background of this problem, various MIS simulators have been developed to train MIS basic skills outside the OR. Aim of this study is to evaluate to what extent MIS training programs and simulators improve the residents’ skills in performing their first MIS procedures on patients. Method The current multicentric RCT will be performed with surgical residents without prior active experience in MIS (n = 14). After the participants have completed their first laparoscopic cholecystectomy as baseline evaluation (CHE I), they will be randomized into two groups: 1) The intervention group will perform the Lübeck Toolbox curriculum, whereas 2) the control group will not undergo any MIS training. After 6 weeks, both groups will perform the second laparoscopic CHE (CHE II). Changes or improvements in operative performance (between CHE I and CHE II) will be analyzed and evaluated according to the Global Operative Assessment of Laparoscopic Skill (GOALS) Score (primary endpoint). Discussion The multicentric randomized controlled trial will help to determine the value of MIS training outside the operation room. Proof of effectiveness in practice transfer could be of considerable relevance with regard to an integration of MIS training programs into surgical education.
Collapse
Affiliation(s)
- Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Tilman Laubert
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Markus Zimmermann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | | | - Reinhard Vonthein
- Institut für Medizinische Biometrie, University Medical Center Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, ZKS Lübeck, Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Claudia Benecke
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| |
Collapse
|
11
|
Langlois J, Bellemare C, Toulouse J, Wells GA. Spatial abilities training in the field of technical skills in health care: A systematic review. Heliyon 2020; 6:e03280. [PMID: 32190751 PMCID: PMC7068633 DOI: 10.1016/j.heliyon.2020.e03280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/24/2019] [Accepted: 01/06/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To conduct a systematic review of the effect of interventions on spatial abilities in the field of technical skills in health care. Methods A literature search was conducted up to November 14, 2017 in Scopus and in several databases on EBSCOhost platform. Citations were obtained, articles related to retained citations were reviewed and a final list of included studies was identified. Methods in the field of technical skills relating an intervention to spatial abilities test scores between intervention groups or obtained before and after the intervention were identified as eligible. The quality of included studies was assessed and data were extracted in a systematic way. Results A series of 5513 citations was obtained. Ninety-nine articles were retained and fully reviewed, yielding four included studies. No difference in the Hidden Figure Test score after one year was observed after residency training in General Surgery of at least nine months. A first-year dental curriculum was not found to elevate the Novel Object Cross-Sections Test score (P = 0.07). A two-semester learning period of abdominal sonography was found to increase the Revised Minnesota Paper Form Board Test score (P < 0.05). A hands-on radiology course using interactive three-dimensional image post-processing software consisting of seven two-hour long seminars on a weekly basis was found to amplify the Cube Perspective Test score (P < 0.001). Conclusion Spatial abilities tests scores were enhanced by courses in abdominal sonography and hands-on radiology, but were not improved by residency training in General Surgery and first-year dental curriculum.
Collapse
Affiliation(s)
- Jean Langlois
- Department of Emergency Medicine, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Christian Bellemare
- Department of Multidisciplinary Services, Clinical Quality Division, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josée Toulouse
- Librairies and Archives Services, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
12
|
Balafoutas D, Joukhadar R, Kiesel M, Häusler S, Loeb S, Woeckel A, Herr D. The Role of Deconstructive Teaching in the Training of Laparoscopy. JSLS 2019; 23:JSLS.2019.00020. [PMID: 31285653 PMCID: PMC6600054 DOI: 10.4293/jsls.2019.00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying. Methods Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups. Results Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs -4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance. Conclusion Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.
Collapse
Affiliation(s)
- Dimitrios Balafoutas
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Ralf Joukhadar
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Matthias Kiesel
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Sebastian Häusler
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Sanja Loeb
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Achim Woeckel
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| | - Daniel Herr
- University Hospital of Würzburg, Department of Obstetrics and Gynecology, Würzburg, Germany
| |
Collapse
|
13
|
Azari D, Greenberg C, Pugh C, Wiegmann D, Radwin R. In Search of Characterizing Surgical Skill. JOURNAL OF SURGICAL EDUCATION 2019; 76:1348-1363. [PMID: 30890315 DOI: 10.1016/j.jsurg.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/17/2019] [Accepted: 02/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This paper provides a literature review and detailed discussion of surgical skill terminology. Culminating in a novel model that proposes a set of unique definitions, this review is designed to facilitate shared understanding to study and develop metrics quantifying surgical skill. DESIGN Objective surgical skill analysis depends on consistent definitions and shared understanding of terms like performance, expertise, experience, aptitude, ability, competency, and proficiency. STRUCTURE Each term is discussed in turn, drawing from existing literature and colloquial uses. IMPLICATIONS A new model of definitions is proposed to cement a common and consistent lexicon for future skills analysis, and to quantitatively describe a surgeon's performance throughout their career.
Collapse
Affiliation(s)
- David Azari
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Caprice Greenberg
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, Wisconsin Surgical Outcomes Research (WiSOR) Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carla Pugh
- Department of Surgery, Stanford University, Stanford, California
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Radwin
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
| |
Collapse
|
14
|
Burkhardt R, Hämmerle CHF, Lang NP. How do visual-spatial and psychomotor abilities influence clinical performance in periodontal plastic surgery? J Clin Periodontol 2018; 46:72-85. [PMID: 30358900 DOI: 10.1111/jcpe.13028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 10/05/2018] [Accepted: 10/19/2018] [Indexed: 11/29/2022]
Abstract
AIM We want to evaluate the relationship of self-assessed experience and proficiency, manual dexterity and visual-spatial ability with surgical performance. MATERIAL AND METHODS A total of 26 professionals were included in the study which consisted of four parts: (a) self-assessment by a questionnaire regarding proficiency and experience, (b) evaluation of visual-spatial ability, (c) testing of manual dexterity assessed by validated psychomotor tests and (d) evaluation of surgical performance by Objective Structured Assessment of Technical Skills (OSATS). RESULTS Self-assessed proficiency and experience levels did not correlate with objectively evaluated surgical performances (OSATS). However, low-level visual-spatial ability tests strongly correlated with OSATS while intermediate- and high-level tests did not. No correlation was found between psychomotor ability and clinical performance. CONCLUSIONS Self-assessed proficiency is not a good predictor for surgical performance as experts tend to be overconfident. To evaluate and predict surgical performance, visual-spatial ability tests seem to be more appropriate than measuring manual dexterity which failed to correlate with the surgical outcome.
Collapse
Affiliation(s)
- Rino Burkhardt
- Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR.,Universities of Berne and Zurich, Switzerland
| | - Christoph H F Hämmerle
- Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR.,Universities of Berne and Zurich, Switzerland
| | - Niklaus P Lang
- Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR.,Universities of Berne and Zurich, Switzerland
| | | |
Collapse
|
15
|
Vajsbaher T, Schultheis H, Francis NK. Spatial cognition in minimally invasive surgery: a systematic review. BMC Surg 2018; 18:94. [PMID: 30404634 PMCID: PMC6223063 DOI: 10.1186/s12893-018-0416-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023] Open
Abstract
Background Spatial cognition is known to play an important role in minimally invasive surgery (MIS), as it was found to enable faster surgical skill acquisition, reduce surgical time and errors made and significantly improve surgical performance. No prior research attempted to summarize the available literature, to indicate the level of importance of the individual spatial abilities and how they impact surgical performance and skill acquisition in MIS. Methods Psychological and medical databases were systematically searched to identify studies directly exploring spatial cognition in MIS learning and performance outcomes. Articles written in the English language articles, published between 2006 and 2016, investigating any and all aspect of spatial cognition in direct relation to influence over performance or learning of MIS, were deemed eligible. Results A total of 26 studies satisfied this criterion and were included in the review. The studies were very heterogeneous and the vast majority of the participants were novice trainees but with variable degree of skills. There were no clinical studies as almost all studies were conducted on either box trainers or virtual reality simulators. Mental rotation ability was found to have a clear impact on operative performance and mental practice was identified as an effective tool to enhance performance, pre-operatively. Ergonomic set-up of the MIS equipment has a marked influence on MIS performance and learning outcomes. Conclusions Spatial cognition was found to play an important role in MIS, with mental rotation showing a specific significance. Future research is required to further confirm and quantify these findings in the clinical settings.
Collapse
Affiliation(s)
- Tina Vajsbaher
- Bremen Spatial Cognition Center & Department of Human and Health Sciences, University of Bremen, Enrique-Schmidt-Str.5, 28359, Bremen, Germany. .,Department of Human and Health Sciences, University of Bremen, Bremen, Germany.
| | - Holger Schultheis
- Bremen Spatial Cognition Center & Department of Human and Health Sciences, University of Bremen, Enrique-Schmidt-Str.5, 28359, Bremen, Germany
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.,Faculty of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| |
Collapse
|
16
|
Sakamoto Y, Okamoto S, Shimizu K, Araki Y, Hirakawa A, Wakabayashi T. Hands-on Simulation versus Traditional Video-learning in Teaching Microsurgery Technique. Neurol Med Chir (Tokyo) 2017; 57:238-245. [PMID: 28381653 PMCID: PMC5447816 DOI: 10.2176/nmc.oa.2016-0317] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Bench model hands-on learning may be more effective than traditional didactic practice in some surgical fields. However, this has not been reported for microsurgery. Our study objective was to demonstrate the efficacy of bench model hands-on learning in acquiring microsuturing skills. The secondary objective was to evaluate the aptitude for microsurgery based on personality assessment. Eighty-six medical students comprising 62 men and 24 women were randomly assigned to either 20 min of hands-on learning with a bench model simulator or 20 min of video-learning using an instructional video. They then practiced microsuturing for 40 min. Each student then made three knots, and the time to complete the task was recorded. The final products were scored by two independent graders in a blind fashion. All participants then took a personality test, and their microsuture test scores and the time to complete the task were compared. The time to complete the task was significantly shorter in the simulator group than in the video-learning group. The final product scores tended to be higher with simulator-learning than with video-learning, but the difference was not significant. Students with high “extraversion” scores on the personality inventory took a shorter time to complete the suturing test. Simulator-learning was more effective for microsurgery training than video instruction, especially in understanding the procedure. There was a weak association between personality traits and microsurgery skill.
Collapse
Affiliation(s)
- Yusuke Sakamoto
- Department of Neurosurgery, Nagoya University, Graduate School of Medicine.,Department of Neurosurgery, Kamiiida Daiichi General Hospital
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University, Graduate School of Medicine
| | - Kenzo Shimizu
- Department of Neurosurgery, Nagoya University, Graduate School of Medicine.,Department of Neurosurgery and Spine Surgery, Aichi Spine Institute Ito Orthopedics and Internal Clinic
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University, Graduate School of Medicine
| | - Akihiro Hirakawa
- Nagoya University Hospital, Center for Advanced Medicine and Clinical Research, Statistical Analysis Section
| | | |
Collapse
|