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Hoyt BW, Clark DM, Lundy AE, Schroeder NS, Wagner SC, Langhammer C. Validation of a High-Fidelity Fracture Fixation Model for Skill Acquisition in Orthopedic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1282-1294. [PMID: 35581114 DOI: 10.1016/j.jsurg.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/08/2021] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Simulation has become a widely accepted part of training and credentialing processes due to its ability to supplement technical skill acquisition outside of the operating room (OR). This project explores implementation of a bench-top simulation of open reduction with internal fixation (ORIF) as a cost-effective method for practicing and evaluating surgical skill. DESIGN, SETTING, AND PARTICIPANTS Participants ranging from intern to attending surgeon performed ORIF using a standard fixation set and a bovine or porcine tibia/radius model. Performance was recorded and scored by blinded reviewers based on a modified global rating scale (GRS), objective structured assessment of technical skills (OSATS) procedure-specific checklist, and critical-mistakes (CM) model. We calculated Fleiss' kappa for inter-rater reliability, Cronbach's alpha for internal consistency of scoring systems, and used univariate analysis to determine the ability of this model to discriminate between training levels. We also performed a normalized performance-versus-cost analysis to characterize perceived value of this simulation compared to other modalities. RESULTS Twenty subjects completed the fracture fixation exercise. Fleiss' kappa for all scoring systems indicated substantial inter-rater agreement (k = 0.81, 0.80, and 0.74 for GRS, OSATS, and CM, respectively). Internal consistency reliability for GRS and OSATS were high with Cronbach's alpha 0.96(95%CI 0.94-0.97) and 0.94(95%CI 0.91-0.96), respectively. Using a Kuskal-Wallis rank sum test, GRS, OSATS, and CM were found effective for measuring differences between resident levels (p < 0.001, p < 0.001, and p = 0.002, respectively). Qualitative valuation of the exercise indicated similar value for education compared to time spent in the OR and surgical skills labs. CONCLUSIONS This benchtop surgical simulation provides quantitative measurement of operative skills progression, increases trainee familiarity with ORIF principles, and permits targeted education by senior surgeons with the goal of training safe graduates. Procedure-specific checklist grading tools reliably differentiated between training levels with high internal validity. Implementing this model may decrease training costs and accelerate skill acquisition.
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Affiliation(s)
- Benjamin W Hoyt
- Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - DesRaj M Clark
- Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alex E Lundy
- Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicole S Schroeder
- Department of Orthopaedics, University of California San Francisco, San Francisco, California
| | - Scott C Wagner
- Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Chris Langhammer
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Zaidman M, Al-Shaqsi S, Yeung C, Novak CB, Dengler J. COVID-19 Restrictions Presented Opportunities and Challenges for Plastic Surgery Residents. Plast Surg (Oakv) 2021; 29:294-302. [PMID: 34760847 PMCID: PMC8573642 DOI: 10.1177/22925503211024842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Restrictions placed during the COVID-19 pandemic to prevent viral spread led to substantial changes in surgical resident education. The aim of this study was to assess the positive and negative impact of COVID-19 on plastic surgery education and training and provide recommendations for continued competency. METHODS A cross-sectional online survey of plastic surgery residents across Canada was used to evaluate the impact of COVID-19 on clinical exposure, experience with virtual education, and long-term impact of COVID-19 on surgical training. RESULTS This study included 61 plastic surgery residents (40% participation rate). Common educational modalities used during COVID-19 included online seminars (95%) and workshops (58%). Teaching sessions were effective if structured around patient cases (72%), recorded (66%), and limited to 1 hour (64%). There were mixed reactions towards online education sessions; residents reported feeling grateful (54%), motivated (38%), enthusiastic (28%), overwhelmed (41%), pressured to participate (23%), and anxious (13%). There were significantly less residents who felt that their clinical exposure was sufficient during (21%) versus before (72%) pandemic restrictions (P < .001). Overall, 87% of residents felt that the pandemic had a negative impact on their training, surgical skill development, fellowship plans, and job prospects. CONCLUSIONS During the initial wave of COVID-19, residents faced altered educational opportunities, which elicited positive and negative emotions with concern regarding surgical skill development and impact on future career plans. Characterizing early educational impact on residency training to identify opportunities for change is worthwhile as the overall effect of the pandemic is ongoing and remains uncertain.
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Affiliation(s)
- Maya Zaidman
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sultan Al-Shaqsi
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Celine Yeung
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christine B. Novak
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Dias RD, Zenati MA, Conboy HM, Clarke LA, Osterweil LJ, Avrunin GS, Yule SJ. Dissecting Cardiac Surgery: A Video-based Recall Protocol to Elucidate Team Cognitive Processes in the Operating Room. Ann Surg 2021; 274:e181-e186. [PMID: 31348036 PMCID: PMC7241253 DOI: 10.1097/sla.0000000000003489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate the cognitive processes involved in surgical procedures from the perspective of different team roles (surgeon, anesthesiologist, and perfusionist) and provide a comprehensive compilation of intraoperative cognitive processes. SUMMARY BACKGROUND DATA Nontechnical skills play a crucial role in surgical team performance and understanding the cognitive processes underlying the intraoperative phase of surgery is essential to improve patient safety in the operating room (OR). METHODS A mixed-methods approach encompassing semistructured interviews with 9 subject-matter experts. A cognitive task analysis was built upon a hierarchical segmentation of coronary artery bypass grafting procedures and a cued-recall protocol using video vignettes was used. RESULTS A total of 137 unique surgical cognitive processes were identified, including 33 decision points, 23 critical communications, 43 pitfalls, and 38 strategies. Self-report cognitive workload varied substantially, depending on team role and surgical step. A web-based dashboard was developed, providing an integrated visualization of team cognitive processes in the OR that allows readers to intuitively interact with the study findings. CONCLUSIONS This study advances the current body of knowledge by making explicit relevant cognitive processes involved during the intraoperative phase of cardiac surgery from the perspective of multiple OR team members. By displaying the research findings in an interactive dashboard, we provide trainees with new knowledge in an innovative fashion that could be used to enhance learning outcomes. In addition, the approach used in the present study can be used to deeply understand the cognitive factors underlying surgical adverse events and errors in the OR.
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Affiliation(s)
- Roger D Dias
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Marco A Zenati
- Medical Robotics and Computer Assisted Surgery (MRCAS) Laboratory, Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Heather M Conboy
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Lori A Clarke
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Leon J Osterweil
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - George S Avrunin
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA
| | - Steven J Yule
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
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Cognitive Training in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00004. [PMID: 33720112 PMCID: PMC7954369 DOI: 10.5435/jaaosglobal-d-21-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
Over the past two decades, various factors have led to fewer opportunities for hands-on learning in the operating room among orthopaedic surgery trainees. Innovative training platforms using anatomic models, cadaveric specimens, and augmented reality have been devised to address this deficiency in surgical training, but such training tools are often costly with limited accessibility. Cognitive training is a low-cost training technique that improves physical performance by refining the way in which information is mentally processed and has long been used by professional athletes and world-class musicians. More recently, cognitive training tools have been developed for several orthopaedic surgery procedures, but the overall utility of cognitive training in orthopaedic surgery remains unknown.
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Grosser J, Bientzle M, Shiozawa T, Hirt B, Kimmerle J. Acquiring Clinical Knowledge from an Online Video Platform: A Randomized Controlled Experiment on the Relevance of Integrating Anatomical Information and Clinical Practice. ANATOMICAL SCIENCES EDUCATION 2019; 12:478-484. [PMID: 30347523 DOI: 10.1002/ase.1841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/10/2018] [Accepted: 10/13/2018] [Indexed: 06/08/2023]
Abstract
Basic subjects in medical education, such as anatomy, are often taught through teaching formats that do not always sufficiently demonstrate the relevance of this basic information for clinical practice. Accordingly, it is a recent trend in anatomy education to link anatomical information more explicitly to clinical practice. This article presents an online video platform (Tuebingen's Sectio Chirurgica [TSC]) as one means of explicitly integrating preclinical anatomical knowledge and clinical application. The purpose of the study presented here was to examine the effects of videos through which medical students were educated about Anterior Cruciate Ligament reconstruction. A TSC video about this surgical procedure was compared to a video with a traditional lecture providing the identical information. Participants (n = 114) perceived the TSC video to be superior in comprehensibility of the presentation (P = 0.003) and conceivability of the surgical procedure (P = 0.027), and to be more entertaining (P < 0.001). Moreover, participants in the TSC condition acquired more clinical knowledge than in the lecture condition (P = 0.043) but did not differ in their acquisition of anatomical knowledge. Mediation analyses indicated that the effect on the acquisition of clinical knowledge was mediated by comprehensibility, conceivability, and entertainment. These findings are discussed regarding their implications for medical education in terms of contributing to the general trend of linking preclinical anatomical knowledge to clinical application. A discussion about the limitations of the study and suggestions for future research are also provided.
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Affiliation(s)
- Johannes Grosser
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Martina Bientzle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
| | - Thomas Shiozawa
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Bernhard Hirt
- Department of Anatomy, Institute of Clinical Anatomy and Cell Analysis, Faculty of Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Joachim Kimmerle
- Knowledge Construction Laboratory, Knowledge Media Research Center (Leibniz-Institut fuer Wissensmedien), Tuebingen, Germany
- Department of Psychology, Faculty of Science, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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Di Stasi LL, Díaz-Piedra C, Ruiz-Rabelo JF, Rieiro H, Sanchez Carrion JM, Catena A. Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices. APPLIED ERGONOMICS 2017; 65:168-174. [PMID: 28802436 DOI: 10.1016/j.apergo.2017.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. METHODS Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. RESULTS LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. CONCLUSION Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).
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Affiliation(s)
- Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA.
| | - Carolina Díaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA
| | | | - Héctor Rieiro
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
| | - Jose M Sanchez Carrion
- IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, 18016 Granada, Spain
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
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