Using Technological Advances to Improve Surgery Curriculum: Experience With a Mobile Application

Defining digital surgery: a SAGES white paper

BACKGROUND

Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas.

METHODS

This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology.

RESULTS

In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth.

CONCLUSION

Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.

Video feedback combined with peer role-playing: a method to improve the teaching effect of medical undergraduates

OBJECTIVE

The purpose of this study was to investigate the effectiveness of implementation of video feedback combined with peer role-playing (PRP) teaching method in medical undergraduates adopting problem-based learning (PBL) teaching mode.

METHODS

The undergraduates of five-year clinical medicine who get enrollment of Wuhan local University from 2016 and 2018 were selected to be the research objects. The same grade level is randomly divided into several groups to carry out PBL, with 6-10 students in each group. Following the principle of voluntary participation, 34 students were enrolled in the study group and 33 students in the control group finally. The research regards group as the unit, and study report in group should be carried out to fulfill the research. In the study group, the students were asked to perform PRP report, and the report videos were used for feedback. At the same time, the control group reported by PPT, and the feedback was carried out according to the PPT. At the end of the study, the "Competency Improvement Satisfaction Questionnaire (CISQ)" was distributed to investigate students' satisfaction with this teaching method to improve their ability, Arizona Clinical Interview Score (ACIR) was administered in Chinese by a trained teacher unrelated using PRP method to assess students' clinical inquiry ability and communication skills, and theory test was performed to assess mastery of theoretical knowledge.

RESULTS

The results show that the study group is superior to the control group in improving the interest of learning and the ability of independent learning, interpersonal communication and active problem solving. Although it is in terms of the confidence in becoming a real doctor and the ability of teamwork, language expression, clinical thinking cultivated, active knowledge acquired and understood that study group are better than the control group, the difference was not statistically significant. ACIR shows that the study group is significantly better than the control group in organization, timeline planning, and transition statements, openly questioning, smooth progress, and avoiding repetition, summarizing, understandable language, documentation and total score. There is no significant difference in eye contact and no interruption. The differences between the two groups are not statistically significant in terms of responsing to concerns, positive feedback, and additional questions. The theoretical test scores of the study group are significantly higher than those of the control group.

CONCLUSION

Video feedback combined with peer role-playing teaching method implemented in medical undergraduates adopting PBL teaching mode is effective, it could stimulate interest in learning actively, improve interpersonal communication ability, improve learning efficiency and clinical knowledge and skills, and improve the confidence of becoming a real doctor. It is worthy of further research and promotion.

REMOTE ASYNCHRONOUS FEEDBACK FOR UNSUPERVISED LAPAROSCOPIC TRAINING: THE "LAPP" PLATFORM

BACKGROUND

The advantages of laparoscopic surgery over traditional open surgery have changed the surgical education paradigm in the past 20 years. Among its benefits are an improvement in clinical outcomes and patient safety, becoming the standard in many surgical procedures. However, it encompasses an additional challenge due to the complexity to achieve the desired competency level. Simulation-based training has emerged as a solution to this problem. However, there is a relative scarcity of experts to provide personalized feedback. Technology-Enhanced Learning could be a valuable aid in personalizing the learning process and overcoming geographic and time-related barriers that otherwise would preclude the training to happen. Currently, various educational digital platforms are available, but none of them is able to successfully provide personalized feedback.

AIMS

The aim of this study was to develop and test a proof of concept of a novel Technology-Enhanced Learning laparoscopic skills platform with personalized remote feedback.

METHODS

The platform "Lapp," a web and mobile cloud-based solution, is proposed. It consists of a web and mobile application where teachers can evaluate remotely and asynchronously exercises performed by students, adding personalized feedback for trainees to achieve a learning curve wherever and whenever they train. To assess the effectiveness of this platform, two groups of students were compared: 130 participants received in-person feedback and 39 participants received remote asynchronous feedback throughout the application.

RESULTS

The results showed no significant differences regarding competency levels among both groups.

CONCLUSION

A novel Technology-Enhanced Learning strategy consisting of remote asynchronous feedback throughout Lapp facilitates and optimizes learning, solving traditional spatiotemporal limitations.

Student video production within health professions education: A scoping review

BACKGROUND

Recent technological developments have influenced a shift in the use of videos in Health Professions Education (HPE). Rather than casting students in the role of observers of videos, educators have been asking students to produce videos as a learning activity. The assumption is that video production is often an active and collaborative exercise, therefore could engage students and enhance learning. However, applications of this emerging pedagogical approach vary, and there has not been a knowledge synthesis to guide future research and practice.

METHODS

With a view to mapping existing knowledge, identifying avenues for further research, and informing practice, we conducted a scoping review to establish current understanding of video production in HPE. We undertook a literature search of seven databases and identified thirty-six studies.

RESULTS

The findings showed considerable variation in purposes and implementation approaches, consequences and challenges associated with video production. In particular, the assumption that creating a video automatically promotes student engagement was not well supported, especially when the intended learning was not made apparent to students.

CONCLUSION

Overall, the review suggests that despite the increasing adoption of video production in HPE, the purposes are often unclear; pedagogical considerations underlying project design are limited, which risks undermining the intended learning. To optimise educational benefits, future video production projects should be explicit in their intention and approach, draw upon pedagogical theories, anticipate and address implementation issues, and be robust in their formative and summative assessment processes. Future research should more explicitly show the relationship between the intended learning and the underlying pedagogy and thoroughly evaluate the effectiveness and feasibility of video production projects.

Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation

OBJECTIVE

This review discusses the literature on Video-Based Coaching (VBC) and explores the barriers to widespread implementation.

DESIGN

A search was performed on Scopus and PubMed for the terms "operation," "operating room," "surgery," "resident," "house staff," "graduate medical education," "teaching," "coaching," "assessment," "reflection," "camera," and "video" on July 27, 2021, in English. This yielded 828 results. A single author reviewed the titles and abstracts and eliminated any results that did not pertain to operative VBC or assessment. All bibliographies were reviewed, and appropriate manuscripts were included in this study. This resulted in a total of 52 manuscripts included in this review.

SETTING/PARTICIPANTS

Original, peer-reviewed studies focused on VBC or assessment.

RESULTS

VBC has been both subjectively and objectively found to be a valuable educational tool. Nearly every study of video recording in the operating room found that subjects, including surgical residents and seasoned surgeons alike, overwhelmingly considered it a useful, non-redundant adjunct to their training. Most studies that evaluated skill acquisition via standardized assessment tools found that surgical residents who underwent a VBC program had significant improvements compared to their counterparts who did not undergo video review. Despite this evidence of effectiveness, fewer than 5% of residency programs employ video recording in the operating room. Barriers to implementation include significant time commitments for proposed coaching curricula and difficulty with integration of video cameras into the operating room.

CONCLUSIONS

VBC has significant educational benefits, but a scalable curriculum has not been developed. An optimal solution would ensure technical ease and expediency, simple, high-quality cameras, immediate review, and overcoming entrenched surgical norms and culture.

Effectiveness and quality of peer video feedback in health professions education: A systematic review

OBJECTIVES

This review aimed to evaluate the effectiveness of peer video feedback (PVF) on healthcare students' reactions and learning outcomes against other feedback methods (e.g., expert- or self-video feedback). It also synthesized the characteristics of PVF within health professions education to identify its effective elements.

DATA SOURCES

Seven databases were systematically searched to identify relevant studies, including CENTRAL, CINAHL, ERIC, Embase, PubMed, PsycINFO, and Scopus.

REVIEW METHODS

This review was conducted based on the PRISMA Statement Guidelines. Reviewers independently extracted data from the included articles and assessed the risk of bias and quality of the studies. The effectiveness of PVF on students' reactions, learning, and quality of peer feedback was summarized.

RESULTS

A total of 22 articles were included. Results showed PVF was a helpful learning tool, and students were satisfied with its overall learning experience. PVF demonstrated its positive effect on skill-based learning. The top concern was its quality (accuracy and content), ascribing to peers' limited knowledge, expertise, or feedback experience.

CONCLUSIONS

This review affirmed the potential effect of PVF on skill-based learning but revealed students' ambivalent feelings towards its quality. Six effective elements were proposed for its best practice. Future studies are needed to investigate further these proposed elements and how they mediate the educational effects of PVF.

Acute Surgical Management of Vascular Injuries in Hip and Knee Arthroplasties

With an increasing number of total hip and knee arthroplasties being done at surgical centers and vascular surgeons often not immediately available in this setting, it is critical for orthopaedic surgeons to be comfortable with the acute surgical management of vascular injuries. Although they are fortunately uncommon in primary total hip and knee arthroplasties, damage to a major artery or vein can have potentially devastating consequences. Surgeons operating both in a hospital and an ambulatory surgical setting should be familiar with techniques to gain proximal control of massive bleeding because the principles can be helpful in primary and revision arthroplasties. In this study, we review the vascular anatomy around the hip and knee and the surgical management of these potentially catastrophic complications.

Application of Universal Design for Learning (UDL) Principles to Surgical Education During the COVID-19 Pandemic

OBJECTIVE

During the COVID-19 pandemic in 2020, we have faced unprecedented challenges in the delivery of surgical education. At the time of writing, changes to the structure and nature of the surgical workforce are occurring rapidly, even daily. Surgical educators are utilizing remote learning solutions, including flipped classroom approaches, online educational materials, telemedicine, and simulations, to continue education for surgical residents despite cancelations of face-to-face instruction. Our objective is to delineate an interdisciplinary strategy, utilizing the principles of Universal Design for Learning (UDL), by which we can optimize learning during this pandemic.

DESIGN

This perspective describes the UDL framework which can be used to situate solutions to issues with delivery of surgical education during this pandemic within the broader view of strategic inclusive instructional design to meet diverse learning needs..

CONCLUSION

The principles of UDL can inform curricular and pedagogical changes in surgical education that may be employed during a time of social distancing, isolation, and quarantine. UDL involves planning flexibility into curricular design from the outset, recognizing that learners are varied in their learning preferences and capabilities, motivational characteristics, and environmental constraints. Viewing the design of remote learning opportunities through the UDL lens aims to remove barriers to learning during this pandemic by targeting three areas: expansion of the means that information is communicated, ways that learners are supported and motivated, and approaches to assessing learning through available distance learning technologies.

A Systematic Review of Educational Mobile-Applications (Apps) for Surgery Residents: Simulation and Beyond

INTRODUCTION

The number of mobile-applications (Apps) increases daily. The regulation of App content is minimal yet surgical residents use these in daily educational practice. Surgical educators must be aware of the quality, efficacy, and validity of Apps available to effectively educate residents. The aim of this review was to determine the quality, efficacy, and validity evidence for educational Apps used by surgical residents.

MATERIALS AND METHODS

We searched PubMed, Embase, and ERIC for articles published before September 1, 2019. Controlled vocabulary and natural language describing Apps/surgical residents were used. Two reviewers evaluated abstracts for inclusion.

INCLUSION CRITERIA

studies measuring the quality, efficacy, or validity of educational Apps for surgical residents. Data was extracted from full text of included articles: study design, participants, App investigated, App development, evidence for efficacy, or validity of App.

RESULTS

Initial search identified 278 articles. 64 articles were duplicates and 214 articles were screened. A further 156 were excluded with 58 full text articles assessed for eligibility. Forty-five were included in analysis. Simulation (9/45) and Feedback (15/45) Apps were the most commonly studied in surgical residents. These were the main Apps that provided validity evidence for their use in education.

CONCLUSION

Surgical education is evolving as educational technology becomes more prevalent. To be effective as surgical educators we must understand and appropriately use available tools. Of the educational Apps studied (21 Apps in 8 categories), only 3 categories reported validity evidence. Future studies should take care to measure validity and efficacy of educational Apps for surgical education to ensure quality control.

Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial

BACKGROUND

Artificial reality technologies are currently being explored as potential options to improve surgical education. Previous studies have primarily examined the efficacy of artificial reality in laparoscopic procedures, but to our knowledge, none have been performed in orthopaedically relevant procedures such as intramedullary tibial nailing, which calls for more versatile large-scale movements.

QUESTIONS/PURPOSES

Does a virtual reality simulator with or without a standard technique guide result in (1) a higher proportion of participants who completed the insertion of an intramedullary tibial nail in a synthetic bones model and (2) greater procedural accuracy than does training with a technique guide alone?

METHODS

Twenty-five first- and second-year medical students without prior exposure to intramedullary tibial nail insertion were recruited. Participants were randomly assigned to the technique guide control group (n = 8), the virtual reality group (n = 8), or the virtual reality and technique guide group (n = 9). The technique guide was adapted from a commercially available technique guide, which participants in the assigned groups could use to prepare as much as desired. The virtual reality simulation was based on the same procedure, and we used a commercially available virtual reality simulator that we purchased for this task. Participants in the virtual reality experimental groups completed the simulation on three separate sessions, at a set interval of 3 to 4 days apart. After 10 to 14 days of preparation, all participants attempted to insert an intramedullary nail into an intact, compact bone-model tibia that lacked surrounding soft tissue. Participants were given written hints if requested, but no other assistance was given. A procedure was considered complete if the nail and screw were properly placed. Procedural accuracy was defined as the number of incorrect steps normalized out of the 16 possible performed. After the procedure, one orthopaedic surgeon assessed a blinded video of the participant performing it so the assessor could not recognize the individual or that individual's gender. Additionally, the assessor was unaware of which group each participant had been randomized to during the evaluation.

RESULTS

A higher proportion of participants in the virtual reality group (6 of 8) and the virtual reality and technique guide group (7 of 9) completed the intramedullary nail than did participants in the technique guide group (2 of 8; p = 0.01). There was no difference in completion between the virtual reality groups (p = 0.89). Participants in the virtual reality and virtual reality and technique guide had fewer normalized incorrect steps than did participants in the technique guide group (3.2 ± 0.1 of 16 and 3.1 ± 0.1 of 16 versus 5.7 ± 0.2 of 16, respectively; p = 0.02 for comparisons of virtual reality groups to technique guide, p = 0.63 between the virtual reality group).

CONCLUSIONS

Virtual reality increased both procedural accuracy and the completion proportion compared with a technique guide in medical students. Based on our findings, virtual reality may help residents learn the procedural workflow and movements required to perform surgical procedures. Future studies should examine how and when exactly the technology can be applied to residencies and its impact on residents.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Factors Influencing Technology Integration in the Curriculum for Taiwanese Health Profession Educators: A Mixed-Methods Study

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator–student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.