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Feltmate C, Easter SR, Gilner JB, Karam AK, Khourry-Callado F, Fox KA. Graduate and Continuing Medical Education of Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1002-1008. [PMID: 37336218 DOI: 10.1055/s-0043-1761640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Surgical training experience in obstetrics-gynecology (OB-GYN) residency and fellowship training, particularly in open abdominal surgeries has declined over the last 2 decades. This is due, in part, due to a universal trend toward non-invasive treatments for gynecologic conditions once treated surgically. Management of placenta accreta spectrum (PAS) often requires complex surgical skills, including, but not limited to highly complex hysterectomy. The decline in surgical case numbers has fallen as the incidence of PAS has risen, which we anticipate will lead to a gap in critical skills needed for graduating obstetrician-gynecologists to able to safely care for people with PAS.
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Affiliation(s)
- Colleen Feltmate
- Division of Gynecologic Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts
| | - Sarah R Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer B Gilner
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amer K Karam
- Division of Gynecologic Oncology, Stanford University, Palo Alto, California
| | - Fady Khourry-Callado
- Division of Gynecologic Oncology, Columbia University, Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, Texas
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Open laryngeal surgery training on ex-vivo ovine model: Development and dissection experience. Auris Nasus Larynx 2021; 48:1150-1156. [PMID: 33896675 DOI: 10.1016/j.anl.2021.04.001] [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: 11/23/2020] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To develop and validate an ex-vivo dissection model suitable for open laryngeal surgery (open partial laryngectomy and total laryngectomy) training. METHODS A fresh ex-vivo 6-months old ovine model was tested by experienced laryngologists and validated during two international dissection courses on open laryngeal surgery held in December 2018 and 2019. Each participant completed a survey to subjectively evaluate the dissection experience. Likewise, four experienced laryngologists rated their experience. Statistical comparison of these ratings was performed. RESULTS The suitability of the ex-vivo ovine model for open laryngeal surgery was assessed among 28 head and neck surgeons with a mean experience of 6.3 years and 4 expert laryngologists. The feedback from all the participants was excellent with a mean overall impression of 9.5 (± 0.7 SD) and a mean recommendation score of 9.6 (± 0.6 SD) for further use. No statistically significant differences were found comparing neither the overall grade (p= 0.63) nor the recommendation rating (p= 0.24), testifying that even for expert laryngologists this remains a viable model for open laryngeal surgery training. CONCLUSIONS The complexity of open laryngeal surgery makes simulation an attractive option for developing skills that are transferrable to operating setting. Due to the anatomic resemblance with the human, the ex-vivo ovine model is herein proposed as a training model for open laryngeal surgery. Validation among beginners and expert laryngologists revealed its suitability as effective teaching means in laryngectomies.
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De Virgilio A, Costantino A, Ebm C, Conti V, Mondello T, Di Bari M, Cugini G, Mercante G, Spriano G. High definition three-dimensional exoscope (VITOM 3D) for microsurgery training: a preliminary experience. Eur Arch Otorhinolaryngol 2020; 277:2589-2595. [DOI: 10.1007/s00405-020-06014-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
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Rinaldi V, Costantino A, Moffa A, Casale M. Ex-vivo surgical model for “Barbed Snore Surgery”: a feasibility study. Eur Arch Otorhinolaryngol 2019; 276:3539-3542. [DOI: 10.1007/s00405-019-05660-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/16/2019] [Indexed: 12/23/2022]
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How Do Thresholds of Principle and Preference Influence Surgeon Assessments of Learner Performance? Ann Surg 2019; 268:385-390. [PMID: 28463897 DOI: 10.1097/sla.0000000000002284] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The present study asks whether intraoperative principles are shared among faculty in a single residency program and explores how surgeons' individual thresholds between principles and preferences might influence assessment. BACKGROUND Surgical education continues to face significant challenges in the implementation of intraoperative assessment. Competency-based medical education assumes the possibility of a shared standard of competence, but intersurgeon variation is prevalent and, at times, valued in surgical education. Such procedural variation may pose problems for assessment. METHODS An entire surgical division (n = 11) was recruited to participate in video-guided interviews. Each surgeon assessed intraoperative performance in 8 video clips from a single laparoscopic radical left nephrectomy performed by a senior learner (>PGY5). Interviews were audio recorded, transcribed, and analyzed using the constant comparative method of grounded theory. RESULTS Surgeons' responses revealed 5 shared generic principles: choosing the right plane, knowing what comes next, recognizing normal and abnormal, making safe progress, and handling tools and tissues appropriately. The surgeons, however, disagreed both on whether a particular performance upheld a principle and on how the performance could improve. This variation subsequently shaped their reported assessment of the learner's performance. CONCLUSIONS The findings of the present study provide the first empirical evidence to suggest that surgeons' attitudes toward their own procedural variations may be an important influence on the subjectivity of intraoperative assessment in surgical education. Assessment based on intraoperative entrustment may harness such subjectivity for the purpose of implementing competency-based surgical education.
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AbdelFattah KR, Spalding MC, Leshikar D, Gardner AK. Team-based simulations for new surgeons: Does early and often make a difference? Surgery 2017; 163:912-915. [PMID: 29229317 DOI: 10.1016/j.surg.2017.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current work hour restrictions and the expansion of requirements for surgery residents has led to decreased time on high-acuity rotations such as trauma and acute care surgery. In an effort to improve resident competency, we examined the efficacy of a new team-based trauma curriculum for postgraduate year 1 (PGY1) residents. METHODS After completing required Advanced Trauma Life Support certification, PGY1s participated in a series of trauma simulations in 3-person teams from June to August. Scenarios were created to develop skills related to trauma management, teamwork, and communication. Each simulation was followed by video-based debriefing with a faculty facilitator. Clinical performance on a 1-month trauma rotation during the year was assessed by trauma faculty using a 24-item evaluation assessing management of acutely ill patients, leadership, communication, cooperation, and professionalism on a 1 (poor) to 5 (very effective) scale. Performance metrics of this intern class were compared with 2 years of previous cohorts who had not participated in any trauma-focused simulation curricula. One-way analysis of variance was used to examine differences in performance ratings across groups. RESULTS The 2015 intern class (n = 30) each participated in 6 scenarios during their first 2 months in residency. Trauma as intended specialty and performance on preinternship Advanced Trauma Life Support course were similar across 2013, 2014, and 2015 cohorts. Average performance on the trauma rotation was 3.55 ± 0.56 for the 2013 cohort (n = 11), 3.50 ± 0.57 for the 2014 cohort (n = 11), and 4.35 ± 0.68 for the 2015 cohort (n = 12). Post hoc analyses indicated no difference between means of the 2013 and 2014 cohort. However, the mean of the 2015 cohort was statistically significantly better than both the 2013 cohort (P < .01) and the 2014 cohort (P < .01). CONCLUSION Trauma-focused simulation improved PGY1 faculty ratings of performance in the clinical setting compared with previous cohorts with no such simulation experience. Adoption of these curricula is both feasible and beneficial.
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Comparison of simulation-based assessments and faculty ratings for general surgery resident milestone evaluation: Are they telling the same story? Am J Surg 2017; 214:547-553. [DOI: 10.1016/j.amjsurg.2016.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022]
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Seeley MA, Fabricant PD, Lawrence JTR. Teaching the Basics: Development and Validation of a Distal Radius Reduction and Casting Model. Clin Orthop Relat Res 2017; 475:2298-2305. [PMID: 28374350 PMCID: PMC5539021 DOI: 10.1007/s11999-017-5336-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool. QUESTIONS/PURPOSES Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement. METHODS A distal radius fracture model was created with radiopaque bony segments and articulating elbows and shoulders. Simulated periosteum and internal deforming forces required proper reduction and casting techniques to achieve and maintain reduction. The forces required were estimated through an iterative process through feedback from experienced clinicians. Embedded monofilaments allowed for quantitative assessment of residual displacement and angulation through the use of fluoroscopy. Subjects were asked to perform closed reduction and apply a long arm fiberglass cast. Primary performance variables assessed included reduction time, residual angulation, and displacement. Secondary performance variables consisted of number of fluoroscopic images, casting time, and cast index (defined as the ratio of the internal width of the forearm cast in the sagittal plane to the internal width in the coronal plane at the fracture site). Subject grading was performed by two blinded reviewers. Interrater reliability was nearly perfect across all measurements (intraclass correlation coefficient range, 0.94-0.99), thus disagreements in measurements were handled by averaging the assessed values. After completion the participants answered a Likert-based questionnaire regarding the realism of simulation. Eighteen participants consented to participate in the study (eight attending pediatric orthopaedic surgeons, six junior residents, four senior residents). The performances of junior residents (Postgraduate Year [PGY] 1-2), senior residents (PGY 3-5), and attending surgeons were compared using one-way ANOVA with Tukey's-adjusted pairwise comparisons. RESULTS The majority of participants (15 of 18) felt that the model looked, felt, and moved like a human forearm. All participants strongly agreed that the model taught the basic steps of fracture reduction and should be implemented in orthopaedic training. Attending surgeons reduced fractures in less time than junior residents (60 ± 27 seconds versus 460 ± 62 seconds; mean difference, 400 seconds; 95% CI, 335-465 seconds; p < 0.001). Residual angulation was greater for junior residents when compared with attending surgeons on AP (7° ± 5° versus 0.7° ± 0.9°; mean difference, 6.3°; 95% CI, 3°-11°; p = 0.003) and lateral (27° ± 7° versus 7° ± 5°; mean difference, 20°; 95% CI, 13°-27°; p = 0.001) radiographs. Similarly, residual displacement was greater for junior residents than either senior residents (mean difference, 16 mm; 95% CI, 2-34 mm; p = 0.05) or attending surgeons (mean difference, 15 mm; 95% CI, 3-27 mm; p = 0.02) on lateral images. There were no differences identified in secondary performance variables (number of fluoroscopic images, casting time, and cast index) between groups. CONCLUSIONS This is the first distal radius fracture reduction model to incorporate an elbow and shoulder and allow quantitative assessment of the fracture reduction. This simulator may be useful in an orthopaedic resident training program to help them reach a defined minimum level of competency. This simulator also could easily be integrated in other accreditation and training programs, including emergency medicine. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Mark A Seeley
- Geisinger Medical Center, 100 N Academy Avenue, Danville, PA, 17821, USA.
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Campbell RJ, El-Defrawy SR, Gill SS, Whitehead M, Campbell EDL, Hooper PL, Bell CM, ten Hove M. New Surgeon Outcomes and the Effectiveness of Surgical Training. Ophthalmology 2017; 124:532-538. [DOI: 10.1016/j.ophtha.2016.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022] Open
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Grenda TR, Ballard TNS, Obi AT, Pozehl W, Seagull FJ, Chen R, Cohn AM, Daskin MS, Reddy RM. Computer Modeling to Evaluate the Impact of Technology Changes on Resident Procedural Volume. J Grad Med Educ 2016; 8:713-718. [PMID: 28018536 PMCID: PMC5180526 DOI: 10.4300/jgme-d-15-00503.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As resident "index" procedures change in volume due to advances in technology or reliance on simulation, it may be difficult to ensure trainees meet case requirements. Training programs are in need of metrics to determine how many residents their institutional volume can support. OBJECTIVE As a case study of how such metrics can be applied, we evaluated a case distribution simulation model to examine program-level mediastinoscopy and endobronchial ultrasound (EBUS) volumes needed to train thoracic surgery residents. METHODS A computer model was created to simulate case distribution based on annual case volume, number of trainees, and rotation length. Single institutional case volume data (2011-2013) were applied, and 10 000 simulation years were run to predict the likelihood (95% confidence interval) of all residents (4 trainees) achieving board requirements for operative volume during a 2-year program. RESULTS The mean annual mediastinoscopy volume was 43. In a simulation of pre-2012 board requirements (thoracic pathway, 25; cardiac pathway, 10), there was a 6% probability of all 4 residents meeting requirements. Under post-2012 requirements (thoracic, 15; cardiac, 10), however, the likelihood increased to 88%. When EBUS volume (mean 19 cases per year) was concurrently evaluated in the post-2012 era (thoracic, 10; cardiac, 0), the likelihood of all 4 residents meeting case requirements was only 23%. CONCLUSIONS This model provides a metric to predict the probability of residents meeting case requirements in an era of changing volume by accounting for unpredictable and inequitable case distribution. It could be applied across operations, procedures, or disease diagnoses and may be particularly useful in developing resident curricula and schedules.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rishindra M. Reddy
- Corresponding author: Rishindra M. Reddy, MD, FACS, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI 48109, 734.763.7337, fax 734.615.2656,
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Gee DW, Phitayakorn R, Khatri A, Butler K, Mullen JT, Petrusa ER. A Pilot Study to Gauge Effectiveness of Standardized Patient Scenarios in Assessing General Surgery Milestones. JOURNAL OF SURGICAL EDUCATION 2016; 73:e1-e8. [PMID: 27886969 DOI: 10.1016/j.jsurg.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Some General Surgery Milestones can be difficult to assess in traditional clinical settings and especially difficult to assess in junior residents. The purpose of this pilot study was to METHODS: A total of 9 categorical interns participated in a comprehensive, 4-module, SP scenario designed to evaluate and manage right upper quadrant pain. SP checklist scores (SP%) were converted to Milestone-equivalent scores for direct comparison (SP-C). Milestone scores were analyzed from 3 different sources: SP, faculty (FAC), and CCC. Interns completed course evaluations at the end of each session. Spearman's rho was used to determine correlations. Wilcoxon signed rank tests were used to test for differences between scores from different sources. RESULTS Individual intern Milestone scores from the 3 sources (SP-C, FAC, and CCC) did not correlate. All 7 mean Milestone scores from SPs were significantly higher than from FAC and CCC. FAC and CCC scores were statistically equivalent except for Systems-Based Practice 1 (SBP1) and Patient Care 3 (PC3) where CCC scores were significantly higher than FAC. Mean SP% scores for PC1 were significantly lower than for PROF1, MK1, MK2, and ICS1 (p < 0.05). Interns felt the modules were moderately to very useful. CONCLUSIONS Developing an SP scenario for Milestones evaluation is feasible. SPs, faculty observers, and CCC each use different data to provide a unique source of Milestone assessment. SP scenarios may be ideally suited to assess specific resident strengths and weaknesses and provide individualized feedback, thus augmenting traditional evaluations. Additional SP scenarios, assessing a broader range of skills and Milestones, are advisable for more reliable estimates of resident performance.
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Affiliation(s)
- Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Avni Khatri
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn Butler
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil R Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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A pilot study examining experiential learning vs didactic education of abdominal compartment syndrome. Am J Surg 2016; 214:358-364. [PMID: 27771036 DOI: 10.1016/j.amjsurg.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Current surgical education relies on simulated educational experiences or didactic sessions to teach low-frequency clinical events such as abdominal compartment syndrome (ACS). The purpose of this pilot study was to evaluate if simulation would improve performance and knowledge retention of ACS better than a didactic lecture. METHODS Nineteen general surgery residents were block randomized by postgraduate year level to a didactic or a simulation session. After 3 months, all residents completed a knowledge assessment before participating in an additional simulation. Two independent reviewers assessed resident performance via audio-video recordings. RESULTS No baseline differences in ACS experience were noted between groups. The observational evaluation demonstrated a significant difference in performance between the didactic and simulation groups: 9.9 vs 12.5, P = .037 (effect size = 1.15). Knowledge retention was equivalent between groups. CONCLUSIONS This pilot study suggests that simulation-based education may be more effective for teaching the basic concepts of ACS.
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Simulation to Improve Trainee Knowledge and Comfort About Twin Vaginal Birth. Obstet Gynecol 2016; 128 Suppl 1:34S-39S. [DOI: 10.1097/aog.0000000000001598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mattioli F, Presutti L, Caversaccio M, Bonali M, Anschuetz L. Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience. Otolaryngol Head Neck Surg 2016; 156:1136-1141. [DOI: 10.1177/0194599816668324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques). Study Design Experimental construction and validation of a highly specialized dissection station. Setting Laboratory and international dissection course. Methods We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction’s footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016. Results We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5. Conclusion The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery.
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Affiliation(s)
- Francesco Mattioli
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Marco Caversaccio
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marco Bonali
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Lukas Anschuetz
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Gardner AK, DeMoya MA, Tinkoff GH, Brown KM, Garcia GD, Miller GT, Zaidel BW, Korndorffer JR, Scott DJ, Sachdeva AK. Using simulation for disaster preparedness. Surgery 2016; 160:565-70. [DOI: 10.1016/j.surg.2016.03.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 01/22/2023]
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How to Assess Dermatology Resident Surgical Training: New Techniques. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ianacone DC, Gnadt BJ, Isaacson G. Ex vivo ovine model for head and neck surgical simulation. Am J Otolaryngol 2016; 37:272-8. [PMID: 27178523 DOI: 10.1016/j.amjoto.2016.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate a fresh, ovine/sheep head and neck tissue model to teach otolaryngology-head and neck surgical techniques. STUDY DESIGN Observational animal study. SETTING A university animal resource facility. METHODS Tissue was collected from pre-pubescent sheep (n=10; mean age: 4months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated and stored at 5°C for 1-5days. The tissues were tested in a variety of simulated procedures by a medical student and four fellowship-trained otolaryngology faculty. Practicality and similarity to human surgeries were assessed. RESULTS While ovine head and neck structures are proportionally different, the consistencies of skin, subcutaneous tissues and bone are remarkably similar to that seen in human dissection. Particularly useful were the eyelids and orbits, facial nerve and parotid gland, mandible, anterior neck and submandibular triangle. Surgeries performed included blepharoplasty, ptosis repair, orbital floor exploration, facial nerve dissection and repair, mandibular plating, tracheotomy, laryngofissure, tracheal resection and laryngectomy. The model was also useful for flexible and microsuspension laryngoscopy. CONCLUSION Fresh, ovine tissue provides a readily available, anatomically compatible, affordable, model for training in otolaryngology-head and neck surgery. The use of sheep tissues carries a low risk for disease transmission and is ethically defensible. Structural variations in the sheep temporal bone, paranasal sinuses and skull base anatomy limit the usefulness of the model for surgical training in these areas.
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Best practices across surgical specialties relating to simulation-based training. Surgery 2015; 158:1395-402. [DOI: 10.1016/j.surg.2015.03.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 01/22/2023]
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Gardner AK, Lachapelle K, Pozner CN, Sullivan ME, Sutherland D, Scott DJ, Sillin L, Sachdeva AK. Expanding simulation-based education through institution-wide initiatives: A blueprint for success. Surgery 2015; 158:1403-7. [PMID: 26013982 DOI: 10.1016/j.surg.2015.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Consortium of American College of Surgeons Accredited Education Institutes (ACS-AEIs) was created to promote patient safety through the use of simulation, develop innovative education and training, advance technologies, identify best practices, and encourage research and collaboration. METHODS During the seventh annual meeting of the consortium, leaders from across the consortium who have developed institution-wide simulation centers were invited to participate in a panel to discuss their experiences and the lessons learned. CONCLUSION These discussions resulted in definition of 5 key areas that need to be addressed effectively to support efforts of the ACS-AEIs.
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Affiliation(s)
- Aimee K Gardner
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
| | - Kevin Lachapelle
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Charles N Pozner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maura E Sullivan
- Department of Surgery, University of Southern California, Los Angeles, CA
| | | | - Daniel J Scott
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Lelan Sillin
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
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