Development of a laparoscopic surgical skills simulation curriculum: Enhancing resident training through directed coaching and closed-loop feedback

Characteristics of Surgical Coaching Interventions: A Systematic Review

OBJECTIVE

Coaching is increasingly utilized as an educational intervention for performance improvement in surgeons and surgical trainees. Surgical coaching has been utilized across a broad range of specialties, experience levels and outcomes with generally positive results. Coaching interventions are often developed by individual institutions for their own context which has resulted in a heterogenous group of interventions. This review aims to investigate surgical coaching interventions to identify common characteristics that comprise an effective coaching intervention.

METHODS

A systematic review was conducted to identify studies investigating surgical coaching interventions up to July 2024. Studies were limited to English language peer-reviewed studies that adequately described the characteristics and outcomes of the surgical coaching intervention. Data on the primary and secondary outcomes, study objective and participants' demographics were also recorded.

RESULTS

The search across 4 electronic databases generated 9538 citations. Following screening and review of full text articles 28 studies were included in the review. Surgical coaching interventions were carried out in 8 separate countries with the majority (22/28) in North America. Studies involved between 3 and 107 participants. Coaching interventions were markedly heterogenous, and specific details of the methods used were inconsistently documented. Study length ranged from 1 (9/28) to 14 (1/28) sessions and duration from less than 15 minutes (1/29) to greater than 3 hours (3/28). The most common themes were goal setting (10/28), feedback (7/28) and reflection (7/28). Outcomes were generally positive with 47 of 55 identified outcomes demonstrating benefit from surgical coaching. There were 3 key domains and 13 sub-domains that comprised the majority of coaching interventions.

CONCLUSIONS

Surgical coaching has been shown to be a promising intervention that requires more rigorous research to develop the field. We have identified 3 key domains which can be utilized to analyses and develop coaching interventions in the future.

Practice patterns and factors influencing surgical trainees' involvement in laparoscopic appendectomy in Northern Italy's largest educational network

Introduction Laparoscopic Appendectomy (LA) allows residents to get early exposure to minimally invasive techniques. Despite its importance, involving residents as primary surgeons is a complex process, influenced by more than just clinical factors. Mentorship, environment, and perceptions play crucial roles. This study aimed to explore rates of residents' involvement in LA, the factors influencing the decision-making, and how surgeons and residents perceive the process. Methods We analyzed data from the REsiDENT-1 trial, covering 653 LA performed between 2019 and 2023 in 24 hospitals affiliated with the University of Milan. Adults with intraoperative acute appendicitis were included. Univariable analysis and multivariable logistic regression explored factors impacting residents' involvement and clinical outcomes. A survey captured the perspectives of surgeons and residents. Results Residents approached 35.9% of the procedures, with longer operative times 67.14 (± 28.1) vs 71.68 (± 24.44), p = 0.001. Trainees were more involved in academic hospitals and emergency surgery units and less complex cases with lower complication rates. Residents' involvement was hampered by patients' complexity in the multivariable analysis. Surgeons prioritized non-technical factors such as punctuality and reliability, whereas residents highlighted clinical complexity as a key consideration for the decision-making of the operator. Both groups agreed that structured feedback systems could improve the educational and training experiences. Conclusion LA remains a crucial procedure for surgical training, balancing hands-on learning with patient safety. Structured mentorship in academic and emergency settings could allow safe resident involvement. Future improvements should focus on clear feedback processes, better access to simulations, and standardized competency-based training to prepare residents for independent practice.

Combination of mentor-based and resident-based learning may benefit to improving the ability of clinical practice in resident training

BACKGROUND

Mentor-based learning (MBL) is common teaching method in medical resident training and presents many shortcomings such as few practice opportunities and lack of efficiency. This study proposed the combination of mentor-based and resident-based learning (CMRL) and explored the role of CMRL in improving the effect of medical resident training.

METHODS

Seventy-two residents who participated in standardized resident training (SRT) were recruited and randomly divided into the CMRL and MBL groups. The CMRL group adopted CMRL and MBL group adopted MBL for daily medical teaching for four weeks. The primary outcome measure was the difference in trainee's scores of comprehensive analysis ability between CMRL group and MBL group after teaching. The secondary outcome measures were the differences in trainee's scores of diagnosis ability, prescribing medical orders ability, and incorrect operations, as well as the differences in questionnaire scores of the trainee's communication skills and patient care between CMRL group and MBL group after teaching.

RESULTS

The ability scores of CMRL group after teaching were higher than those before teaching (ability of diagnosis, 78.75 ± 17.83% vs. 67.08 ± 24.10%, p < 0.05; ability of comprehensive analysis 88.27 ± 10.95% vs. 69.56 ± 13.11%, p < 0.05; ability of prescribing medical orders, 90.03 ± 9.63% vs. 78.31 ± 10.28%, p < 0.05; respectively). In addition, scores of CMRL group in patient's evaluation on trainees after teaching were higher than that before teaching (communication skills 7.78 ± 1.02 scores vs. 6.22 ± 1.62 scores, p < 0.05; patient care 8.69 ± 0.92 scores vs. 6.92 ± 1.65 scores, p < 0.05; respectively). Meanwhile, the scores of CMRL group in ability of comprehensive analysis or prescribing medical orders after teaching were higher than those of MBL group. Moreover, scores of the trainee's communication skills and patient care in CMRL group were higher than those in MBL group after teaching.

CONCLUSION

CMRL is beneficial to improving residents' ability of comprehensive analysis and prescribing medical orders as well as residents' ability of communication skills and patient care in SRT. CMRL may be beneficial to improving the ability of clinical practice.

Pancreas-left gastric artery angle predicts difficulty of suprapancreatic lymph node dissection in gastrectomy for gastric cancer: a cross-sectional study

PURPOSE

Suprapancreatic lymph node dissection is one of the most challenging procedures performed in the treatment of gastric cancer. This study aimed to investigate whether the pancreas-left gastric artery angle (PLA) can be used to predict the difficulty of the procedure.

METHODS

This was a single-center cross-sectional study. Before gastrectomy, the patients were classified according to the size of the PLA into the small PLA (s-PLA; < 30°) and large PLA (l-PLA; ≥ 30°) groups in a surgeon-blinded manner. After gastrectomy, a surgeon evaluated suprapancreatic lymph node dissection as hard, normal, or easy to perform.

RESULTS

Seventy-three patients were enrolled in the study. Surgeons evaluated lymph node dissection as hard in 43.8 and 8.7% of patients in the s-PLA and l-PLA groups, respectively (p = 0.002). The time taken for suprapancreatic lymph node dissection was also significantly longer in the s-PLA group than in the l-PLA group (p = 0.040). In patients who underwent laparoscopic gastrectomy, the time for node dissection in the s-PLA group was also significantly longer than that in the s-PLA group (p = 0.021), while there was no difference in those who underwent robotic surgery (p = 0.815).

CONCLUSION

PLA is useful for predicting the degree of difficulty of suprapancreatic lymph node dissection during gastrectomy for gastric cancer.

Adapting Surgical Coaching: Feasibility and Perceptions of Intraoperative Resident Peer Coaching

INTRODUCTION

Surgical coaching is utilized to enhance technical, nontechnical, and teaching skills. This study aims to evaluate the feasibility and benefit of a resident peer coaching program.

METHODS

Chief residents (postgraduate year 5) acted as coaches for junior residents (postgraduate year 1-3, "coachees"). All participants completed the Harvard Surgical Coaching for Operative Performance Enhancement curriculum. The coaching structure included 1) preoperative goal setting, 2) unscrubbed intraoperative observation, and 3) postoperative debrief. Upon completion, residents were surveyed to assess their experience. Descriptive and thematic analyses were performed.

RESULTS

There were 22 participants (6 coaches, 16 coachees). Five (83.3%) coaches and 14 (87.5%) coachees reported the program was useful, citing dedicated reflection outside the operating room, in-depth feedback, and structured self-assessment with increased accountability. Thirteen (81.3%) coachees reported perceived improvement in technical skills and 12 (75%) within nontechnical skills. All coaches felt they benefited and improved their ability to provide feedback. When asked how coaching compared to usual methods of operative feedback, 14 (87.5%) coachees and 5 (83.3%) coaches reported it was better, with only 1 coachee reporting it was worse. Benefits over typical operating room teaching included more feedback provided, more specific feedback, and the benefit of peer relationships. Twelve (54.5%) residents cited difficulty with coordinating sessions, but 21 (95.5%) reported that they would participate again.

CONCLUSIONS

Implementation of a resident peer surgical coaching program is feasible. Both coaches and coachees perceive significant benefit with improvement in technical, nontechnical, and feedback delivery skills. Given preference over other methods of operative feedback, expansion of peer coaching programs is warranted.

LapBot-Safe Chole: validation of an artificial intelligence-powered mobile game app to teach safe cholecystectomy

BACKGROUND

Gaming can serve as an educational tool to allow trainees to practice surgical decision-making in a low-stakes environment. LapBot is a novel free interactive mobile game application that uses artificial intelligence (AI) to provide players with feedback on safe dissection during laparoscopic cholecystectomy (LC). This study aims to provide validity evidence for this mobile game.

METHODS

Trainees and surgeons participated by downloading and playing LapBot on their smartphone. Players were presented with intraoperative LC scenes and required to locate their preferred location of dissection of the hepatocystic triangle. They received immediate accuracy scores and personalized feedback using an AI algorithm ("GoNoGoNet") that identifies safe/dangerous zones of dissection. Player scores were assessed globally and across training experience using non-parametric ANOVA. Three-month questionnaires were administered to assess the educational value of LapBot.

RESULTS

A total of 903 participants from 64 countries played LapBot. As game difficulty increased, average scores (p < 0.0001) and confidence levels (p < 0.0001) decreased significantly. Scores were significantly positively correlated with players' case volume (p = 0.0002) and training level (p = 0.0003). Most agreed that LapBot should be incorporated as an adjunct into training programs (64.1%), as it improved their ability to reflect critically on feedback they receive during LC (47.5%) or while watching others perform LC (57.5%).

CONCLUSIONS

Serious games, such as LapBot, can be effective educational tools for deliberate practice and surgical coaching by promoting learner engagement and experiential learning. Our study demonstrates that players' scores were correlated to their level of expertise, and that after playing the game, most players perceived a significant educational value.

New Training Options for Minimally Invasive Surgery Skills

Veterinary minimally invasive surgery (MIS) training options are becoming more available. This article reviews new developments in this area and the current evidence for manual skills and cognitive training of MIS.

Educational Effectiveness of Telementoring as a Continuing Professional Development Intervention for Surgeons in Practice: A Systematic Review

Objective

We performed a systematic review to determine the educational effectiveness of telementoring as a continuing professional development (CPD) intervention for surgeons in practice.

Background

Surgeons can mentor their peers in remote locations using videoconferencing communication, referred to as telementoring.

Methods

We searched MEDLINE and EMBASE and included studies assessing the educational effectiveness of telementoring interventions used by surgeons in practice. We excluded studies involving only trainees and those not evaluating educational effectiveness. Two reviewers independently screened, extracted data, and assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI; maximum score 18). Educational outcomes were categorized using Moore's Outcomes Framework.

Results

We retrieved a total of 1351 records, and 252 studies were selected for full-text review. Twenty-eight studies were included with 1 randomized controlled trial, 19 cohort studies, 5 qualitative studies, and 3 case studies, totaling 178 surgeons and 499 cases. The average MERSQI score was 10.21 ± 2.2 out of 18. Educational outcomes included surgeons' satisfaction with telementoring interventions (Moore's Level 2) in 12 studies, improvement in surgeons' procedural knowledge (Level 3b) in 3 studies, improvements in surgeons' procedural competence in an educational setting (Level 4) in 4 studies, performance in a workplace-based setting (Level 5) in 23 studies, and patient outcomes (Level 6) in 3 studies. No studies reported community health outcomes (Level 7).

Conclusions

Moderate-level evidence demonstrates the use of telementoring as effective in changing surgeons' knowledge and competence in both educational and workplace-based settings. Its use is also associated with changes in patient outcomes.