Mobile Simulation Unit: taking simulation to the surgical trainee

Effect of Smartphone Laparoscopy Simulator on Laparoscopic Performance in Medical Students

BACKGROUND

This study aims to investigate if a smartphone laparoscopy simulator, SimuSurg, is effective in improving laparoscopic skills in surgically inexperienced medical students.

METHODS

This is a single-blinded randomized controlled trial featuring 30 preclinical medical students without prior laparoscopic simulation experience. The students were randomly allocated to a control or intervention group (n = 15 each) and 28 students completed the study (n = 14 each). All participants performed three validated exercises in a laparoscopic box trainer and repeated them after 1 week. The intervention group spent the intervening time completing all levels in SimuSurg, whereas the control group refrained from any laparoscopic activity. A prestudy questionnaire was used to collect data on age, sex, handedness, and experience with gaming.

RESULTS

The total score improved significantly between the two testing sessions for the intervention group (n = 14, median change [MC] = 182.00, P = 0.009) but not for the control group (n = 14, MC = 161.50, P = 0.08). Scores for the nondominant hand improved significantly in the intervention group (MC = 66.50, P = 0.008) but not in the control group (MC = 9.00, P = 0.98). There was no improvement in dominant hand scores for either the intervention (MC = 62.00, P = 0.08) or control (MC = 26.00, P = 0.32) groups. Interest in surgery (β = -234.30, P = 0.02) was positively correlated with the baseline total scores; however, age, sex, and experience with video games were not.

CONCLUSIONS

The results suggest that smartphone applications improve laparoscopic skills in medical students, especially for the nondominant hand. These simulators may be a cost-effective and accessible adjunct for laparoscopic training among surgically inexperienced students and clinicians.

MOBILE SIMULATION: SCIENTIFIC CONTRIBUTIONS FOR THE HEALTH AREA

ABSTRACT Objective: to identify and analyze in the literature the use of the mobile simulation strategy for health professionals and for the community. Method: a scoping review based on the procedures recommended by the Joanna Briggs Institute. The search databases were the following: PubMed, CINAHL via EBSCO, Scopus, LILACS, Portugal's Open Access Scientific Repository and CAPES Dissertations Database. The guiding question was the following: What contributions of the mobile simulation have been identified and assessed in the training processes of health professionals and of the community? There was no limitation regarding publication year, and nine studies were selected. Results: 2011 had the highest number of publications on this theme, most of them coming from the United States. It was evidenced that the mobile simulation contributed to the training of health professionals and community-dwelling individuals, favored the development of the professionals' clinical competencies, and proved to be an effective tool to take training to remote zones. Conclusion: mobile simulation is a modality that contributes to the development of the simulated practice regarding the active teaching method; however, it is still little explored, and expanding the perspectives of its implementation emerges as a challenge.

Mobile medical simulation for rural anesthesia providers: A feasibility study

INTRODUCTION

Family practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan.

METHODS

Using a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience.

RESULTS

Financial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap.

DISCUSSION

Mobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization's commitment to CME for rural physicians.

Best Approaches to Evaluation and Feedback in Post-Graduate Medical Education

PURPOSE OF REVIEW

The objectives of this literature review are to appraise current approaches and assess new technologies that have been utilized for evaluation and feedback of residents, with focus on surgical trainees.

RECENT FINDINGS

In 1999, the Accreditation Council for Graduate Medical Education introduced the Milestone system as a tool for summative evaluation. The organization allows individual program autonomy on how evaluation and feedback are performed. In the past, questionnaire evaluations and informal verbal feedback were employed. However, with the advent of technology, they have taken a different shape in the form of crowdsourcing, mobile platforms, and simulation. Limited data is available on new methods but studies show promise citing low cost and positive impact on resident education. No one "best approach" exists for evaluation and feedback. However, it is apparent that a multimodal approach that is based on the ACGME Milestones can be effective and aid in guiding programs.

ASERNIP-S: unusual acronym, outstanding results

In the late 1990s, concerns regarding the introduction of new surgical procedures arose following the rapid uptake of some minimally invasive procedures. At that time, the evidence was not clear on the safety and effectiveness of these new procedures, and it was recommended that data be collected to look at both short- and long-term outcomes. Based on a UK group, 'the Safety and Efficacy Register of New Interventional Procedures (SERNIP)', the Australian SERNIP was born under the auspices of the Royal Australasian College of Surgeons, with '-S' added to the acronym to highlight the focus on surgery. ASERNIP-S was established to review the evidence on new interventional procedures before their introduction into the Australian healthcare system. The programme operated with initial national government funding for 7 years. Following establishment of the Medical Services Advisory Committee, ASERNIP-S became a contractor and remains so today. ASERNIP-S was an also an early adopter of Horizon Scanning, a key activity informing of new procedures/technologies on the verge of introduction into our healthcare system. A strong international reputation of ASERNIP-S is recognised, both by lead roles of international networks and in working relationships with overseas agencies. In recent years the remit of ASERNIP-S has expanded to include research and evaluation services across the Royal Australasian College of Surgeons (including committees) and for Specialty Surgical Societies. Externally funded work is growing, including for the Federal Office of Public Health in Switzerland and the Ludwig Boltzmann Institute in Austria. It is unknown what the future will be for this unusually titled programme, but its long history in promoting and supporting surgical evidence and innovation is clear.

Bridging the Stressful Gap Between ICU and Home: Medical Simulation for Pediatric Patients and Their Families

OBJECTIVES

Introduce an expanding role for pediatric critical care and medical simulation to optimize the care for children with technology dependence.

DATA SOURCES

Limited review of literature and practice for current teaching paradigms, vulnerability of the patient population, and efficacy of simulation as a medical educational tool.

CONCLUSIONS

In accordance with new care models and patient need, critical care requires parallel evolution of care practices, including new educational and care models, in order to maximally reduce risk, fear, and anxiety and to insure quality and consistent care in the community for patients and families transitioning between the ICU and home environments.

[Simulation in surgical training]

BACKGROUND

Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge.

OBJECTIVES

Are there alternatives to traditional master-apprentice learning?

MATERIALS AND METHODS

A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented.

RESULTS

Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses.

CONCLUSIONS

Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.