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Varela E, Castelli I, Szwarcfiter V, Turner L, Gaete MI, Belmar F, Cortés M, Jiménez G, Corvetto M, Varas J. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1708. [PMID: 36542006 PMCID: PMC9767423 DOI: 10.1590/0102-672020220002e1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice. AIMS This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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Affiliation(s)
- Eduardo Varela
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Ignacio Castelli
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Vania Szwarcfiter
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - Lawrence Turner
- Universidade Católica do Chile, School of Medicine – Santiago, Chile
| | - María Inés Gaete
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Francisca Belmar
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Matías Cortés
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Gerónimo Jiménez
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Marcia Corvetto
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
| | - Julián Varas
- Universidade Católica do Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery – Santiago, Chile
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Kejela S, Tiruneh AG. Determinants of satisfaction and self-perceived proficiency of trainees in surgical residency programs at a single institution. BMC MEDICAL EDUCATION 2022; 22:473. [PMID: 35717190 PMCID: PMC9206365 DOI: 10.1186/s12909-022-03521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND We aimed to identify factors contributing to training program satisfaction and self-perceived proficiency of residents in 5 integrated surgical residency programs within the same referral institution. METHODS We conducted a cross-sectional survey including all senior surgical residents in all integrated sub-specialty and general surgery residency programs at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Training programs were assessed on 6 educational components including operative case volume and diversity, intra-operative hands-on training, morning teaching sessions, seminars, ward rounds, and research opportunities. RESULTS Of 82 eligible residents, 69 (84.1%) responded to the survey. Overall resident satisfaction (rated from 0-10) varied between the 5 training programs, from a mean of 6.03 to 7.89 (overall p = 0.03). The percentage of residents who agreed they would be proficient by the end of their training ranged from 44.2%-88.9%. General surgery residents had the lowest overall satisfaction score, and lowest scores in all educational components except seminar teaching. In multivariable analysis, operative case volume and diversity (AOR 3.67; 95% CI, 1.24-10.83; P = 0.019), and hands-on training (AOR 4.15; 95% CI, 1.27-13.5; P = 0.018) were significantly associated with overall resident satisfaction. In ordinal logistic regression, hands-on training (OR 3.94, 95% CI, 1.69-9.2; P = 0.001), and seminar sessions (OR 2.43, 95% CI, 1.11-5.33; P = 0.028) were significantly associated with self-perceived proficiency. CONCLUSION Different surgical residency training programs within the same institution had divergent resident satisfaction scores and proficiency scores. Operative case volume and diversity, and intraoperative hands-on training are the most important predictors of resident satisfaction while hands-on training and seminar sessions independently predicted self-perceived proficiency. Attention to these key components of resident education is likely to have a strong effect on training outcomes.
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Affiliation(s)
- Segni Kejela
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Das De S, Chin AY, Chong AK, Edward Puhaindran M, Sechachalam S, Teoh LC. Evolution of hand surgery as an independent speciality over three decades: the Singapore model. J Hand Surg Eur Vol 2022; 47:665-668. [PMID: 35575278 DOI: 10.1177/17531934221095472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Soumen Das De
- Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Andrew Yh Chin
- Department of Hand & Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Alphonsus Ks Chong
- Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Mark Edward Puhaindran
- Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | | | - Lam-Chuan Teoh
- Department of Hand & Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore
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Wignadasan W, Mohamed A, Kayani B, Magan A, Plastow R, Haddad FS. Restarting elective orthopaedic surgery as COVID-19 lockdown restrictions are reduced : have patient perceptions towards surgery changed? Bone Jt Open 2021; 2:865-870. [PMID: 34666506 PMCID: PMC8559661 DOI: 10.1302/2633-1462.210.bjo-2021-0076.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims The COVID-19 pandemic drastically affected elective orthopaedic services globally as routine orthopaedic activity was largely halted to combat this global threat. Our institution (University College London Hospital, UK) previously showed that during the first peak, a large proportion of patients were hesitant to be listed for their elective lower limb procedure. The aim of this study is to assess if there is a patient perception change towards having elective surgery now that we have passed the peak of the second wave of the pandemic. Methods This is a prospective study of 100 patients who were on the waiting list of a single surgeon for an elective hip or knee procedure. Baseline characteristics including age, American Society of Anesthesiologists (ASA) grade, COVID-19 risk, procedure type, and admission type were recorded. The primary outcome was patient consent to continue with their scheduled surgical procedure. Subgroup analysis was also conducted to define if any specific patient factors influenced decision to continue with surgery Results Overall, 88 patients (88%) were happy to continue with their scheduled procedure at the earliest opportunity. Patients with an ASA grade I were most likely to agree to surgery, followed by patients with ASA grades II, then those with grade III (93.3%, 88.7%, and 78.6% willingness, respectively). Patients waitlisted for an injection were least likely to consent to surgery, with just 73.7% agreeing. In all, there was a large increase in the proportion of patient willingness to continue with surgery compared to our initial study during the first wave of the pandemic. Conclusion As COVID-19 lockdown restrictions are lifted after the second peak of the pandemic, we are seeing greater willingness to continue with scheduled orthopaedic surgery, reinforcing a change in patient perception towards having elective surgery. However, we must continue with strict COVID-19 precautions in order to minimize viral transmission as we increase our elective orthopaedic services going forward. Cite this article: Bone Jt Open 2021;2(10):865–870.
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Affiliation(s)
- Warran Wignadasan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Abdulrahman Mohamed
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,The Princess Grace Hospital, London, UK
| | | | - Fares S Haddad
- The Princess Grace Hospital, London, UK.,The Bone & Joint Journal, London, UK
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Developing paediatric endoscopic surgery skills for trainees in the era of COVID-19: narrative review from trainee perspective. JOURNAL OF PEDIATRIC ENDOSCOPIC SURGERY 2021. [PMCID: PMC8108435 DOI: 10.1007/s42804-021-00102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the outbreak of Coronavirus 2019 (COVID-19) pandemic, paediatric endoscopic surgery training has taken a backseat. Simulation and virtual learning have become cornerstones in educating trainees across different surgical specialties. Paediatric minimal access surgery is an exceptionally challenging field due to the extreme variations in the size of the patients, ranging from newborns to adolescents. Finding possible solutions to continue training in this field during the pandemic will require focused efforts from the educators and leaders of paediatric endoscopic societies and universities.
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Samaratunga R, Johnson L, Gatzidis C, Swain I, Wainwright T, Middleton R. A review of participant recruitment transparency for sound validation of hip surgery simulators: a novel umbrella approach. J Med Eng Technol 2021; 45:434-456. [PMID: 34016011 DOI: 10.1080/03091902.2021.1921868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Malposition of implants is associated with complications, higher wear and increased revision rates in total hip replacement (THR) along with surgeon inexperience. Training THR residents to reach expert proficiency is affected by the high cost and resource limitations of traditional training techniques. Research in extended reality (XR) technologies can overcome such barriers. These offer a platform for learning, objective skill-monitoring and, potentially, for automated certification. Prior to their incorporation into curricula however, thorough validation must be undertaken. As validity is heavily dependent on the participants recruited, there is a need to review, scrutinise and define recruitment criteria in the absence of pre-defined standards, for sound simulator validation. A systematic review on PubMed and IEEE databases was conducted. Training simulator validation research in fracture, arthroscopy and arthroplasty relating to the hip was included. 46 validation studies were reviewed. It was observed that there was no uniformity in reporting or recruitment criteria, rendering cross-comparison challenging. This work developed Umbrella categories to help prioritise recruitment, and has formulated a detailed template of fields and guidelines for reporting criteria so that, in future, research may come to a consensus as to recruitment criteria for a hip "expert" or "novice".
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Affiliation(s)
| | - Layla Johnson
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Christos Gatzidis
- Faculty of Science and Technology, Bournemouth University, Poole, UK
| | - Ian Swain
- Faculty of Science and Technology, Bournemouth University, Poole, UK.,Orthopaedic Research Institute, Bournemouth University, UK
| | - Thomas Wainwright
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
| | - Robert Middleton
- Orthopaedic Research Institute, Bournemouth University, UK.,University Hospitals Dorset NHS Foundation Trust, UK
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Tripathy SK, Varghese P, Panigrahi S, Panda BB, Srinivasan A, Sen RK. Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis. Chin J Traumatol 2021:S1008-1275(21)00088-2. [PMID: 34154865 PMCID: PMC8135192 DOI: 10.1016/j.cjtee.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem. METHODS A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3. RESULTS After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13-7.47, p < 0.00001) and 15.12 (95% CI: 6.12-37.37, p < 0.00001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49-17.30, p < 0.009) and they remain admitted for a longer time in hospital (MD = 3.6, 95% CI: 1.74-5.45, p = 0.0001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients. CONCLUSIONS There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
| | - Bijnya Birajita Panda
- Department of Ophthalmology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, 753007, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
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Randomized controlled trial comparing the effectiveness of mass and spaced learning in microsurgical procedures using computer aided assessment. Sci Rep 2021; 11:2810. [PMID: 33531563 PMCID: PMC7854604 DOI: 10.1038/s41598-021-82419-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/13/2021] [Indexed: 11/08/2022] Open
Abstract
Spaced-learning refers to teaching spread over time, compared to mass-learning where the same duration of teaching is completed in one session. Our hypothesis is that spaced-learning is better than mass-learning in retaining microsurgical suturing skills. Medical students were randomized into mass-learning (single 8-h session) and spaced-learning (2-h weekly sessions over 4 weeks) groups. They were taught to place 9 sutures in a 4 mm-wide elastic strip. The primary outcome was precision of suture placement during a test conducted 1 month after completion of sessions. Secondary outcomes were time taken, cumulative performance, and participant satisfaction. 42 students (24 in the mass-learning group; 18 in spaced-learning group) participated. 3 students in the spaced-learning group were later excluded as they did not complete all sessions. Both groups had comparable baseline suturing skills but at 1 month after completion of teaching, the total score for suture placement were higher in spaced-learning group (27.63 vs 31.60,p = 0.04). There was no statistical difference for duration and satisfaction in either group. Both groups showed an improvement in technical performance over the sessions, but this did not differ between both groups. Microsurgical courses are often conducted in mass-learning format so spaced learning offers an alternative that enhances retention of complex surgical skills.
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Tripathy SK, Varghese P, Panigrahi S, Panda BB, Velagada S, Sahoo SS, Naik MA, Rao SK. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis. World J Orthop 2021; 12:35-50. [PMID: 33520680 PMCID: PMC7814308 DOI: 10.5312/wjo.v12.i1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Timely intervention in hip fracture is essential to decrease the risks of perioperative morbidity and mortality. However, limitations of the resources, risk of disease transmission and redirection of medical attention to a more severe infective health problem during coronavirus disease 2019 (COVID-19) pandemic period have affected the quality of care even in a surgical emergency.
AIM To compare the 30-d mortality rate and complications of hip fracture patients treated during COVID-19 pandemic and pre-pandemic times.
METHODS The search of electronic databases on 1st August 2020 revealed 45 studies related to mortality of hip fracture during the COVID-19 pandemic and pre-pandemic times. After careful screening, eight studies were eligible for quantitative and qualitative analysis of data.
RESULTS The pooled data of eight studies (n = 1586) revealed no significant difference in 30-d mortality rate between the hip fracture patients treated during the pandemic and pre-pandemic periods [9.63% vs 6.33%; odds ratio (OR), 0.62; 95%CI, 0.33, 1.17; P = 0.14]. Even the 30-d mortality rate was not different between COVID-19 non-infected patients who were treated during the pandemic time, and all hip fracture patients treated during the pre-pandemic period (OR, 1.03; 95%CI, 0.61, 1.75; P = 0.91). A significant difference in mortality rate was observed between COVID-19 positive and COVID-19 negative patients (OR, 6.99; 95%CI, 3.45, 14.16; P < 0.00001). There was no difference in the duration of hospital stay (OR, -1.52, 95%CI, -3.85, 0.81; P = 0.20), overall complications (OR, 1.62; P = 0.15) and incidence of pulmonary complications (OR, 1.46; P = 0.38) in these two-time frames. Nevertheless, the preoperative morbidity was more severe, and there was less use of general anesthesia during the pandemic time.
CONCLUSION There was no difference in 30-d mortality rate between hip fracture patients treated during the pandemic and pre-pandemic periods. However, the mortality risk was higher in COVID-19 positive patients compared to COVID-19 negative patients. There was no difference in time to surgery, complications and hospitalization time between these two time periods.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Paulson Varghese
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | - Sibasish Panigrahi
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Sandeep Velagada
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, India
| | | | - Monappa A Naik
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576104, India
| | - Sharath K Rao
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, Manipal 576104, India
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