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Schardey J, Hüttl F, Jacobsen A, Brunner S, Tripke V, Wirth U, Werner J, Kalff JC, Sommer N, Huber T. [The new continuing education regulations-A challenge for visceral surgery : Results of a survey among DGAV members and solution strategies of the Young Surgeons]. Chirurgie (Heidelb) 2024:10.1007/s00104-024-02082-1. [PMID: 38671250 DOI: 10.1007/s00104-024-02082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The new competency-based further training regulations (nWBO) for surgical training have been adopted by all German state medical associations. METHODS From May to June 2023 the Young Surgeons' Working Group (CAJC) conducted an anonymous online survey among the 5896 members of the German Society for General and Visceral Surgery (DGAV). OBJECTIVE The survey aimed to assess expectations regarding the nWBO and to develop strategies for enhancing surgical training. RESULTS With 488 participants (response rate 8.3%) the study is representative. The respondents consisted of 107 continuing education assistants (WBA 21.9%), 69 specialist physicians, and 188 senior physicians (specialist physicians 14.1% and senior physicians 38.5%), as well as 107 chief physicians (21.9%). The majority worked in regular care providers (44%), followed by maximum care providers (26.8%) and university clinics (20.1%). Only 22% considered the required operative spectrum of the new medical specialist training regulations (nWBO) to be realistic. Half of the respondents believed that full training in their clinic according to the new catalog will no longer be possible and 54.6% considered achieving the target numbers in 6 years to be impossible or state that they can no longer train the same number of continuing education assistants (WBAs) in the same time frame. Endoscopy (17.1-18.8%), fundoplication (15.4-17.7%) and head and neck procedures (12.1-17.1%) were consistently mentioned as bottlenecks across all levels of care. Rotations for balance were reported to be already established or not necessary in 64.7%. In 48% it was stated that the department had established the partial steps concept. The importance of a structured training concept was considered important by 85% of WBAs, compared to 53.3% of chief physicians (CÄ). If a structured training concept was present in the department, the achievability of the target numbers was significantly assessed more positively in the univariate analysis. In the multivariate analysis, male gender and the status of "habilitated/professor" were independent factors for a more positive assessment of the nWBO. Objective certification of training was considered important by 51.5%. CONCLUSION Concerns surround the nWBO and the sentiment is pessimistic. Additional requirements and hospital reforms could exacerbate the situation. Collaboration and rotations are crucial but still insufficiently implemented. Quality-oriented certification could enhance the quality of training.
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Affiliation(s)
- Josefine Schardey
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Florentine Hüttl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Anne Jacobsen
- Klinik für Allgemein- und Viszeralchirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Stefanie Brunner
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Verena Tripke
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Ulrich Wirth
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Jens Werner
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Jörg C Kalff
- Klinik für Chirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Nils Sommer
- Klinik für Chirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Tobias Huber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie (CAJC), Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland.
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Huber T, Hanke LI, Boedecker C, Vradelis L, Baumgart J, Heinrich S, Bartsch F, Mittler J, Schulze A, Hansen C, Hüttl F, Lang H. Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial. Trials 2022; 23:403. [PMID: 35562806 PMCID: PMC9100295 DOI: 10.1186/s13063-022-06347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background A multitude of different diseases—benign and malign—can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications. Methods The presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues. Discussion The described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations. Trial registration Prospective trials registration at the German Clinical Trials register with the registration number DRKS00027865. Registration Date: January 24, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06347-0.
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Affiliation(s)
- Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
| | - Laura Isabel Hanke
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Lukas Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Janine Baumgart
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Stefan Heinrich
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Alicia Schulze
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Christian Hansen
- Institute of Simulation and Graphics, Faculty of Informatics, University Magdeburg, Magdeburg, Germany
| | - Florentine Hüttl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
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Huber T, Hüttl F, Braun B, Blank B, Schierholz S, Fritz T, Kroeplin J. [Fridays for future! - All days for surgery! : Thoughts of young surgeons on a modern promotion of the next generation]. Chirurg 2022; 93:250-255. [PMID: 35132445 DOI: 10.1007/s00104-022-01577-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/10/2023]
Abstract
In order to be able to exploit the increasing complexity of modern surgery as best as possible in the future, the focus of young surgeons is on horizontal networking in addition to vertical networking: More interdisciplinary cooperation, more diversity, more perspectives. Future effective project work thrives on the exchange of young specialist society forums, junior resident spokespersons and junior student representation. However, the increasing establishment of mentoring programs and the experiences from daily practice show that this does not work without the experience and the readiness of the "greats" to impart knowledge. This article sketches the current challenges for the next generation of surgeons in the three fields of surgical training, life and surgery as well as promotion of excellence in academic surgery.
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Affiliation(s)
- Tobias Huber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55130, Mainz, Deutschland.
| | - Florentine Hüttl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55130, Mainz, Deutschland
| | - Benedikt Braun
- Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Beate Blank
- Klinik für Plastische und Handchirurgie, Klinikum Kulmbach, Kulmbach, Deutschland
| | - Stefanie Schierholz
- Klinik für Chirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Tobias Fritz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Juliane Kroeplin
- Mund-Kiefer- und Gesichtschirurgie, Helios Kliniken Schwerin, Schwerin, Deutschland
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Heinrich S, Seehofer D, Corvinus F, Tripke V, Huber T, Hüttl F, Penzkofer L, Mittler J, Abu Hilal M, Lang H. [Advantages and future perspectives of laparoscopic liver surgery]. Chirurg 2021; 92:542-549. [PMID: 32995902 DOI: 10.1007/s00104-020-01288-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic liver surgery (LLS) is increasingly utilized worldwide due to several potential advantages over open liver surgery. OBJECTIVE Analysis and presentation of the advantages and disadvantages of LLS in comparison to open surgery. MATERIAL AND METHODS Analysis of clinically relevant factors of minimally invasive liver surgery in comparison to open liver surgery in the current literature. RESULTS In addition to obvious cosmetic advantages, the current literature shows advantages regarding length of hospital stay and quality of life after LLC. In contrast to major liver resections, parenchyma-preserving resections often appear cost-neutral due a shorter postoperative hospital stay compared to conventional liver resections. In addition to particular personnel requirements, LLS also has technical prerequisites, such as a dedicated intraoperative ultrasound system. Furthermore, contrast-enhanced laparoscopic examinations are possible and ultrasound information can be fused with preoperative imaging. Virtual reality technology and 3‑dimensional printing are currently under investigation to improve the intraoperative anatomical orientation of LLS. CONCLUSION The current literature reveals significant advantages for LLS so that this procedure should be further developed in Germany in order to offer this technique to as many patients as possible.
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Affiliation(s)
- Stefan Heinrich
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Daniel Seehofer
- Klinik u. Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Florian Corvinus
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Verena Tripke
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Tobias Huber
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Florentine Hüttl
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Lea Penzkofer
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Jens Mittler
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Mohammad Abu Hilal
- Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero Multispecialistico, Brescia, Italien
| | - Hauke Lang
- Klinik f. Allgemein‑, Viszeral- u. Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
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Streuber S, Saalfeld P, Podulski K, Hüttl F, Huber T, Buggenhagen H, Boedecker C, Preim B, Hansen C. Training of patient handover in virtual reality. Current Directions in Biomedical Engineering 2020. [DOI: 10.1515/cdbme-2020-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Patient handover is an important part for information transfer between medical professionals in a clinical setting. Yet, in current medical education, these conversations are only trained sparsely, since they are costly to perform as they take place in offsite courses and are led by experts over several days. Virtual reality (VR)-based training courses could increase the availability of training, by eliminating travel costs and reducing the time-commitment of the teaching experts. This work presents a VR prototype of a multi-user training and examination application for patient handover. To ensure a similar interaction quality to its current real world counterpart, this work used omni-directional video recordings to create a realistic setting and compared different projection methods. A pilot study highlighted distinct use-cases of sphere and mesh projections to visualize the recordings. The results suggest enhanced spatial presence relating to the usage of omni-directional videos in VR-applications.
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Affiliation(s)
- Sebastian Streuber
- Faculty of Computer Science & Research Campus STIMULATE, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
| | - Patrick Saalfeld
- Faculty of Computer Science & Research Campus STIMULATE, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
| | - Katja Podulski
- Faculty of Computer Science & Research Campus STIMULATE, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
| | - Florentine Hüttl
- Department of General, Visceral and Transplant Surgery , University Medicine of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery , University Medicine of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Holger Buggenhagen
- Rudolph-Frey-Lernklinik, University Medicine of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Christian Boedecker
- Department of General, Visceral and Transplant Surgery , University Medicine of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Bernhard Preim
- Faculty of Computer Science & Research Campus STIMULATE, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
| | - Christian Hansen
- Faculty of Computer Science & Research Campus STIMULATE, Otto-von-Guericke University Magdeburg , Magdeburg , Germany
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Abstract
The most frequent primary hepatic malignancies are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (intrahepatic cholangiocellular adenocarcinoma [iCCA]). For HCC in cirrhosis, liver transplantation offers the advantage of a complete hepatectomy radically removing all tumorous tissue along with the surrounding cirrhotic parenchyma, which is otherwise associated with a very high risk of recurrence. For HCC in non-cirrhotic livers and iCCA, liver resection is the treatment of choice. Nowadays, even extended resections can be performed with low mortality in experienced centers. Surgical therapy is more and more embedded into multimodal treatment concepts and decision making should be interdisciplinary as for other gastrointestinal tumors.
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Affiliation(s)
- H Lang
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
| | - S Heinrich
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - F Bartsch
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - F Hüttl
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - J Baumgart
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - J Mittler
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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