1
|
Chou R, Naz H, Boahene KDO, Maxwell JH, Wanamaker JR, Byrne PJ, Papel ID, Kontis TC, Hager GD, Ishii LE, Malekzadeh S, Vedula SS, Ishii M. Correcting for Rater Effects in Operating Room Surgical Skills Assessment. Laryngoscope 2024. [PMID: 38470307 DOI: 10.1002/lary.31391] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty. METHODS We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill. We validated this model against conventional measures including the level of expertise and post-graduation year (PGY) commensurate with the trainee's performance, the actual PGY of the trainee, and whether the surgical goals were achieved. RESULTS Our dataset included 188 assessments by 7 raters and 41 trainees. The model with one latent construct for surgical skill and the rater as a random effect was the best. Rubric scores depended on how severe or lenient the rater was, sometimes almost as much as they depended on trainee skill. Rater-adjusted latent skill scores increased with attending-estimated skill levels and PGY of trainees, increased with the actual PGY, and appeared constant over different levels of achievement of surgical goals. CONCLUSION Our work provides a method to obtain rater effect adjusted surgical skill assessments in the operating room using structured rating scales. Our method allows for the creation of standardized (i.e., rater-effects-adjusted) quantitative surgical skill benchmarks using national-level databases on trainee assessments. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
Collapse
Affiliation(s)
- Ryan Chou
- Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Hajira Naz
- Dugoni School of Dentistry, University of Pacific, San Francisco, California, U.S.A
| | - Kofi D O Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jessica H Maxwell
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, U.S.A
- ENT Section, Veterans Affairs Medical Center, Washington, DC, U.S.A
| | - John R Wanamaker
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, U.S.A
- ENT Section, Veterans Affairs Medical Center, Washington, DC, U.S.A
| | - Patrick J Byrne
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Ira D Papel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Aesthetic Center at Woodholme, Baltimore, Maryland, U.S.A
| | - Theda C Kontis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Aesthetic Center at Woodholme, Baltimore, Maryland, U.S.A
| | - Gregory D Hager
- Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Lisa E Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, U.S.A
- ENT Section, Veterans Affairs Medical Center, Washington, DC, U.S.A
| | - S Swaroop Vedula
- Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| |
Collapse
|
2
|
Foppiani J, Stanek K, Alvarez AH, Weidman A, Valentine L, Oh IJ, Albakri K, Choudry U, Rogers-Vizena CR, Lin SJ. Merits of simulation-based education: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 90:227-239. [PMID: 38387420 DOI: 10.1016/j.bjps.2024.01.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. METHODS A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. RESULTS Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. CONCLUSIONS Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.
Collapse
Affiliation(s)
- Jose Foppiani
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Allan Weidman
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lauren Valentine
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Irena J Oh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Umar Choudry
- Department of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
3
|
Carsuzaa F, Payen C, Gallet P, Favier V. French translation and validation of the OSATS tool for the assessment of surgical skill. J Visc Surg 2023; 160:402-406. [PMID: 37661561 DOI: 10.1016/j.jviscsurg.2023.08.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
AIM OF THE STUDY The OSATS rating scale is one of the tools most widely used in the scientific literature for assessing technical surgical skill. The aim of this study was to translate this scale into French (OSATS-FR) and validate it. METHODS OSATS was translated into French by two independent translators. The two translations were pooled and back-translated by a third translator into English to produce a consensus version (OSATS-FR). Three independent assessors then used it to assess surgical skill in tracheostomy videos. The reproducibility of the scoring was measured. RESULTS The OSATS-FR version was easily understood and used by all three assessors. In all, 18 procedures were assessed, performed by 14 interns and 4 senior surgeons. The mean OSATS-FR score was 18.6±4.08 for the interns and 31.6±1.62 for the seniors (p<0.0001). The Pearson correlation coefficient was 0.937 CI95% [0.867-1.269] between assessors 1 and 2, 0.977 CI95% [0.899-1.149] between assessors 1 and 3, and 0.965 CI95% [0.876-1.196] between assessors 2 and 3. Cronbach's alpha was greater than 0.9 for each assessor. CONCLUSION OSATS-FR can distinguish between two groups with different surgical expertise and assess surgical skill with an inter-assessor reproducibility and internal consistency comparable to those of the English version.
Collapse
Affiliation(s)
- Florent Carsuzaa
- Faculty of Medicine of Poitiers, University of Poitiers, Poitiers, France; ENT Department, University Hospital Center of Poitiers, Poitiers, France
| | - Caroline Payen
- Faculty of Medicine of Montpellier-Nîmes, Montpellier University, Montpellier, France
| | - Patrice Gallet
- Faculty of Medicine of Nancy, Lorraine University, Vandœuvre-lès-Nancy, France; ENT Department, Brabois Hospital, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Valentin Favier
- Faculty of Medicine of Montpellier-Nîmes, Montpellier University, Montpellier, France; ENT Department, Cervico-facial and maxillofacial surgery, Gui de Chauliac Hospital, University Hospital Center of Montpellier, 34295 Montpellier, France.
| |
Collapse
|
4
|
Maybodi FR, Keshmiri F, Kazemipoor M, Owlia F. Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study. BMC Med Educ 2023; 23:889. [PMID: 37990200 PMCID: PMC10664488 DOI: 10.1186/s12909-023-04875-0] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Updating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method. METHODS All six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used. RESULTS There was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores. CONCLUSION Considering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.
Collapse
Affiliation(s)
- Fahimeh Rashidi Maybodi
- Periodontics Department, Dental faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fatemeh Keshmiri
- Faculty of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Kazemipoor
- Department of Endodontics, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Owlia
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
5
|
Hamoudi C, Sapa MC, Facca S, Xavier F, Goetsch T, Liverneaux P. Influence of surgical performance on clinical outcome after osteosynthesis of distal radius fracture. Hand Surg Rehabil 2023; 42:430-434. [PMID: 37356571 DOI: 10.1016/j.hansur.2023.06.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Clinical outcome after surgery depends on the surgeon's level of expertise or performance. The present study of minimally invasive plate osteosynthesis (MIPO) with anterior plate for distal radius fracture assessed whether clinical outcome correlated with surgeon performance. METHODS The series included 30 distal radius fractures: 15 operated on by 4 level III surgeons (Group 1) and 15 by 4 level V surgeons (Group 2), utilizing the MIPO technique. The surgical performance of all 8 surgeons was assessed using the OSATS global rating scale. Clinical outcomes were assessed at 3 months' follow-up using the modified Mayo score (MMS), in 4 grades: 0-64 (poor), 65-79 (moderate), 80-89 (good), and 90-100 (excellent). The QuickDASH score (QDASH) was also calculated, and complications were recorded. RESULTS Median MMS was better for level V (75 = fair result) than level III surgeons (62 = poor result). Median QDASH score likewise was better in group 2 (9.1) than group 1 (22.7). In group 1, there were 2 paresthesias in the median nerve territory, 1 type-1 complex regional pain syndrome, and 1 hypoesthesia in the scar area. Mean correlation between the 2 scores was -0.68. Group 1 patients were on average 7 years older. The number of patients, number of surgeons and distribution of OA A and C fractures were almost identical in the two groups. On MMS, the overall result of the two groups was moderate (70.5), which can be explained by short mean follow-up. DISCUSSION Quality of the clinical outcome on MMS and QDASH increased with surgical performance, with fewer complications. In the patients' interest, protocols for improving surgical performance should be implemented, for example, through deliberate practice.
Collapse
Affiliation(s)
- Ceyran Hamoudi
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France.
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
| | - Fred Xavier
- Orthopedic Surgery & Biomedical Engineering, Bayside, NY 11360, USA
| | - Thibaut Goetsch
- Department of Public Health, Strasbourg University Hospital, FMTS, GMRC, 1 Avenue De l'Hôpital, 67000 Strasbourg Cedex, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
| |
Collapse
|
6
|
Ramazani F, Wright ED, Randall DR, Lin JR, Jeffery CC. Developing an Objective Structured Assessment of Technical Skills ( OSATS) for Microlaryngoscopy. Laryngoscope 2023; 133:2719-2724. [PMID: 36815598 DOI: 10.1002/lary.30610] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Microlaryngoscopy is a basic technical skill in Oto-HNS. It is essential for residency programs to have a competency-based assessment tool to evaluate residents' performance of this procedure. An Objective Structured Assessment of Technical Skills (OSATS) is a procedure-specific assessment, which consists of the following: (a) Operation-Specific Checklist and (b) Global Rating Scale (GRS). OBJECTIVE The objective of this study was to create an OSATS for adult microlaryngoscopy. METHODS This was a prospective study, with an initial qualitative phase for OSATS development (Phase I), and a clinical pilot phase (Phase II). In Phase I, interviews were conducted with three laryngologists to establish a stepwise description of adult microlaryngoscopy and review a previously validated GRS for relevance to microlaryngoscopy. Responses were used to create a framework for the OSATS. The OSATS was then presented to Oto-HNS residents and laryngologists in an alternating fashion, for review of clarity and relevance. A pilot study was then performed to evaluate the resident performance of adult microlaryngoscopy. Multiple regression analysis was carried out to investigate whether training level, case complexity, and previous OSATS exposure could predict participant scores. RESULTS Phase I of this study led to the creation of a 34-item OSATS. The pilot study (N = 28 procedures) revealed that training level was significantly correlated with increased OSATS scores. There was no statistically significant correlation between case complexity and resident scores. Assessors reported the perceived utility of the OSATS and intent for use in residency training. CONCLUSION Application of the proposed OSATS will allow for competency-based assessment of the resident performance of microlaryngoscopy. LEVEL OF EVIDENCE NA Laryngoscope, 133:2719-2724, 2023.
Collapse
Affiliation(s)
- Fatemeh Ramazani
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Erin D Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Derrick R Randall
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jun R Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Dasci S, Schrem H, Oldhafer F, Beetz O, Kleine-Döpke D, Vondran F, Beneke J, Sarisin A, Ramackers W. Learning surgical knot tying and suturing technique - effects of different forms of training in a controlled randomized trial with dental students. GMS J Med Educ 2023; 40:Doc48. [PMID: 37560044 PMCID: PMC10407582 DOI: 10.3205/zma001630] [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] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 08/11/2023]
Abstract
Objective The acquisition of surgical skills requires motor learning. A special form of this is intermanual transfer by transferring motor skills from the nondominant hand (NDH) to the dominant hand (DH). The purpose of this study was to determine the learning gains that can be achieved for the DH by training with the DH, the NDH, and by non-surgical alternative training (AT). Methods 124 preclinical (n=62) and clinical (n=62) dental students completed surgical knot tying and suturing technique training with the DH, with the NDH, and an AT in a controlled randomized trial. Results A statistically significant learning gain in knot tying and suture technique with the DH was evident only after training with the DH when compared to training with the NDH (p<0.001 and p=0.004, respectively) and an AT (p=0.001 and p=0.010, respectively). Of those students who achieved a learning gain ≥4 OSATS points, 46.4% (n=32) benefited in their knot tying technique with the DH from training with the DH, 29.0% (n=20) from training with the NDH, and 24.6% (n=17) from an AT while 45.7% (n=32) benefited in their suturing technique with the DH from training with the DH, 31.4% (n=22) from training with the NDH, and 22, 9% (n=16) from an AT. Conclusions Training with the DH enabled significantly better learning gains in the surgical knot tying and suturing techniques with the DH.
Collapse
Affiliation(s)
- Sükran Dasci
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Harald Schrem
- Medical University of Graz, General, Visceral and Transplant Surgery, Graz, Austria
| | - Felix Oldhafer
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Oliver Beetz
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Dennis Kleine-Döpke
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Florian Vondran
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Jan Beneke
- Hannover Medical School, Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - Akin Sarisin
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| | - Wolf Ramackers
- Hannover Medical School, General, Visceral and Transplant Surgery, Hannover, Germany
| |
Collapse
|
8
|
Boro SS, Mathew AK, Kumar A. An Innovative Technique of Microsurgical Training on Fresh "Chicken Quarter" Model: Our Experience. Indian J Plast Surg 2023; 56:245-250. [PMID: 37435337 PMCID: PMC10332895 DOI: 10.1055/s-0043-1768244] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Purpose Regular practice, quality clinical exposure, and academic discussion are essential in any surgical specialty training. This study discusses and validates the option of using a fresh "chicken quarter" model with a measurable scoring system, as a standard training regimen in microvascular surgery. This can be a very effective, economical, and easily accessible model for residents. Materials and Methods This study was conducted in the Department of Plastic surgery, from October 2020 to May 2021. Twenty-four fresh "chicken quarter" specimens were dissected and the ischial arteries and femoral veins' external diameter (ED) were measured. The microsurgical skills of the trainee were assessed in 6 months intervals using the Objective Structured Assessment of Technical Skills Scale (OSATS) as well as the time taken for anastomosis. All the data were analyzed using SPSS (statistical package for social sciences) version 21. Results A task-specific score value of 50% on October 2020 improved to 85.7% by May 2021. This was found to be statistically significant ( p = 0.043). The mean ED of the ischial artery and femoral vein was 2.07 and 2.26 mm, respectively. The mean width of the vein measured at the lower one-third of the tibia was 2.08 mm. A greater than 50% reduction in anastomosis time was observed after a period of 6 months. Conclusion In our minimal experience, the "chicken quarter model" with OSATS scoring system seems to be effective, economical, very affordable, and easily accessible microsurgery training model for the residents. Our study is done only as a pilot project due to limited resources and we have the plan to introduce it as a proper training method in the near future with more residents.
Collapse
Affiliation(s)
- Sumanjit S. Boro
- Department of Burns and Plastic Surgery, All India Institute of Medical Science, Guwahati, Assam, India
| | - Anil K. Mathew
- Department of Maxillofacial Surgery, Powai Hospital, Mumbai, Maharashtra, India
| | - Anchit Kumar
- Dr B. Borooah Cancer Institute, A Grant-in-aid Institute of Department of Atomic Energy, Govt. of India and a Unit of Tata Memorial Centre-Mumbai, Guwahati, Assam, India
| |
Collapse
|
9
|
Fouillen KJ, Duncan HF, de Vries P, Chevalier V. Development and preliminary validation of an Objective Structured Assessment of Technical Skills ( OSATS) for a partial pulpotomy procedure. Int Endod J 2023. [PMID: 37228032 DOI: 10.1111/iej.13938] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
AIM To develop an Objective Structured Assessment of Technical Skills (OSATS) tool for partial pulpotomy and to preliminary assess the validity of this tool. Secondary objectives were to check internal consistency as well as the interrater reliability of this specific checklist and to compare it with the previously validated global rating score (GRS). METHODOLOGY The study assessed three groups of dental participants (mix of practitioners or students) possessing differing levels of clinical experience (7 novices, 7 intermediates, 7 experts), during a partial pulpotomy procedure on a simulated tooth with deep caries, using a bespoke procedure-specific checklist (PSC) and the GRS. Two independent examiners received the study participants in groups of two, in order to be able to directly observe their actions and grade the different steps of the procedure from 1 to 5 on the PSC and GRS. The internal validity of the specific checklist was assessed using a Cronbach's alpha test. As the construct validity of such a tool can be determined when the tool differentiates performance based on the level of experience, the total score of the PSC of the three groups (e.g. novice group, intermediate group, experienced group) were compared using Kruskal-Wallis and post-hoc Mann-Whitney pairwise U test. The total scores of the GRS were also analysed in the same manner. A correlation test (Correlation Matrices Test) was carried out for the entire sample between the specific checklist and the GRS (on total score). The intraclass correlation coefficient was used to measure the degree of agreement between the two evaluators. The statistical analysis was performed with XLSTAT® and Statistica® (significance p = 0.05). RESULTS The partial pulpotomy specific checklist graded from 1 to five demonstrated good internal consistency (0.86) and a good interrater reliability (0.91), a correct construct validity (p generally <0.05) and a good positive correlation with the validated GRS (r=0.92). CONCLUSIONS To address the need to develop education in vital pulp treatment, and more specifically the technical skills assessment of partial pulpotomy, an OSATS specific checklist was developed and preliminary validated. The checklist will need to be validated in larger cohorts.
Collapse
Affiliation(s)
- K J Fouillen
- University of Bretagne Occidentale, Brest University Hospital, Brest, France
- University of Bretagne Occidentale, Brest, France
| | - H F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - P de Vries
- University of Bretagne Occidentale, Brest University Hospital, Brest, France
- University of Bretagne Occidentale, Brest, France
| | - V Chevalier
- University of Bretagne Occidentale, Brest University Hospital, Brest, France
- University of Bretagne Occidentale, Brest, France
| |
Collapse
|
10
|
Ducournau F, El Amiri L, Vernet P, Sapa MC, Liverneaux P. Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: "expertise" versus "performance". Int Orthop 2023; 47:193-199. [PMID: 36264303 DOI: 10.1007/s00264-022-05609-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The results of surgical techniques vary depending on the level of the surgeon's experience. The level of expertise can be evaluated quantitatively or qualitatively. In this study, we evaluated the duration of the procedure and the size of the incision of minimally invasive fixation of distal radius fractures as a means of grading expertise and surgical performance. The null hypothesis of our study was that the level of expertise did not match the level of performance. MATERIAL AND METHODS The study included 52 surgeons split in five levels of expertise who had performed 467 minimally invasive fixations of distal radius fractures. The performance of the surgeons in terms of duration of the procedure and size of the incision were scored according to the five levels of surgical experience using four different methodologies: clinical (setting limits compared to data found in literature), statistical (setting statistical limits of comparison in percentiles (20th, 40th, 60th, 80th) for each of the two parameters measured), arithmetical (setting limits compared to equal intervals for each of the 2 variables), and success rate (setting a threshold for each of the 2 variables). RESULTS Our results showed a great disparity between levels of experience depending on the method used. The scores for levels 1 and 2 were 72% for expertise, 13% for performance according to the clinical method, 75% for the statistical method, 0% for the arithmetical method, and 57% according the success rate. The rate of level 3 was 23% for expertise, 41% for performance by the clinical method, 17% by the statistical method, 17% by the arithmetical method, and 15% by the success rate. The rates of levels 4 and 5 were 5% for expertise, 46% for performance clinical method, 8% by the statistical method, 83% by the arithmetical method, and 28% by the success rate. DISCUSSION The null hypothesis of our study was confirmed by the results which show that there was no correlation between levels of expertise and performance. The clinical method of assessment appears to reflect best the true level of performance of the surgeon. CONCLUSION Publications reporting the results of a surgical technique for a given pathology should always mention the level of performance as measured on a clinical scale.
Collapse
Affiliation(s)
- François Ducournau
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Laela El Amiri
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Paul Vernet
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Marie-Cécile Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, 67200, Strasbourg, France.
- ICube CNRS, UMR7357, Strasbourg University, 2-4 rue Boussingault, 67000, Strasbourg, France.
| |
Collapse
|
11
|
Neves Lopes V, Dantas I, Barbosa JP, Barbosa J. Telestration in the Teaching of Basic Surgical Skills: A Randomized Trial. J Surg Educ 2022; 79:1031-1042. [PMID: 35331681 DOI: 10.1016/j.jsurg.2022.02.013] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/16/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate how an affordable course using telestration with augmented reality can be compared to the traditional teaching of basic surgical skills. DESIGN Prospective, randomized and blinded study. SETTING Faculty of Medicine of Porto University. PARTICIPANTS AND METHODS Twenty medical students without any experience in basic surgical skills were randomized into two different learning groups: telestration and traditional teaching (on-site mentoring) groups. Five different types of sutures were taught: the single interrupted, the cruciate mattress, the horizontal mattress, the vertical mattress and the simple continuous sutures. Data was obtained on the time taken to learn each of the techniques and to perform each exercise without any support from the faculty, tension of the suture, quality of the procedure using a modified Objective Structured Assessment of Technical Skills and participants' answers to a Likert questionnaire in terms of their learning experience, confidence, and self-evaluation. RESULTS Trainees in the telestration group were globally faster when performing independently (1393.40 [SD 288.89] vs 1679.00 [SD 328.22] seconds, p = 0.04) particularly during the cruciate mattress suture (235.50 [SD 61.81] vs 290.00 [SD 68.77] seconds, p = 0.05) and the simple continuous suture (492.40 [SD 87.49] vs 630.30 [SD 132.34] seconds, p = 0.01).Time needed for students to learn the procedures was similar between the groups. There were also no statistically significant differences in terms of the quality of the surgical gesture, tension of the suture, self-evaluation or confidence. CONCLUSIONS A basic surgical skills course using telestration through a head-mounted device with augmented reality capabilities can be a viable alternative to traditional teaching, considering time and quality of the gesture. Though costs can discourage from using this technology in basic procedures, the use of free software may turn it into an affordable option in the context of distant learning.
Collapse
Affiliation(s)
- Vítor Neves Lopes
- Department of General Surgery, University Hospital Center of São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Isabel Dantas
- Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - José Barbosa
- Department of General Surgery, University Hospital Center of São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
12
|
Cafarelli L, El Amiri L, Facca S, Chakfé N, Sapa MC, Liverneaux P. Anterior plating technique for distal radius: comparing performance after learning through naive versus deliberate practice. Int Orthop 2022; 46:1821-1829. [PMID: 35670866 DOI: 10.1007/s00264-022-05464-4] [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] [Received: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surgical teaching is most often carried out in the operating theatre through mentorship, and the performance of surgical procedures is rarely measured. The objective of this article is to compare the progression in learning curves of junior surgeons trained in the anterior plating technique for the distal radius on a nonbiological model according to three different methods. METHODS The materials comprised 12 junior surgeons of level 1 or 2 (as per Tang and Giddins) divided into three groups: control (G1), naive practice (G2), and deliberate practice (G3). The three groups watched a demonstration video of a level 5 expert. The four G1 surgeons (two level 1 and two level 2) saw the video only once, and each inserted five plates. The four G2 surgeons (two level 1 and two level 2) inserted five plates and watched the video before each time. The four G3 surgeons (two level 1 and two level 2) saw the video before the first plate insertion. Before posing the subsequent four plates, the four G3 surgeons watched their own video, and the expert indicated their errors and how to avoid them next time. A 12-criteria OSATS defined on the basis of the 60 videos, each graded from one (min.) to five (max.), was used to measure the objective surgical performance per plating (min. 12; max. 60) and per series of five plate fixations (min. 60, max. 300). RESULTS The total average objective performance of G1 was 44.73, of G2 was 50.57 and of G3 was 54.35. Change in objective performance was better for G3 (13.25) than G2 (5) or G1 (3.75). For all groups, the progression in objective performance was better amongst level 1 surgeons (9) than level 2 surgeons (5.6). CONCLUSION Surgical teaching is based on mentorship and experience. However, since "see one, practice many, do one" has started to replace "see one, do one, teach one", learning techniques have increasingly relied on procedure simulators. Against this background, few studies have looked at measuring the performance of surgical procedures and improved learning curves. Our results appear to suggest that deliberate practice, when used in addition to mentorship, is the best option for shortening the growth phase of the learning curve and improving performance. Deliberate practice is a learning technique for surgical procedures that is complementary to mentorship and experience, which allows the growth phase of the learning curve to be shortened and the objective performance of junior surgeons to be improved.
Collapse
Affiliation(s)
- Laurine Cafarelli
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France
| | - Laela El Amiri
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France
| | - Sybille Facca
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France.,Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, Strasbourg, 67200, France
| | - Nabil Chakfé
- Gepromed, Bâtiment d'Anesthésiologie, 4 rue Kirschleger, Strasbourg Cedex, 67085, France
| | - Marie-Cécile Sapa
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France
| | - Philippe Liverneaux
- ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France. .,Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, Strasbourg, 67200, France. .,Gepromed, Bâtiment d'Anesthésiologie, 4 rue Kirschleger, Strasbourg Cedex, 67085, France.
| |
Collapse
|
13
|
Zwart MJW, Jones LR, Fuente I, Balduzzi A, Takagi K, Novak S, Stibbe LA, de Rooij T, van Hilst J, van Rijssen LB, van Dieren S, Vanlander A, van den Boezem PB, Daams F, Mieog JSD, Bonsing BA, Rosman C, Festen S, Luyer MD, Lips DJ, Moser AJ, Busch OR, Abu Hilal M, Hogg ME, Stommel MWJ, Besselink MG. Performance with robotic surgery versus 3D- and 2D-laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials. Surg Endosc 2022; 36:4518-4528. [PMID: 34799744 PMCID: PMC9085660 DOI: 10.1007/s00464-021-08805-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/27/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Robotic surgery may improve surgical performance during minimally invasive pancreatoduodenectomy as compared to 3D- and 2D-laparoscopy but comparative studies are lacking. This study assessed the impact of robotic surgery versus 3D- and 2D-laparoscopy on surgical performance and operative time using a standardized biotissue model for pancreatico- and hepatico-jejunostomy using pooled data from two randomized controlled crossover trials (RCTs). METHODS Pooled analysis of data from two RCTs with 60 participants (36 surgeons, 24 residents) from 11 countries (December 2017-July 2019) was conducted. Each included participant completed two pancreatico- and two hepatico-jejunostomies in biotissue using 3D-robotic surgery, 3D-laparoscopy, or 2D-laparoscopy. Primary outcomes were the objective structured assessment of technical skills (OSATS: 12-60) rating, scored by observers blinded for 3D/2D and the operative time required to complete both anastomoses. Sensitivity analysis excluded participants with excess experience compared to others. RESULTS A total of 220 anastomoses were completed (robotic 80, 3D-laparoscopy 70, 2D-laparoscopy 70). Participants in the robotic group had less surgical experience [median 1 (0-2) versus 6 years (4-12), p < 0.001], as compared to the laparoscopic group. Robotic surgery resulted in higher OSATS ratings (50, 43, 39 points, p = .021 and p < .001) and shorter operative time (56.5, 65.0, 81.5 min, p = .055 and p < .001), as compared to 3D- and 2D-laparoscopy, respectively, which remained in the sensitivity analysis. CONCLUSION In a pooled analysis of two RCTs in a biotissue model, robotic surgery resulted in better surgical performance scores and shorter operative time for biotissue pancreatic and biliary anastomoses, as compared to 3D- and 2D-laparoscopy.
Collapse
Affiliation(s)
- Maurice J. W. Zwart
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Leia R. Jones
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands ,grid.415090.90000 0004 1763 5424Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Ignacio Fuente
- grid.414775.40000 0001 2319 4408Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Balduzzi
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands ,grid.411475.20000 0004 1756 948XGeneral and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Kosei Takagi
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands ,grid.261356.50000 0001 1302 4472Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Okayama University, Okayama, Japan
| | - Stephanie Novak
- grid.412689.00000 0001 0650 7433Department of Surgery, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Luna A. Stibbe
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Thijs de Rooij
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Jony van Hilst
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - L. Bengt van Rijssen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Aude Vanlander
- grid.5342.00000 0001 2069 7798Department of Surgery, University Hospital Ghent, University of Ghent, Ghent, Belgium
| | - Peter B. van den Boezem
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Freek Daams
- grid.12380.380000 0004 1754 9227Department of Surgery, Amsterdam UMC, VU University, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J. Sven D. Mieog
- grid.10419.3d0000000089452978Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A. Bonsing
- grid.10419.3d0000000089452978Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Camiel Rosman
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastiaan Festen
- grid.440209.b0000 0004 0501 8269Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Misha D. Luyer
- grid.413532.20000 0004 0398 8384Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Daan J. Lips
- grid.415214.70000 0004 0399 8347Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Arthur J. Moser
- grid.38142.3c000000041936754XDepartment of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Olivier R. Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | - Mohammad Abu Hilal
- grid.415090.90000 0004 1763 5424Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Melissa E. Hogg
- grid.240372.00000 0004 0400 4439Department of Surgery, Northshore University Health System, Chicago, IL USA
| | - Martijn W. J. Stommel
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117 (ZH-7F), 1081 HV Amsterdam, The Netherlands
| | | |
Collapse
|
14
|
Schmidt MW, Haney CM, Kowalewski KF, Bintintan VV, Abu Hilal M, Arezzo A, Bahra M, Besselink MG, Biebl M, Boni L, Diana M, Egberts JH, Fischer L, Francis N, Hashimoto DA, Perez D, Schijven M, Schmelzle M, Soltes M, Swanstrom L, Welsch T, Müller-Stich BP, Nickel F. Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A- OSATS score. Surg Endosc 2022; 36:4529-4541. [PMID: 34755235 PMCID: PMC9085690 DOI: 10.1007/s00464-021-08806-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS). MATERIALS AND METHODS The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8). RESULTS The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807-0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923-0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale. CONCLUSION With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.
Collapse
Affiliation(s)
- Mona W. Schmidt
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Caelan M. Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103 Leipzig, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Vasile V. Bintintan
- Department of Surgery, 1st Surgical Clinic, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mohammed Abu Hilal
- Department of Surgery, Hepatobiliary Pancreatic and Minimally Invasive Unit, Poliambulanza Foundation Hospital, Brescia, Italy ,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Marcus Bahra
- Department of Surgical Oncology and Robotics, Waldfriede Hospital, Berlin, Germany
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthias Biebl
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Luigi Boni
- Fondazione IRCCS-Ca`Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Michele Diana
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France ,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France ,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France ,ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
| | - Jan H. Egberts
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Baden-Baden, Germany
| | - Nader Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK
| | | | - Daniel Perez
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlies Schijven
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Moritz Schmelzle
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Marek Soltes
- 1St Department of Surgery, University of Pavol Jozef Safarik, Košice, Slovakia
| | - Lee Swanstrom
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Thilo Welsch
- Department of Visceral, Thoracic, and Vascular Surgery, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| |
Collapse
|
15
|
Nishi H, Yokoyama H, Yaku H, Doi K, Nishimura Y, Abe K, Tsukui H, Tabata M, Okamoto K, Park YK, Matsuda H. Efficacy of simulation training for beating heart coronary anastomosis using BEAT + YOUCAN simulator. Asian Cardiovasc Thorac Ann 2021; 30:661-668. [PMID: 34757850 DOI: 10.1177/02184923211060214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to evaluate our distributed practice program developed for training for beating heart anastomosis by employing a novel beating heart simulator. METHODS Eleven trainees watched and reviewed instructional video recordings of coronary anastomosis methods with a BEAT + YOUCAN training device, then performed coronary anastomosis procedures under a beating condition. Next, they participated in a four-hour training program developed by faculty surgeons. Ten different anastomosis components were assessed on a five-point rating scale (5, good; 3, average; 1, poor). After finishing the training program, each trainee again performed a coronary anastomosis procedure. Component scores were then compared before and after the training program. RESULTS The mean time to completion of the procedure improved from 1033 ± 424 to 795 ± 201 s (p < 0.05). Assessment scores improved from 1.88 ± 0.41 to 2.57 ± 0.30 (p < 0.05). Improvements in some technical components related to handling of instruments were noted (p < 0.05), whereas no significant improvement was seen with arteriotomy, graft orientation, suture management, or knot tying after finishing the training program. CONCLUSION Trainees who participated in our four-hour focused training program for coronary anastomosis with a novel beating heart simulator showed improved ability under the beating condition in regard to technical skills related to handling instruments.
Collapse
Affiliation(s)
- Hiroyuki Nishi
- Department of Cardiovascular Surgery, 13707National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, 12775Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, 12898Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, 38225Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, 13145Wakayama Medical University, Wakayama, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Tsukui
- Department of Cardiothoracic Surgery, 22426Excela Health Westmoreland Hospital, Jeannette, United States
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo-Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, 12872Kindai University, Higashiosaka, Japan
| | - Young-Kwang Park
- Department of Cardiovascular Surgery, 12775Fukushima Medical University, Fukushima, Japan
| | - Hikaru Matsuda
- Department of Cardiovascular Surgery, Higashi-Takarazuka Satoh Hospital, Hyogo, Japan
| |
Collapse
|
16
|
Aruparayil N, Gnanaraj J, Maiti S, Chauhan M, Quyn A, Mishra A, Bains L, Mathew G, Harris C, Cundill B, Fellows A, Gordon K, Dawkins B, Shinkins B, Brown J, Jayne D. Training programme in gasless laparoscopy for rural surgeons of India (TARGET study) - Observational feasibility study. Int J Surg Open 2021; 35:None. [PMID: 34632156 DOI: 10.1016/j.ijso.2021.100399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 12/11/2022]
Abstract
Background Benefits of laparoscopic surgery are well recognised but uptake in rural settings of low- and middle-income countries is limited due to implementation barriers. Gasless laparoscopy has been proposed as an alternative but requires a trained rural surgical workforce to upscale. This study evaluates a feasibility of implementing a structured laparoscopic training programme for rural surgeons of North-East India. Methods A 3-day training programme was held at Kolkata Medical College in March 2019. Laparoscopic knowledge and Fundamentals of Laparoscopic Skills (FLS) were assessed pre and post simulation training using multiple choice questions and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), respectively. Competency with an abdominal lift device was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and live operating performance via the Global Operative Assessment of Laparoscopic Skills (GOALS) scores during live surgery. Costs of the training programme and qualitative feedback were evaluated. Results Seven rural surgeons participated. There was an improvement in knowledge acquisition (mean difference in MCQ score 5.57 (SD = 4.47)). The overall normalised mean MISTELS score for the FLS tasks improved from 386.02 (SD 110.52) pre-to 524.40 (SD 94.98) post-training (p = 0.09). Mean OSATS score was 22.4 out of 35 (SD 3.31) indicating competency with the abdominal lift device whilst a mean GOALS score of 16.42 out of 25 (SD 2.07) indicates proficiency in performing diagnostic laparoscopy using the gasless technique during live operating. Costs of the course were estimated at 354 USD for trainees and 461 USD for trainers. Conclusion Structured training programme in gasless laparoscopy improves overall knowledge and skills acquisition in laparoscopic surgery for rural surgeons of North-East India. It is feasible to deliver a training programme in gasless laparoscopy for rural surgeons. Larger studies are needed to assess the benefits for wider adoption in a similar context.
Collapse
|
17
|
Suozzi KC, Kibbi N, Lee KC, Worley B, Furlan KC, Kang BY, Ibrahim SA, Poon E, Alam M, Harikumar V, Keimig EL, Alster TS, Bolotin D, Dover JS, Galadari H, Goodman GJ, Hexsel D, Kaminer MS, Kim JYS, Karen J, Lask G, Lewis AB, Maher IA, Paul BC, Negishi K, Touma DJ, Waldman A, Beer K, Bertucci V, Burgess CM, Casabona G, De Boulle KL, Fitzgerald R, Green JB, Goldman MP, Humphrey S, Ibrahim SF, Ibrahimi OA, Jagdeo J, Kim HS, Lawrence N, Marmur E, Matarasso SL, McDonald M, Obagi S, Ortiz AE, Philipp-Dormston WG, Rossi AM, Solish N, Taylor SC, Trindade de Almeida AR, Weinkle SH. Development of Objective Structured Assessment of Technical Skills in Facial Cosmetic Procedures: Botulinum Toxin Neuromodulator and Soft Tissue Filler Injection. J Am Acad Dermatol 2021; 86:463-467. [PMID: 34499988 DOI: 10.1016/j.jaad.2021.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kathleen C Suozzi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kachiu C Lee
- Main Line Center for Laser Surgery, Philadelphia, PA, USA
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karina C Furlan
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily L Keimig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tina S Alster
- Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA
| | - Diana Bolotin
- Section of Dermatology, The University of Chicago, Chicago, IL, USA
| | - Jeffrey S Dover
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA; Department of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA; SkinCare Physicians, Chestnut Hill, MA, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Greg J Goodman
- Monash University, Melbourne, AUA; University College of London, London, UK
| | - Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, GBR
| | - Michael S Kaminer
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA; SkinCare Physicians, Chestnut Hill, MA, USA
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gary Lask
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA; Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | | | - Ian A Maher
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Kei Negishi
- Institute of Geriatrics, Tokyo Women's Medical University, Tokyo, JPN
| | | | - Abigail Waldman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Vince Bertucci
- Division of Dermatology, University of Toronto, Toronto, ON, CAN
| | - Cheryl M Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, DC, USA
| | | | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, FL, USA
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, CA, USA
| | - Shannon Humphrey
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, CAN
| | - Sherrif F Ibrahim
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; Dermatology Service, VA New York Harbor Healthcare System-Brooklyn Campus, Brooklyn, NY, USA
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, KOR
| | - Naomi Lawrence
- Division of Dermatology, Section of Procedural Dermatology, Cooper Hospital, Rowan University, Camden, NJ, USA
| | - Ellen Marmur
- Marmur Medical, Dermatology, New York, NY, USA; Department of Dermatology, The Mount Sinai Medical Center, New York, NY, USA
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Michel McDonald
- Department of Dermatology, Vanderbilt University, Nashville, TN, USA
| | - Suzan Obagi
- Cosmetic Surgery & Skin Health Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arisa E Ortiz
- Department of Dermatology, University of California, San Diego Health, La Jolla, CA, USA
| | - Wolfgang G Philipp-Dormston
- Faculty of Health, University Witten/Herdecke, Witten, DEU; Hautzentrum Koeln, Klinik Links vom Rhein, Cologne, DEU
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nowell Solish
- Division of Dermatology, University of Toronto, Toronto, ON, CAN
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Susan H Weinkle
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL, USA
| |
Collapse
|
18
|
Zhou NJ, Kamil RJ, Zhu J, Hillel AT, Tan M, Walsh J, Russell JO, Eisele D, Akst LM. Preoperative Briefings and Postoperative Debriefings to Increase Resident Operative Autonomy and Performance. J Surg Educ 2021; 78:1450-1460. [PMID: 33757726 DOI: 10.1016/j.jsurg.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To implement the use of standardized preoperative briefings and postoperative debriefings for surgical cases involving residents in an effort to improve resident autonomy and skill acquisition. DESIGN Prospective longitudinal study. SETTING Johns Hopkins Department of Otolaryngology-Head and Neck Surgery. PARTICIPANTS Resident and attending physicians. RESULTS Joint Huddles for Improving Resident Education (JHFIRE) tool was created and successfully implemented by 19 residents and 17 faculty members. Over the course of three data collection periods spanning an academic year, overall scores improved though not statistically significantly in the metrics of Zwisch autonomy, Resident Performance, and Objective Structured Assessment of Technical Skills (OSATS) scores. Female residents were scored significantly higher by attendings than their male counterparts in the assessment of baseline Resident Performance. CONCLUSIONS (1) JHFIRE tool implemented a standardized preoperative briefing and postoperative debriefing to improve communication and resident skill acquisition; (2) The tool was accepted and utilized throughout an academic year; (3) Zwisch, Resident Performance, and OSATS scores improved though not significantly.
Collapse
Affiliation(s)
- Nancy J Zhou
- Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Rebecca J Kamil
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jiafeng Zhu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
19
|
Zwart MJW, Jones LR, Balduzzi A, Takagi K, Vanlander A, van den Boezem PB, Daams F, Rosman C, Lips DJ, Moser AJ, Hogg ME, Busch ORC, Stommel MWJ, Besselink MG; Dutch Pancreatic Cancer Group. Added value of 3D-vision during robotic pancreatoduodenectomy anastomoses in biotissue (LAEBOT 3D2D): a randomized controlled cross-over trial. Surg Endosc 2021; 35:2928-35. [PMID: 32661707 DOI: 10.1007/s00464-020-07732-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND We tested the added value of 3D-vision on procedure time and surgical performance during robotic pancreatoduodenectomy anastomoses in biotissue. Robotic surgery has the advantage of articulating instruments and 3D-vision. Consensus is lacking on the added value of 3D-vision during laparoscopic surgery. Given the improved dexterity with robotic surgery, the added value of 3D-vision may be even less with robotic surgery. METHODS In this experimental randomized controlled cross-over trial, 20 surgeons and surgical residents from 5 countries performed robotic pancreaticojejunostomy and hepaticojejunostomy anastomoses in a biotissue organ model using the da Vinci® system and were randomized to start with either 3D- or 2D-vision. Primary endpoint was the time required to complete both anastomoses. Secondary endpoint was the objective structured assessment of technical skill (OSATS; range 12-60) rating; scored by two observers blinded to 3D/2D. RESULTS Robotic 3D-vision reduced the combined operative time from 78.1 to 57.3 min (24.6% reduction, p < 0.001; 20.8 min reduction, 95% confidence intervals 12.8-28.8 min). This reduction was consistent for both anastomoses and between surgeons and residents, p < 0.001. Robotic 3D-vision improved OSATS performance by 6.1 points (20.8% improvement, p = 0.003) compared to 2D (39.4 to 45.1 points, ± 5.5). CONCLUSION 3D-vision has a considerable added value during robotic pancreatoduodenectomy anastomoses in biotissue in both time reduction and improved surgical performance as compared to 2D-vision.
Collapse
|
20
|
Ji S, Hwang C, Karmakar M, Matusko N, Thompson-Burdine J, Williams AM, Leininger L, Minter RM, Sandhu G. Association of intraoperative entrustment with clinical competency amongst general surgery residents. Am J Surg 2019; 219:245-252. [PMID: 31870532 DOI: 10.1016/j.amjsurg.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Lack of transparency and meaningful assessment in surgical residency has led to inconsistent intraoperative entrustment and highly variable trainee competence at graduation. The relationship between faculty entrustment and resident entrustability on clinical competency remains unclear. We sought to evaluate the dynamic between entrustment/entrustability and clinical competency in general surgery residency. METHODS Intraoperative observations were conducted across a 22-month period at an academic tertiary center. Entrustment/entrustability were measured using OpTrust. Clinical competencies were appraised via ACGME Milestones and Objective Structured Assessment of Technical Skill (OSATS) scores. Mixed effects linear regression was used to investigate the relationship among overall ACGME Milestone scores, OSATS domain scores, and overall OpTrust scores. RESULTS Overall OpTrust scores significantly correlated with overall Milestone scores and multiple OSATS score domains. CONCLUSIONS OpTrust demonstrated a positive association between ACGME general surgery Milestones and OSATS scores. Overall, OpTrust may help optimize intraoperative faculty entrustment and resident entrustability, facilitating surgical trainee success during residency.
Collapse
Affiliation(s)
- Sunjong Ji
- University of Michigan Medical School, 7300 Medical Science Building I - A Wing, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Charles Hwang
- University of Michigan Medical School, 7300 Medical Science Building I - A Wing, 1301 Catherine Street, Ann Arbor, MI, 48109, USA
| | - Monita Karmakar
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Julie Thompson-Burdine
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aaron M Williams
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lisa Leininger
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA; Department of Learning Health Sciences, Michigan Medicine, 209 Victor Vaughan Building, 1111 E. Catherine Street, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
21
|
Jokinen E, Mikkola TS, Härkki P. Simulator training and residents' first laparoscopic hysterectomy: a randomized controlled trial. Surg Endosc 2019; 34:4874-4882. [PMID: 31768724 PMCID: PMC7572324 DOI: 10.1007/s00464-019-07270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hysterectomy rates are decreasing in many countries, and virtual reality simulators bring new opportunities into residents' surgical education. The objective of this study was to evaluate the effect of training in laparoscopic hysterectomy module with virtual reality simulator on surgical outcomes among residents performing their first laparoscopic hysterectomy. METHODS This randomized study was carried out at the Department of Obstetrics and Gynecology in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty residents and randomly signed half of them to train ten times with the laparoscopic hysterectomy module on a virtual reality simulator, while the rest represented the control group. Their first laparoscopic hysterectomy was video recorded and assessed later by using the Objective Structured Assessment of Technical Skills (OSATS) forms and Visual Analog Scale (VAS). The scores and surgical outcomes were compared between the groups. RESULTS The mean OSATS score for the Global Rating Scale (GRS) was 17.0 (SD 3.1) in the intervention group and 11.2 (SD 2.4) in the control group (p = 0.002). The mean procedure-specific OSATS score was 20.0 (SD 3.3) and 16.0 (SD 2.8) (p = 0.012), and the mean VAS score was 55.0 (SD 14.8) and 29.9 (SD 14.9) (p = 0.001). Operative time was 144 min in the intervention group and 165 min in the control group, but the difference did not reach statistical significance (p = 0.205). There were no differences between the groups in blood loss or direct complications. CONCLUSION Residents training with a virtual reality simulator prior to the first laparoscopic hysterectomy seem to perform better in the actual live operation. Thus, a virtual reality simulator hysterectomy module could be considered as a part of laparoscopic training curriculum.
Collapse
Affiliation(s)
- Ewa Jokinen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland.
| | - Tomi S Mikkola
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland
| | - Päivi Härkki
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, P.O. Box 140, 00029 HUS, Helsinki, Finland
| |
Collapse
|
22
|
Augestad KM, Butt K, Ignjatovic D, Keller DS, Kiran R. Video-based coaching in surgical education: a systematic review and meta-analysis. Surg Endosc 2019; 34:521-535. [PMID: 31748927 DOI: 10.1007/s00464-019-07265-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the era of competency-based surgical education, VBC has gained increased attention and may enhance the efficacy of surgical education. The objective of this systematic review was to summarize the existing evidence of video-based coaching (VBC) and compare VBC to traditional master-apprentice-based surgical education. METHODS We performed a systematic review and meta-analysis of randomized controlled trials (RCT) assessing VBC according to the PRISMA and Cochrane guidelines. The MEDLINE, EMBASE, and COCHRANE and Researchgate databases were searched for eligible manuscripts. Standard mean difference (SMD) of performance scoring scales was used to assess the effect of VBC versus traditional training without VBC (control). RESULTS Of 627 studies identified, 24 RCTs were eligible and evaluated. The studies included 778 surgical trainees (n = 386 VBC vs. n = 392 control). 13 performance scoring scales were used to assess technical competence; OSATS-GRS was the most common (n = 15). VBC was provided preoperative (n = 11), intraoperative (n = 1), postoperative (n = 10), and perioperative (n = 2). The majority of studies were unstructured, where identified coaching frameworks were PRACTICE (n = 1), GROW (n = 2) and Wisconsin Coaching Framework (n = 1). There was an effect on performance scoring scales in favor of VBC coaching (SMD 0.87, p < 0.001). In subgroup analyses, the residents had a larger relative effect (SMD 1.13; 0.61-1.65, p < 0.001) of VBC compared to medical students (SMD 0.43, 0.06-0.81, p < 0.001). The greatest source of potential bias was absence of blinding of the participants and personnel (n = 20). CONCLUSION Video-based coaching increases technical performance of medical students and surgical residents. There exist significant study and intervention heterogeneity that warrants further exploration, showing the need to structure and standardize video-based coaching tools.
Collapse
Affiliation(s)
- Knut Magne Augestad
- Department of Postgraduate Surgical Education, University Hospital North Norway, Tromsö, Norway. .,Department of GI Surgery, Sandnessjøen Regional Hospital, Sandnessjøen, Norway. .,Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Khayam Butt
- Department of GI Surgery, Nordlandssykehuset, Bodø, Norway
| | - Dejan Ignjatovic
- Department of GI Surgery, Akershus University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Deborah S Keller
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ravi Kiran
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
23
|
Mannella P, Malacarne E, Giannini A, Russo E, Caretto M, Papini F, Montt Guevara MM, Pancetti F, Simoncini T. Simulation as tool for evaluating and improving technical skills in laparoscopic gynecological surgery. BMC Surg 2019; 19:146. [PMID: 31619236 PMCID: PMC6796391 DOI: 10.1186/s12893-019-0610-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/20/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. METHODS Thirty-three residents in obstetrics and gynecology at University of Pisa, Italy were recruited, and they received a simulation program consisting of 5 tasks. They had to perform basic laparoscopic surgery maneuvers as creating pneumoperitoneum, positioning trocars under vision, demonstrating the appropriate use of dominant and non-dominant hand and making single stitch and knot. They were evaluated with a modified OSATs scale. RESULTS Senior trainees had better score than junior trainees (p value< 0,005) and after different sessions of simulation scores of both groups significantly improved (p < 0,001), especially for the junior group. All the trainees reported self-assessments that matched with the evaluation of external observers demonstrating the importance of simulation also as auto-evaluation test. CONCLUSIONS In this study, we demonstrated the role of simulation as powerful tool to evaluate and to self-assess surgical technical skills and to improve own capacities, with the use of a modified OSATs scale adapted to specific exercises.
Collapse
Affiliation(s)
- Paolo Mannella
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Elisa Malacarne
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Francesca Papini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Federica Pancetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| |
Collapse
|
24
|
Rice MK, Zenati MS, Novak SM, Al Abbas AI, Zureikat AH, Zeh HJ, Hogg ME. Crowdsourced Assessment of Inanimate Biotissue Drills: A Valid and Cost-Effective Way to Evaluate Surgical Trainees. J Surg Educ 2019; 76:814-823. [PMID: 30472061 DOI: 10.1016/j.jsurg.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/28/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Providing feedback to surgical trainees is a critical component for assessment of technical skills, yet remains costly and time consuming. We hypothesize that statistical selection can identify a homogenous group of nonexpert crowdworkers capable of accurately grading inanimate surgical video. DESIGN Applicants auditioned by grading 9 training videos using the Objective Structured Assessment of Technical Skills (OSATS) tool and an error-based checklist. The summed OSATS, summed errors, and OSATS summary score were tested for outliers using Cronbach's Alpha and single measure intraclass correlation. Accepted crowdworkers then submitted grades for videos in 3 different compositions: full video 1× speed, full video 2× speed, and critical section segmented video. Graders were blinded to this study and a similar statistical analysis was performed. SETTING The study was conducted at the University of Pittsburgh Medical Center (Pittsburgh, PA), a tertiary care academic teaching hospital. PARTICIPANTS Thirty-six premedical students participated as crowdworker applicants and 2 surgery experts were compared as the gold-standard. RESULTS The selected hire intraclass correlation was 0.717 for Total Errors and 0.794 for Total OSATS for the first hire group and 0.800 for Total OSATS and 0.654 for Total Errors for the second hire group. There was very good correlation between full videos at 1× and 2× speed with an interitem statistic of 0.817 for errors and 0.86 for OSATS. Only moderate correlation was found with critical section segments. In 1 year 275hours of inanimate video was graded costing $22.27/video or $1.03/minute. CONCLUSIONS Statistical selection can be used to identify a homogenous cohort of crowdworkers used for grading trainees' inanimate drills. Crowdworkers can distinguish OSATS metrics and errors in full videos at 2× speed but were less consistent with segmented videos. The program is a comparatively cost-effective way to provide feedback to surgical trainees.
Collapse
Affiliation(s)
- MaryJoe K Rice
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Mazen S Zenati
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephanie M Novak
- Department of Surgery, Northshore University HealthSystem, Chicago, Illinois
| | - Amr I Al Abbas
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa E Hogg
- Department of Surgery, Northshore University HealthSystem, Chicago, Illinois.
| |
Collapse
|
25
|
Hinchcliff M, Kao M, Johnson K. The importance of technical skills assessment during an airway foreign body removal course. Int J Pediatr Otorhinolaryngol 2019; 117:1-5. [PMID: 30579061 DOI: 10.1016/j.ijporl.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Surgical simulation has proven useful in training for high-acuity, low frequency events such as airway foreign body removal (AWFBR). Studies have supported the role of simulation to improve trainee confidence and technical proficiency, but rigorous methodology is often lacking. Through a pilot study, we sought to evaluate the feasibility and utility of two-view video capture for rigorous assessment of trainee skill in an educational course setting. METHODS Participants were asked to perform 1) self-assessment surveys using 5- point Likert scale questions and 2) rigid bronchoscopy with AWFBR on intubation trainers, at the beginning and end of a multi-institution airway course. Video was collected from endoscopic and wide-angle body cameras. The videos were blinded and evaluated in random order by two expert reviewers using a 5-point pediatric airway endoscopy specific objective structured assessment of technical skills (OSATS) instrument. RESULTS Fourteen trainees submitted pre- and post-course surveys, and eight of these also had complete video data. Faculty feedback indicated the importance of pre- and post-course AWFBR recordings for real-time trainee feedback and post-course curricular refinement. Survey data showed an increase in confidence for AWFBR from 2.0 to 3.3 (p = 0.05). Average OSATS scores increased from 1.84 to 2.58 but this did not reach significance (p = 0.51). Paired improvements in confidence exceeded improvements in OSATS scores (1.29 vs. 0.18, p = 0.058). CONCLUSIONS Rigorously evaluated two-view video capture was feasible in an educational course setting. The course resulted in improvements in confidence to a greater degree than OSATS scores. This supports the importance of assessing course impact and refining curricula using all available data including objectively assessing technical skills.
Collapse
Affiliation(s)
| | - Michael Kao
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, USA; Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's, Seattle, WA, USA
| |
Collapse
|
26
|
Julian O, Patrick H, Felix N, Tilman W, Mirco F, Beat-Peter MS, Gerhard S, Tanner MC. Development and validation of an objective assessment scale for chest tube insertion under 'direct' and 'indirect' rating. BMC Med Educ 2018; 18:320. [PMID: 30587187 PMCID: PMC6307220 DOI: 10.1186/s12909-018-1430-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is an increasing need for objective and validated educational concepts. This holds especially true for surgical procedures like chest tube insertion (CTI). Thus, we developed an instrument for objectification of learning successes: the assessment scale based on Objective Structured Assessment of Technical Skill (OSATS) for chest tube insertion, which is evaluated in this study. Primary endpoint was the evaluation of intermethod reliability (IM). Secondary endpoints are 'indirect' interrater reliability (IR) and construct validity of the scale (CV). METHODS Every participant (N = 59) performed a CTI on a porcine thorax. Participants received three ratings (one 'direct' on site, two 'indirect' via video rating). IM compares 'direct' with 'indirect' ratings. IR was assessed between 'indirect' ratings. CV was investigated by subgroup analysis based on prior experience in CTI for 'direct' and 'indirect' rating. RESULTS We included 59 medical students to our study. IM showed moderate conformity ('direct' vs. 'indirect 1' ICC = 0.735, 95% CI: 0.554-0.843; 'direct' vs. 'indirect 2' ICC = 0.722, 95% CI 0.533-0.835) and good conformity between 'direct' vs. 'average indirect' rating (ICC = 0.764, 95% CI: 0.6-0.86). IR showed good conformity (ICC = 0.84, 95% CI: 0.707-0.91). CV was proven between subgroups in 'direct' (p = 0.037) and 'indirect' rating (p = 0.013). CONCLUSION Results for IM suggest equivalence for 'direct' and 'indirect' ratings, while both IR and CV was demonstrated in both rating methods. Thus, the assessment scale seems a reliable method for rating trainees' performances 'directly' as well as 'indirectly'. It may help to objectify and facilitate the assessment of training of chest tube insertion.
Collapse
Affiliation(s)
- Ober Julian
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Haubruck Patrick
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Nickel Felix
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Walker Tilman
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Friedrich Mirco
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Müller-Stich Beat-Peter
- Department of General, Visceral and Transplantation Surgery Heidelberg University Hospital, D-69120 Heidelberg, Germany
| | - Schmidmaier Gerhard
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| | - Michael C. Tanner
- HTRG – Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany
| |
Collapse
|
27
|
Abstract
Evaluation of surgical skills and competency are important aspects of the medical education process. Measurable and reproducible methods of assessment with objective feedback are essential components of surgical training. Objective Structured Assessment of Technical Skills (OSATS) is widely used across the medical specialties and otolaryngology-specific tools have been developed and validated for sinus and mastoid surgery. Although assessment of surgical skills can be time-consuming and requires human and financial resources, new evaluation methods and emerging technology may alleviate these barriers while also improving data collection practices.
Collapse
Affiliation(s)
- Nasir I Bhatti
- Johns Hopkins University, Department of Otolaryngology-Head and Neck Surgery, 600 North Wolfe Street, Baltimore, MD 21205, USA.
| |
Collapse
|
28
|
Caskey RC, Owei L, Rao R, Riddle EW, Brooks AD, Dempsey DT, Morris JB, Neylan CJ, Williams NN, Dumon KR. Integration of Hands-On Team Training into Existing Curriculum Improves Both Technical and Nontechnical Skills in Laparoscopic Cholecystectomy. J Surg Educ 2017; 74:915-920. [PMID: 28566217 DOI: 10.1016/j.jsurg.2017.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/12/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Nontechnical skills are an essential component of surgical education and a major competency assessed by the ACGME milestones project. However, the optimal way to integrate nontechnical skills training into existing curricula and then objectively evaluate the outcome is still unknown. The aim of this study was to determine the effect laparoscopic team-based task training would have on the nontechnical skills needed for laparoscopic surgery. DESIGN 9 PGY-1 residents underwent an established training curriculum for teaching the knowledge and technical skills involved in laparoscopic cholecystectomy. Initial training involved a didactic session, expert-led practice on a porcine model in a simulated operating room and laparoscopic skills practice on a virtual reality trainer. Residents then performed a laparoscopic cholecystectomy on the same porcine model as a preintervention test. Three to four months following this, residents were subjected to specific nontechnical skills training involving 2 simple team-based laparoscopic tasks. They then practiced a further 4 to 6 hours on the virtual reality trainer. A repeat postintervention laparoscopic cholecystectomy was then performed 3 to 4 months after nontechnical skills training. Both the preintervention and postintervention laparoscopic cholecystectomies were audiovisually recorded and then evaluated by 2 independent surgeons in a blinded fashion. Technical skills were assessed using objective structured assessment of technical skills (OSATS) and a technique specific rating scale (TRS) that we developed for laparoscopic cholecystectomy. Nontechnical skills were assessed using nontechnical skills for surgeons (NOTSS). Residents also completed a survey at the beginning and end of the training. SETTING Tertiary care, university based teaching institution. PARTICIPANTS A total of 9 general surgery residents at the intern level. RESULTS The mean OSATS score improved from 13.7 ± 1.24 to 26.7 ± 0.31 (p < 0.001), the mean TRS score improved from 6 ± 0.46 to 13.1 ± 0.36 (p < 0.001) and the mean NOTSS score improved from 21.7 ± 1.83 to 36.3 ± 0.87 (p < 0.001) following the training. There was a strong correlation between OSATS and NOTSS scores (Pearson's R = 0.98) and TRS and NOTSS (R = 0.94). The inter-rater agreement was 0.79 for NOTSS, 0.9 for OSATS, and 0.82 for TRS. Following completion of the training, residents self-reported improvements in exchanging information (p < 0.01), coordinating activities (p < 0.01) and coping with pressure in the operating room (p < 0.001). CONCLUSION Simple, team-based nontechnical skills training for laparoscopic cholecystectomy that was separate from technical skills training led to a sustained increase in residents' nontechnical skills 3 to 4 months after training. This was associated with a self-reported improvement in many nontechnical skills based on resident survey. Based on these results, we recommend that such designated nontechnical skills training is a valid alternative to other methods such as coaching and debriefing. We, therefore, plan to continue our efforts to develop team-based simulation tasks aimed at improving nontechnical skills for multiple surgical modalities.
Collapse
Affiliation(s)
- Robert C Caskey
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily Owei
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raghavendra Rao
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elijah W Riddle
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ari D Brooks
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel T Dempsey
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon B Morris
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Neylan
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Division of Surgical Education, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Simulation Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
29
|
Lindlohr C, Lefering R, Saad S, Heiss MM, Pape-Köhler C. Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial. Langenbecks Arch Surg 2017; 402:645-653. [PMID: 28238058 DOI: 10.1007/s00423-017-1567-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/09/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. METHODS This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. RESULTS In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. CONCLUSION The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
Collapse
Affiliation(s)
- Cornelia Lindlohr
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - S Saad
- Department for General, Abdominal and Thoracic Surgery, Clinic Gummersbach, Academic Hospital, University of Cologne, Wilhelm-Breckow-Allee 20, 51643, Gummersbach, Germany
| | - M M Heiss
- Department for Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - C Pape-Köhler
- Department for General and Abdominal Surgery, Protestant Hospital, Cologne-Weyertal, Germany
| |
Collapse
|
30
|
Hatala R, Cook DA, Brydges R, Hawkins R. Constructing a validity argument for the Objective Structured Assessment of Technical Skills ( OSATS): a systematic review of validity evidence. Adv Health Sci Educ Theory Pract 2015; 20:1149-75. [PMID: 25702196 DOI: 10.1007/s10459-015-9593-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 02/15/2015] [Indexed: 05/28/2023]
Abstract
In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected original research articles in any language evaluating the OSATS as an assessment tool for any health professional. We iteratively and collaboratively extracted validity evidence from included articles to construct and evaluate the validity argument for varied uses of the OSATS. Twenty-nine articles met the inclusion criteria, all focussed on surgical technical skills assessment. We identified three intended uses for the OSATS, namely formative feedback, high-stakes assessment and program evaluation. Following Kane's framework, four inferences in the validity argument were examined (scoring, generalization, extrapolation, decision). For formative feedback and high-stakes assessment, there was reasonable evidence for scoring and extrapolation. However, for high-stakes assessment there was a dearth of evidence for generalization aside from inter-rater reliability data and an absence of evidence linking multi-station OSATS scores to performance in real clinical settings. For program evaluation, the OSATS validity argument was supported by reasonable generalization and extrapolation evidence. There was a complete lack of evidence regarding implications and decisions based on OSATS scores. In general, validity evidence supported the use of the OSATS for formative feedback. Research to provide support for decisions based on OSATS scores is required if the OSATS is to be used for higher-stakes decisions and program evaluation.
Collapse
Affiliation(s)
- Rose Hatala
- Department of Medicine, University of British Columbia, Suite 5907, Burrard Bldg, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - David A Cook
- Mayo Clinic Online Learning and Mayo Clinic Multidisciplinary Simulation Center, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan Brydges
- Wilson Centre, University Health Network, Toronto, ON, Canada
| | - Richard Hawkins
- Medical Education Programs, American Medical Association, Chicago, IL, USA
| |
Collapse
|
31
|
Kramp KH, van Det MJ, Veeger NJ, Pierie JP. Validity, reliability and support for implementation of independence-scaled procedural assessment in laparoscopic surgery. Surg Endosc 2016; 30:2288-300. [PMID: 26416369 DOI: 10.1007/s00464-015-4254-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/05/2015] [Indexed: 12/20/2022]
Abstract
Background There is no widely used method to evaluate procedure-specific laparoscopic skills. The first aim of this study was to develop a procedure-based assessment method. The second aim was to compare its validity, reliability and feasibility with currently available global rating scales (GRSs). Methods An independence-scaled procedural assessment was created by linking the procedural key steps of the laparoscopic cholecystectomy to an independence scale. Subtitled and blinded videos of a novice, an intermediate and an almost competent trainee, were evaluated with GRSs (OSATS and GOALS) and the independence-scaled procedural assessment by seven surgeons, three senior trainees and six scrub nurses. Participants received a short introduction to the GRSs and independence-scaled procedural assessment before assessment. The validity was estimated with the Friedman and Wilcoxon test and the reliability with the intra-class correlation coefficient (ICC). A questionnaire was used to evaluate user opinion. Results Independence-scaled procedural assessment and GRS scores improved significantly with surgical experience (OSATS p = 0.001, GOALS p < 0.001, independence-scaled procedural assessment p < 0.001). The ICCs of the OSATS, GOALS and independence-scaled procedural assessment were 0.78, 0.74 and 0.84, respectively, among surgeons. The ICCs increased when the ratings of scrub nurses were added to those of the surgeons. The independence-scaled procedural assessment was not considered more of an administrative burden than the GRSs (p = 0.692). Discussion/conclusion A procedural assessment created by combining procedural key steps to an independence scale is a valid, reliable and acceptable assessment instrument in surgery. In contrast to the GRSs, the reliability of the independence-scaled procedural assessment exceeded the threshold of 0.8, indicating that it can also be used for summative assessment. It furthermore seems that scrub nurses can assess the operative competence of surgical trainees.
Collapse
|