Dye-Perfused Human Placenta for Simulation in a Microsurgery Laboratory for Plastic Surgeons

In recent decades, a number of simulation models for microsurgical training have been published. The human placenta has received extensive validation in microneurosurgery and is a useful instrument to facilitate learning in microvascular repair techniques as an alternative to using live animals. This study uses a straightforward, step-by-step procedure for instructing the creation of simulators with dynamic flow to characterize the placental vascular tree and assess its relevance for plastic surgery departments. Measurements of the placental vasculature and morphological characterization of 18 placentas were made. After the model was used in a basic microsurgery training laboratory session, a survey was given to nine plastic surgery residents, two microsurgeons, and one hand surgeon. In all divisions, venous diameters were larger than arterial diameters, with minimum diameters of 0.8 and 0.6 mm, respectively. The majority of the participants considered that the model faithfully reproduces a real microsurgical scenario; the consistency of the vessels and their dissection are similar in in vivo tissue. Furthermore, all the participants considered that this model could improve their surgical technique and would propose it for microsurgical training. As some of the model's disadvantages, an abundantly thick adventitia, a thin tunica media, and higher adherence to the underlying tissue were identified. The color-perfused placenta is an excellent tool for microsurgical training in plastic surgery. It can faithfully reproduce a microsurgical scenario, offering an abundance of vasculature with varying sizes similar to tissue in vivo, enhancing technical proficiency, and lowering patient error.

Role of Simulated Training for Carotid Endarterectomy: A Systematic Review

Vascular surgery trainees often do not get to perform carotid endarterectomy (CEA) directly on the patients as it requires meticulous surgical technique and has a high risk of procedure-related complications. Hence, the role of simulation in training future vascular surgeons becomes essential. This review aims to assess the types and utility of simulators available for CEA. In this systematic review, all the studies performed on CEA simulation were included. The purpose of this review was to assess different types of simulators and their usefulness for CEA. We identified 122 articles, of which 10 were eligible for review. A variety of simulators, ranging from animal models, virtual reality simulators and commercially designed models with high fidelity options were used. Technical competence was the major domain assessed in the majority of the studies (n=8), whereas four studies evaluated anatomical and procedural knowledge. Blinding was done in five studies for assessment purposes. The majority of studies (n=9) found the simulation to be an effective tool for achieving technical competence. This review shows the potential usefulness of simulation in acquiring technical skills and procedural acumen for CEA. The available literature is unfortunately too diverse to have a common recommendation.

A Systematic Review of the Medical Student Feedback on Undergraduate Surgical Education During the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has challenged and changed significant aspects of day-to-day life. With regard to medical education, the challenges have been substantial, and the changes have been innovative. This systematic review focuses specifically on medical student feedback on undergraduate surgical education during the pandemic. It explores the various types of technology used to facilitate online learning and aims to comprehensively review the advantages and disadvantages. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to, and electronic databases PubMed, Medline, and Scopus were used to identify relevant studies. The search yielded 102 papers once duplicates and non-English articles were removed. Of these, 19 articles were included in the review. These publications were appraised, which was the source of the narrative syntheses of this systematic review, and due to the heterogeneous data, a meta-analysis could not be successfully implemented. The integration of real-time image capture devices used to display stakeholders or objects such as models of wounds has resulted in the improvement of virtual learning to an almost in-person experience. Adding to this, the use of communication and participation platforms facilitates active discussion when used appropriately. However, there are still some barriers that may be removed with time as the technology continually improves, and these are not exclusive to connectivity issues and restriction of the senses to only two-dimensional sight and hearing. Despite this, the student feedback was largely positive, and the integration of more innovative methods of delivering teaching will have a positive impact on education as long as it is used as an adjunct and not as a replacement for face-to-face teaching.

Assessment of Informed Consent and the Impact of Simulation on Anesthesia Trainees

Introduction

Over the years, the process of obtaining informed consent has evolved and now places an emphasis on the concept that patients should play a major role in medical decision making. Failure to adequately involve patients in making decisions regarding their health can lead to medicolegal consequences.

Therefore, taking informed consent is a fundamental component of anaesthesia training. Simulation, for training, is an excellent tool that is being utilised widely in the training of medical professionals. The use of simulated training for teaching the process of informed consent is an innovative initiative that can provide improved results.

Material and methods

After approval from the institutional review board, a prospective clinical study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from August 2019 to September 2020. Sixteen anaesthesia trainees were randomly selected for the study. The study was divided into pre-interventional, interventional and post interventional phases. For data collection, a predesigned checklist was used. Data collected was analysed using SPSS version 23 (IBM Inc., Armonk, New York). The McNemar test was deployed to assess the difference between the baseline assessment and post-simulated training assessment; p-value < 0.05 was taken to be significant.

Results

Of the 16 participants, the majority were males (n= 13). A positive impact was observed in terms of improvement of the outcome of the following study components i.e., description of benefits of the procedure (p=0.01), disclosure of associated minor risks (p=0.005), disclosure of major risks (p=0.01), discussion of alternatives (p=0.001), teach back (p=0.001), documentation of patients’ verbal agreement (p=0.01), and communication skills involving utilising the process of connecting, introduction, communication, permission, response, and exit (p = 0.01).

Conclusion

Simulated training had a positive impact in improving outcomes in the following study components: description of benefits of the procedure, disclosure of associated risks, discussion of alternatives, teach back, documentation of patients’ verbal agreement, and utilisation of the process of connecting, introduction, communication, permission, responding, and exiting.

Randomised simulation trial found an association between rescuers' height and weight and chest compression quality during paediatric resuscitation

AIM

Our aim was to examine the relationship between rescuers' anthropometric data and chest compression quality during paediatric resuscitation training.

METHODS

This study focused on 224 medical students (53% women) who performed 2 minutes of paediatric resuscitation at the Medical University of Vienna, Austria: 116 on a baby manikin and 108 on an adolescent manikin. Skill Reporter software measured chest compression quality by recording compression depth, frequency, hand position and complete recoil. The participants' height, weight and body mass index (BMI) were recorded.

RESULTS

Participants with a lower BMI achieved higher total chest compression scores on both the baby and adolescent manikins than participants with a higher BMI. The latter were more likely to exceed the correct compression depth and not achieve complete chest recoil in the adolescent manikin. When it came to the baby manikin, the female participants achieved better chest recoil and the males achieved a higher number of compressions at the correct rate. Males also achieved better chest recoil with the adolescent manikins. Being tall only correlated with incomplete recoil in the adolescent manikin.

CONCLUSION

The results indicate that anthropometric variables were associated with chest compression quality in paediatric patients and should be considered by future education programmes.