Competency of novice anesthesia residents in performing trans thoracic echocardiography following a structured problem-based hands-on course using a trans thoracic echocardiography simulator versus video-based training: a randomized controlled assessor-blinded trial.

IntroductionUnilateral biportal endoscopy (UBE) is a minimally invasive surgical (MIS) technique utilized for lumbar decompression, which has recently gained popularity in Europe. We aimed to explore the value of sequential adaptive e-learning, followed by simulator-based hands-on training modules for UBE at the occasion of the 2024 EANS Young Neurosurgeons meeting.Materials and methodsAn adaptive e-learning was designed by learning engineers (Area 9 Lyceum), based on theoretical content provided by two endoscopic spine surgeons. A two-module simulator training, consisting of an insight-the-box model (basic tasks for eye-hand coordination), followed by a realistic lumbar spine model (execution of an endoscopic decompression) was developed. Course participants completed the e-learning before the hands-on training course. Course experience was evaluated through a standardized self-assessment questionnaire containing a 5-point Likert scale and a 10-point numeric rating scale.ResultsEleven of eighteen (61%) participants with different levels of professional education (62.5% residents in 1st -6th year of training, 37.5% board-certified) completed both trainings. Thirteen participants (72%) had no prior experience with UBE. The perception of knowledge after the e-learning module increased from 2.5 (SD 2) to 6.5 (SD 1.8; p = 0.039). The usefulness, enjoyment, and efficiency of the courses averaged a score of 8.0 (SD 1.8). Regarding the hands-on training, participants estimated an average increase in their skills from 2.9 (SD 1.8) to 6.8 (SD 2, p = 0.028). The overall rating of the two-module course was 7.9 (SD 2.2).Discussion and conclusionSequential e-learning and simulator training appear to be an effective educational adjunct to establish novel, MIS-techniques such as UBE.

A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics

The State of Simulation in Endoscopy Education: Continuing to Advance Toward Our Goals

Strategies for training in diagnostic upper endoscopy: a prospective, randomized trial

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) on the use of endoscopy simulators for training and assessing skill

An increasing use of endoscopic submucosal dissection (ESD) has been reported in Western countries, although some differences in training schemes and outcomes have been described. We aimed to report the training model, implementation, and outcomes of ESD in Portugal. All endoscopists trained at our center from our country (n = 9) were invited to a survey regarding: (a) training period; (b) ESD outcomes and (c) implementation of ESD in each respective center. All endoscopists completed the survey. Learning ESD was centered on human ESD assistance in a high-volume center during a median time of 6 months and complemented mainly by hands-on courses (89%). During the surveyed period, a total of 1229 ESD were performed, mostly in gastric locations (74%). Median complete R0 and curative resection rate were 92% (IQR, 81-96.8) and 87% (IQR, 74-93.3), respectively, and median perforation rate was 0.89% (IQR, 0.25-6.22). The main limitations encountered during the implementation of ESD were related to the lack of initial mentoring or insufficient expertise to progress to more difficult lesions. Learning ESD through participation in hands-on courses and visiting high-volume centers seems to be adequate to achieve a good competence at the initial stage of ESD, which in fact is in consonance with the European Society of Gastrointestinal Endoscopy recommendations. However, mentoring is essential for technical progression, and this represents the fundamental barrier during the adoption of ESD, which may be overcome by increasing hands-on training in animal or artificial simulators, but preferably with the implementation of a structured training program.

Background:Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training.Methods and Results:During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance.Conclusion:Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.

Introduction Simulation training is widely adopted in clinical medicine. Simulated environment provides a safe condition for participants to practice without any harm inflicted on patients. Within the spectrum of clinical anaesthesia, simulation mannequin was first developed in 1960. The first journal article with description about the use of simulator to teach intubation to anaesthesia residents occurred in 1969. The first report about simulated anaesthesia training was in 1988. Since then, there has been a flourishing trend of adopting this simulation training in clinical anaesthesia, across various subspecialties including obstetric anaesthesia, cardiac anaesthesia. For individual perspective, simulation training expanded beyond skill development into non technical skill training. This article is to review the impact of simulation training for individual development for anaesthesia residents or trainees. The aim is to evaluate the evidence of simulation training on individual anaesthesia resident performance and improvement on patient outcome. As a result, more vigorous use of simulation is adopted in modular subspecialty anaesthesia and also non-technical skill training for residents. Methods A search of literatures through search engines of Pubmed, Google Scholars, EMBASE, Cochrane library for ‘Simulation for training of clinical anaesthesia’ was done. After limit the search for English language and past 10 years, there are 223 articles. With appropriate exclusion criteria, 25 articles are selected for detail evaluation. Results Simulation has good effects in various aspects. For various anaesthesia subspecialties, simulation-based training can improve trainees’ confidence and capability in handling rare but life-threatening peri-operative crises. For assessments, simulation is an essential part of Israeli Board Examination in Anesthesia with good discriminating power. For technical skill development, simulation-based training can reduce residents’ time requirement to perform cricothyroidotomy and improve successful rate of central line insertion. The specific skill developed can retain for long period of time such as 12 months. For non-technical skills, there are conflicting results in behavioural scores. For patient safety and outcome perspective, there lacks the result from individual simulation-based training study. Conclusions Simulation in anaesthesia residents training is a worldwide practice. These simulation training allow residents to have exposure in various anesthesia subspecialty including cardiac, obstetrics, liver transplant. There are specific technical and non-technical skill development. Individual performance particularly time to complete cricothyroidotomy and confidence, understanding of procedures and anatomy by residents are also enhanced. Thus, simulation should be allocated more proportion of anaesthesia resident training in Hong Kong. Although there remains no study showing better patient outcome after simulation-based individual training, future studies should be done to confirm such presence and degree of association with simulation training.

Providing Initial Transthoracic Echocardiography Training for Anesthesiologists: Simulator Training Is Not Inferior to Live Training

Introduction Ischemic priapism, a medical emergency involving a painful, rigid erection with an absence of cavernosal blood flow, requires immediate intervention. Due to its complex and infrequent nature, training urology residents in its management presents significant challenges. While there is a need for high-quality simulation-based training, there is a dearth in the literature on this topic. Here we report on the level of trainee comfort with bedside and operative priapism management with novel simulation training developed over a two-year period. Objective To assess self-reported urology resident comfort and competence in the procedural management of ischemic priapism before and after simulation-based training. Methods We developed a low-cost high-fidelity priapism trainer using silicone-based material to mimic the reactivity of natural tissue to scalpels and needles. Balloons were placed inside of the trainer during casting to serve as the corpora and subsequently were attached to elevated dyed saline bags or pre-filled syringes during the simulation training. This model was used as part of a regional AUA resident training curriculum over two successive years. Three components of priapism management were included in the training: corporal aspiration, pharmacologic injection, and distal (T) shunting with tunneling (second year only). Residents completed pre- and post-training surveys regarding their level of training, priapism experience, and relative comfort/competence with step-wise priapism management. Wilcoxon signed rank tests were used to compare pre- and post-responses and to evaluate the proportion of respondents who indicated improvement, no change, or diminished comfort/competence. Responses were also dichotomized to indicate at least moderate comfort/competence vs. lower levels of comfort/competence. McNemar tests were used to compare these proportions. Results A total of 61 residents completed pre- and post-training surveys in April 2024 and March 2025. Survey responses were based on a 1 to 5 Likert scale from ‘not at all comfortable/competent’ to ‘very comfortable/competent’. The majority of trainees were PGY-2 (49.2%) and PGY-3 (39.3%) with PGY-1 (6.6%) and PGY-4 (4.9%) constituting the minority of the group. Of the 61 trainees, only 14 (23%) had prior priapism simulation training while most had procedural experience, typically aspiration and injection (Table 1). 93% of trainees reported either a significant or major impact on their knowledge and skills, and 67.8% reported a moderate or major change in their clinical practice. Comfort/competence was significantly increased overall and in each of the procedures (Table 2). The proportion reporting at least moderate comfort/competence increased significantly for aspiration, pharmacologic injection, shunting and overall comfort. Acute penile prosthesis was not associated with a significant increase in moderate comfort/competence. No differences were noted between the 2024 and 2025 cohorts. Conclusions Our priapism simulation trainer significantly increased resident confidence in multiple priapism management steps. We noted greater pre-training competence for aspiration and injection, procedures for which residents reported having greater pre-training experience. The largest improvement was for distal shunting; competence in penile prosthesis improved but not as markedly as the other procedures. Further research is needed to enhance our simulator and implement across a broader group of urologic and non-urologic providers treating priapism patients. Disclosure No

IntroductionSimulation-based training is an established method of basic endoscopic training, however this is limited in advanced endoscopic techniques due to challenges in creating realistic environments. Uptake of advanced endoscopic techniques...

Progress towards the goal of high-quality endoscopy across health economies has been founded on high-quality structured training programmes linked to credentialing practice and ongoing performance monitoring. This review appraises the recent literature on training interventions, which may benefit performance and competency acquisition in novice endoscopy trainees. Increasing data on the learning curves for different endoscopic procedures has highlighted variations in performance amongst trainees. These differences may be dependent on the trainee, trainer and training programme. Evidence of the benefit of knowledge-based training, simulation training, hands-on courses and clinical training is available to inform the planning of ideal training pathway elements. The validation of performance assessment measures and global competency tools now also provides evidence on the effectiveness of training programmes to influence the learning curve. The impact of technological advances and intelligent metrics from national databases is also predicted to drive improvements and efficiencies in training programme design and monitoring of post-training outcomes. Training in endoscopy may be augmented through a series of pre-training and in-training interventions. In conjunction with performance metrics, these evidence-based interventions could be implemented into training pathways to optimise and quality assure training in endoscopy.

The correction of an anorectal malformation (ARM) is complex and relatively infrequent. Simulation training and subsequent assessment may result in better clinical outcomes. Assessment can be done using a competency assessment tool (CAT). This study aims to develop and validate a CAT for the posterior sagittal anorectoplasty (PSARP) on a simulation model. The CAT-PSARP was developed after consultation with experts in the field. The PSARP was divided into five steps, while tissue and instrument handling were scored separately. Participants of pediatric colorectal hands-on courses in 2019 and 2020 were asked to participate. They performed one PSARP procedure on an ARM simulation model, while being assessed by two objective observers using the CAT-PSARP. A total of 82 participants were enrolled. A fair interobserver agreement was found for general skills (intraclass correlation coefficient [ICC] = 0.524, p < 0.001), a good agreement for specific skills (ICC = 0.646, p < 0.001), and overall performance (ICC = 0.669, p < 0.001). The experienced group scored higher on all steps (p < 0.001), except for "anoplasty (p = 0.540)," compared with an inexperienced group. The CAT-PSARP is a suitable objective assessment tool for the overall performance of the included steps of the PSARP for repair of an ARM on a simulation model.

BackgroundAdvances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block.MethodsFifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire.ResultsThe time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course.ConclusionsA 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.

Nowadays, Industry 4.0 applications have brought unprecedented technological innovations in the transportation logistics value chain. The reflection of these developments in academia and their use in universities is very significant for education. The air transport sector is one of the leading sectors in the use of new technologies. Better results can be obtained by supporting theoretical air transportation education with visual elements and simulations in aviation management education. Students of aviation management departments receive theoretical training. In aviation management departments, students are getting trainings to work different departments of aviation companies. These departments can be supported by hands-on courses such as simulations or laboratories that show how to use information in real life. Within the scope of the research, a trial version of 19 different airport management simulations that can be used for airport management in aviation management departments. It has been evaluated in which simulation the theoretical knowledge of the research airport management course can best be put into practice and contribute to professional development. It is shown which simulations of different scenarios involve airport management strategies.