Acquisition Of Surgical Skills Research Articles

Using neuroimaging to assess brain activity and areas associated with surgical skills: a systematic review.

Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education. We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE. 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts. Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.

426 Effect of Visuospatial Feedback Versus Numeric Scores on Neurosurgical Tumor Resection Skills Among Medical Students in Virtual Reality Simulation Randomized Control Trial

INTRODUCTION: Virtual reality (VR) simulation can be implemented with various feedback modalities to optimize learners’ surgical skills acquisition. The systems can present benchmark scores as either a numeric report or a visuospatial performance assessment. In this context, the optimal feedback methodology to enhance learning remains undefined. METHODS: One hundred and twenty medical students (mean age [SD], 23.1 [3.6] years, 41% women) from four institutions were recruited to practice a simulated subpial tumor resection in five attempts. They were randomly assigned to receive one of four interventions between each attempt: (1) no feedback (n = 30), (2) numerical feedback (n = 30), (3) visual feedback (n = 29), or (4) visuospatial feedback (n = 31). Performance on the first task determined baseline. Skill was evaluated using previously established 14-expert performance benchmarks. The primary outcome was the number of performance benchmarks achieved throughout the five attempts. RESULTS: Participants in all feedback groups significantly improved their performance compared to baseline. Between-subjects comparison demonstrated a significant increase in the number of metrics achieved with visual (mean difference 1.80, p = 0.001) and visuospatial (mean difference 1.89, p < 0.001) feedback compared to control, and no significant increase with numeric assessment (mean difference 1.10, p = 0.093). In the third attempt, visual feedback was significantly superior to numeric assessment (mean difference 1.63, p = 0.016). CONCLUSIONS: Neurosurgical skill acquisition is enhanced with visual and visuospatial feedback in VR simulation training. These engaging modes of performance assessment result in more accelerated rate of benchmark acquisition compared to numerical scores alone. Further research is warranted to explore the potential benefits of visual and visuospatial feedback in other domains of surgical training.

The role of virtual endoscopy in surgical practice of otolaryngology head and neck surgery: a review article

Virtual endoscopy involves the acquisition of data to generate a three-dimensional view of hollow anatomical structures. This interface would allow for the realistic integration of anatomical structures in complex cavities involving sinuses, larynx, and ears. Current literature lacks updated review on the role virtual endoscopy in otolaryngological practice. This paper serves to highlight the use of virtual endoscopy in amongst three main domains: otology, rhinology and laryngology. Review of literature were conducted using various databases including, Pubmed, Scopus, Embase, Web of Science, google scholar. Only papers in full text, English language, and relevant to our objectives were included. A critical descriptive review of the papers were performed to illustrate the strength and weakness on the utilization of virtual endoscopy as a surgical planning tool in otorhinolaryngology practice. The advantages of applying VE in our practice serves two folds; as an educational tool for novice trainees mainly for surgical skill acquisition and as a pre-op planning to understand complex anatomical narrow operative fields. Our paper is the first to demonstrate the most updated commentary review article of the application of virtual endoscopy in sinus surgery, laryngeal airway evaluation and the assessment of ear surgery.

Design and development of a personalized virtual reality-based training system for vascular intervention surgery

Background and objectivesVirtual training has emerged as an exceptionally effective approach for training healthcare practitioners in the field of vascular intervention surgery. By providing a simulated environment and blood vessel model that enables repeated practice, virtual training facilitates the acquisition of surgical skills in a safe and efficient manner for trainees. However, the current state of research in this area is characterized by limitations in the fidelity of blood vessel and guidewire models, which restricts the effectiveness of training. Additionally, existing approaches lack the necessary real-time responsiveness and precision, while the blood vessel models suffer from incompleteness and a lack of scientific rigor. MethodsTo address these challenges, this paper integrates position-based dynamics (PBD) and its extensions, shape matching, and Cosserat elastic rods. By combining these approaches within a unified particle framework, accurate and realistic deformation simulation of personalized blood vessel and guidewire models is achieved, thereby enhancing the training experience. Furthermore, a multi-level progressive continuous collision detection method, leveraging spatial hashing, is proposed to improve the accuracy and efficiency of collision detection. ResultsOur proposed blood vessel model demonstrated acceptable performance with the reduced deformation simulation response times of 7 ms, improving the real-time capability at least of 43.75 %. Experimental validation confirmed that the guidewire model proposed in this paper can dynamically adjust the density of its elastic rods to alter the degree of bending and torsion. It also exhibited a deformation process comparable to that of real guidewires, with an average response time of 6 ms. In the interaction of blood vessel and guidewire models, the simulator blood vessel model used for coronary vascular intervention training exhibited an average response time of 15.42 ms, with a frame rate of approximately 64 FPS. ConclusionsThe method presented in this paper achieves deformation simulation of both vascular and guidewire models, demonstrating sufficient real-time performance and accuracy. The interaction efficiency between vascular and guidewire models is enhanced through the unified simulation framework and collision detection. Furthermore, it can be integrated with virtual training scenarios within the system, making it suitable for developing more advanced vascular interventional surgery training systems.

Gender differences in autonomy and performance assessments in a national cohort of vascular surgery trainees

ObjectiveGender disparities in surgical training and assessment are described in the general surgery literature. Assessment disparities have not been explored in vascular surgery. We sought to investigate gender disparities in operative assessment in a national cohort of vascular surgery integrated residents (VIRs) and fellows (VSFs). MethodsOperative performance and autonomy ratings from the Society for Improving Medical Professional Learning (SIMPL) application database were collected for all vascular surgery participating institutions from 2018 to 2023. Logistic generalized linear mixed models were conducted to examine the association of faculty and trainee gender on faculty and self-assessment of autonomy and performance. Data were adjusted for post-graduate year and case complexity. Random effects were included to account for clustering effects due to participant, program, and procedure. ResultsOne hundred three trainees (n = 63 VIRs; n = 40 VSFs; 63.1% men) and 99 faculty (73.7% men) from 17 institutions (n = 12 VIR and n = 13 VSF programs) contributed 4951 total assessments (44.4% by faculty, 55.6% by trainees) across 235 unique procedures. Faculty and trainee gender were not associated with faculty ratings of performance (faculty gender: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.27-2.29; trainee gender: OR, 1.80; 95% CI, 0.76-0.43) or autonomy (faculty gender: OR, 0.99; 95% CI, 0.41-2.39; trainee gender: OR, 1.23; 95% CI, 0.62-2.45) of trainees. All trainees self-assessed at lower performance and autonomy ratings as compared with faculty assessments. However, women trainees rated themselves significantly lower than men for both autonomy (OR, 0.57; 95% CI, 0.43-0.74) and performance (OR, 0.40; 95% CI, 0.30-0.54). ConclusionsAlthough gender was not associated with differences in faculty assessment of performance or autonomy among vascular surgery trainees, women trainees perceive themselves as performing with lower competency and less autonomy than their male colleagues. These findings suggest utility for exploring gender differences in real-time feedback delivered to and received by trainees and targeted interventions to align trainee self-perception with actual operative performance and autonomy to optimize surgical skill acquisition.

Exploring the Impact of Hand Dominance on Laparoscopic Surgical Skills Development Using Network Models.

Laparoscopic surgery demands high precision and skill, necessitating effective training protocols that account for factors such as hand dominance. This study investigates the impact of hand dominance on the acquisition and proficiency of laparoscopic surgical skills, utilizing a novel assessment method that combines Network Models and electromyography (EMG) data. Eighteen participants, comprising both medical and non-medical students, engaged in laparoscopic simulation tasks, including peg transfer and wire loop tasks. Performance was assessed using Network Models to analyze EMG data, capturing muscle activity and learning progression. The NASA Task Load Index (TLX) was employed to evaluate subjective task demands and workload perceptions. Our analysis revealed significant differences in learning progression and skill proficiency between dominant and non-dominant hands, suggesting the need for tailored training approaches. Network Models effectively identified patterns of skill acquisition, while NASA-TLX scores correlated with participants' performance and learning progression, highlighting the importance of considering both objective and subjective measures in surgical training. The study underscores the importance of hand dominance in laparoscopic surgical training and suggests that personalized training protocols could enhance surgical precision, efficiency, and patient outcomes. By leveraging advanced analytical techniques, including Network Models and EMG data analysis, this research contributes to optimizing clinical training methodologies, potentially revolutionizing surgical education and improving patient care.

Case Curve: A Novel Web-Based Platform and Mobile Phone Application to Evaluate Surgical Competence in Graduate Medical Education.

Competency-based medical education is well established, yet methods to evaluate and document acquisition of surgical skill remain underdeveloped. We describe a novel web-based application for competency-based surgical education at a single neurosurgical department over a 3-year period. We used a web-based application to track procedural and cognitive skills acquisition for neurosurgical residents. This process included self-assessment, resident peer evaluations, evaluations from supervising attending physicians, and blinded video reviews. Direct observation by faculty and video recordings were used to evaluate surgical skill. Cases were subdivided into component skills, which were evaluated using a 5-point scale. The learning curve for each skill was continuously updated and compared with expectations. Progress was reviewed at a monthly surgical skills conference that involved discussion and analysis of recorded surgical performances. During an escalating 3-year pilot from 2019 to 2022, a total of 1078 cases in 39 categories were accrued by 17 resident physicians with 10 neurosurgical faculty who participated as evaluators. A total of 16 251 skill performances in 110 categories were evaluated. The most evaluated skills were those that were common to several types of procedures, such as positioning, hemostasis, and wound closure. The concordance between attending evaluations and resident self-evaluations was 76%, with residents underestimating their performance in 17% of evaluations and overestimating in 7%. We developed a method for evaluating and tracking surgical resident skill performance with an application that provides timely and actionable feedback. The data collected from this system could allow more accurate assessments of surgical skills and deeper insights into factors influencing surgical skill acquisition.

The Feasibility of Practical Training in Minimally Invasive Surgery at Medical School-A Prospective Study on the Pelvitrainer.

Background and Objectives: The acquisition of practical skills at medical school is an important part of the multidimensional education program of future physicians. However, medical schools throughout the world have been slow in incorporating practical skills in their curriculum. Therefore, the aims of the present prospective study were (a) to demonstrate the feasibility of such surgical training, (b) to objectify its benefit in medical education, and (c) to investigate the impact of such training on subsequent career choices. Material and Methods: We introduced a two-day laparoscopy course on the pelvitrainer as part of the curriculum of the gynecological internship of fifth year medical students from 2019 to 2020. The results of the students' training were matched to those of surgeons who completed the same curriculum in a professional postgraduate laparoscopy course from 2017 to 2020 in a comparative study design. Additionally, we performed a questionnaire-based evaluation of the impact of the course on medical education and subsequent career choices directly before and after completing the course. Results: A total of 261 medical students and 206 physicians completed the training program. At baseline, the students performed significantly more poorly than physicians in a median of three of four exercises (p < 0.001). However, this evened out in the final runs, during which students performed more poorly than physicians only in one exercise and even better than physicians in one. The general integration of surgical training in medical school curricula was rated very low (12.4% on the VAS, IQR 3-16%) despite the high demand for such training. In the survey, the course was deemed very beneficial for medical education (median VAS 80.7%, IQR 73-98%), but did not appear to influence the students' subsequent career preferences. Conclusions: The acquisition of practical surgical skills during medical school is significantly under-represented in many medical faculties. The benefits of such training, as demonstrated in our study, would improve the education of future physicians.

Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model

BackgroundEndoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. MethodWe used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. ResultsTen participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a post-simulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. ConclusionsThe endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.

Simulation-Based Training in Basic Surgical Skills: Experiences From a Repeat Cross-Sectional Study in Saudi Arabia

Introduction The conventional surgical apprenticeship has been challenged by patient safety concerns, cost of lengthy operation, and surgical complications. Simulation-based training (SBT) has emerged as a realistic option for surgical skills acquisition outside the operating room (OR). The study aimed to document our experience in implementing SBT to acquire basic surgical skills, offered as an educational course, known as the Basic Surgery Skill Course (BSSC). Methods This was a repeated cross-sectional study conducted between January 2017 and December 2019 at King Abdulaziz University Hospital (KAUH) in Saudi Arabia, including all participants who participated during BSSCs. A pretested questionnaire was used to collect data on age, sex, training level, institution, overall experience, course overload, course duration, best feature of the course, and whether participants would recommend the course to their colleagues. Whenever possible, self-reported data were compared with registration records, and any conflict was resolved by discussion. Results BSSC was found in a total of 489 participants. More than 58% of the participants were men. Majority of students came from out of KAUH (61%) and were medical interns (63%). Overall experience of the course was very beneficial (57%). The course workload and duration were rated as about right by 82% and 75% of participants, respectively. Majority of participants found that the “hands-on practice” as the best segment of the course (76%). Conclusion The study showed a positive perception of this surgical education modality among participants. This study will help guide the future research on advanced simulation-based surgical training in the region.

Making a Stand

This is a review of the advertisements for basic surgical training course on social media and a comment on the ergonomics of the training. The author examined social media advertisements (Twitter and Instagram) over 4 months with a focus on stitching courses. No computer algorithm was available or could be made to ensure a comprehensive inclusion of all courses. One hundred nine basic surgical skills courses were identified, and 102 out of 109 (94%) courses are conducted sitting down. Courses were run in regular rooms or lecture theatres at regular table and using ordinary chairs. The practice and acquisition of basic surgical skills needs to address correctness of the technique and ergonomics especially with regards to posture. This influences not only muscle memory and musculoskeletal health but also the position of the needle and potential trauma to the tissues.

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian

Analyzing Surgical Technique in Diverse Open Surgical Videos With Multitask Machine Learning

To overcome limitations of open surgery artificial intelligence (AI) models by curating the largest collection of annotated videos and to leverage this AI-ready data set to develop a generalizable multitask AI model capable of real-time understanding of clinically significant surgical behaviors in prospectively collected real-world surgical videos. The study team programmatically queried open surgery procedures on YouTube and manually annotated selected videos to create the AI-ready data set used to train a multitask AI model for 2 proof-of-concept studies, one generating surgical signatures that define the patterns of a given procedure and the other identifying kinematics of hand motion that correlate with surgeon skill level and experience. The Annotated Videos of Open Surgery (AVOS) data set includes 1997 videos from 23 open-surgical procedure types uploaded to YouTube from 50 countries over the last 15 years. Prospectively recorded surgical videos were collected from a single tertiary care academic medical center. Deidentified videos were recorded of surgeons performing open surgical procedures and analyzed for correlation with surgical training. The multitask AI model was trained on the AI-ready video data set and then retrospectively applied to the prospectively collected video data set. Analysis of open surgical videos in near real-time, performance on AI-ready and prospectively collected videos, and quantification of surgeon skill. Using the AI-ready data set, the study team developed a multitask AI model capable of real-time understanding of surgical behaviors-the building blocks of procedural flow and surgeon skill-across space and time. Through principal component analysis, a single compound skill feature was identified, composed of a linear combination of kinematic hand attributes. This feature was a significant discriminator between experienced surgeons and surgical trainees across 101 prospectively collected surgical videos of 14 operators. For each unit increase in the compound feature value, the odds of the operator being an experienced surgeon were 3.6 times higher (95% CI, 1.67-7.62; P = .001). In this observational study, the AVOS-trained model was applied to analyze prospectively collected open surgical videos and identify kinematic descriptors of surgical skill related to efficiency of hand motion. The ability to provide AI-deduced insights into surgical structure and skill is valuable in optimizing surgical skill acquisition and ultimately improving surgical care.

Orthopedic oncology residency education, how broad and how deep?

Orthopedic residency training has long been an area of active research and discussion, and as the knowledge and concepts in subspecialties evolve, it is crucial to investigate the implications of these advancements in the musculoskeletal oncology field. It is important to note that the acquisition of surgical skills and scientific knowledge from orthopedic texts alone is not sufficient in this area. Orthopedic residents must also acquire multidisciplinary communication and leadership skills, as well as the mental capacity to make sound clinical decisions. Therefore, this commentary highlights the importance of assessing whether the current curriculum provides adequate preparation for residents' future careers, despite the fact that the expansion of subspecialties in orthopedic education has undoubtedly enhanced the depth of knowledge and concepts in the field. In addition, orthopedic residents must adopt an open-minded and scientific approach toward orthopedic oncology, which has unique principles. Moreover, it is crucial that general orthopedic surgeons have the necessary skills to manage patients and know when to refer them. By exploring these issues, we hope to continually contribute to ongoing discussions about how to improve orthopedic residency education.

Evaluation of arts and humanities programs in surgery education: a systematic review

Purpose This systematic review seeks to understand what outcomes have been reported for arts and humanities programs in surgery education. Methods Authors searched Medline ALL (Ovid), Embase.com, Web of Science, and Academic Search Ultimate to identify articles on evaluated arts and humanities programs in surgery education. The search identified 1,282 titles and abstracts, of which 55 underwent independent full-text review. The authors identified 10 articles that met inclusion criteria, from which they collected and analysed data. Results Medical students were the identified learners in most studies (6/10; 60%). Reflective writing was the arts and humanities activity in half of the studies (5/10; 50%); activities based on film, visual art other than film, literature, or social media in the remaining studies (5/10; 50%). Most studies (8/10; 80%) featured a non-controlled, non-randomized design. Authors categorised 5 studies (50%) as Kirkpatrick Level 1, 4 (40%) as Level 2, and 1 (10%) as Level 3. Conclusion Integration of the arts and humanities into surgery education may promote increased levels of learner reflection and empathy, in addition to improved acquisition of surgical skills. More rigorous evaluation of these programs would clarify the impact of arts and humanities programs on surgery learners.

633 Are Laparoscopic Skills Transferable to Robotic Assisted Surgery? A Systematic Review

Abstract Aim Surgical education programs are being developed to incorporate robotic technical skills training into pre-existing curricula. With limited availability of robotic training platforms, the aim of this paper was to determine if laparoscopic training can facilitate the acquisition of robotic surgical skills. Method A search was conducted using PubMed, MEDLINE, Embase and Cochrane databases according to PRISMA guidelines. Original articles evaluating the transferability of laparoscopic skills into robotic surgery were included across multiple surgical specialities. Non-peer reviewed papers, conference s, and single surgeon’s experience were excluded. The primary outcome was skills transfer, secondary outcomes included; the level of participant experience, tasks performed and assessment tools used. Results 17 papers were included. 9 (53%) showed good evidence for skill transfer from laparoscopic to robotic surgery, 7 (41%) reported no significant difference. 1 (6%) paper demonstrated prior laparoscopic training had a positive impact on robotic skill but this was diminished for senior trainees. The majority of studies compared residents at different stages of training. All papers assessed simulator surgical specific tasks. There was limited standardisation of assessment processes. No papers assessed tasks in real-life surgical practice. Conclusions Evidence exists to suggest that laparoscopic skills are transferable to robotic surgery in a simulation environment. This is particularly evident for surgical novices and less so for experienced laparoscopists. This could potentially enable the use of established laparoscopic training as a means of reducing the robotic learning curve. Further work is needed to assess laparoscopic to robotic skills transfer in a real-world setting.

M1 transcranial direct current stimulation augments laparoscopic surgical skill acquisition

The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.

Use of a Composed Simulator by Veterinarian Non-Experts in Minimally Invasive Surgery for Training and Acquisition of Surgical Skills for Laparoscopic Ovariectomy in Dogs.

This study aims to assess the acquisition of surgical skills for laparoscopic ovariectomy (LOE) in dogs by veterinary surgeons with no experience in minimally invasive surgery using the CALMA Veterinary Lap-trainer simulator (CVLTS) in an experimental and analytical setting. Veterinary surgeons with no experience in minimally invasive surgery (MIS) (experimental, n = 5), and MIS experts (experts, n = 3) were evaluated. Experimental and expert group participants watched an instructional video (initial time) before practicing the LOE on uterine tissues and ovaries freshly reconstituted after elective ovariohysterectomy (initial time evaluation). Then, the experimental group practiced five training sessions on the composite simulator with permanent feedback and then performed the LOE again (final time evaluation). Surgical performances in initial and final evaluations were video recorded and further evaluated by three external MIS experts using Global objective assessment of laparoscopic skills (GOALS) and LOE-specific rating scales (SRSs) in a double-blinded schedule. In addition, a hands movement assessment system (HMAS) attached to the back of the hands was used to quantitatively measure completion time, angularity, and movement smoothness. Data were analyzed with one-factor ANOVA and Tukey's contrast test. No statistically significant differences were found between the novice group's performance after training and the expert group's performance according to the GOALS (p < 0.01) and SRS (p < 0.05) scores. Moreover, the novices had significantly improved time, number of movements, and angularity in the final time compared with the initial time (p < 0.05), with no significant differences compared to the expert group (p > 0.05). LOE training using a composed simulator resulted in significantly improved laparoscopic skills and time, number, and angularity of movements data, providing evidence of the usefulness and reliability of CVLTS in training LOE.

ThTP3.1 Development and early validation of ‘SuturePal’: a novel mixed reality laparoscopic suturing training module

Abstract Aims Laparoscopic suturing is a challenging skill to acquire, requiring extensive training. This study aims firstly to develop a novel self-directed mixed reality laparoscopic suturing training module using the Microsoft Hololens 2 headset and secondly to assess the feasibility of this training tool and advantages over conventional training methods. Methods SuturePal is a self-directed mixed reality training module which combines didactic videos, text, and bespoke interactive 3D models. Ten medical students and surgical trainees participated in a single-blinded prospective randomised feasibility study. Participants received baseline teaching for laparoscopic intracorporeal knot tying and were subsequently randomised to either SuturePal (n=5) or conventional training (n=5). Baseline and post-training knots were recorded and assessed by two blinded examiners for time taken, precision, errors, and proficiency according to two previously validated objective assessment tools. Cognitive load was measured via the validated NASA-TLX tool and participant feedback was recorded. Results SuturePal users reported higher confidence levels (p=0.0476) and lower mental demand (p=0.0397) following training compared to those taught by conventional means. No statistical differences, however, were shown between groups when comparing objective measures of knot tying performance. Conclusions SuturePal provides evidence for how mixed reality technology may enhance engagement in surgical skill acquisition by improving user experience and lowering mental demand. This contributes to the growing body of evidence that mixed reality may have a role in enhancing surgical training. However, further research in the form of larger scale studies is required to determine whether mixed reality improves objective performance of surgical trainees.

WTP6.14 The Effectiveness of Mental Practice in Surgical Skills Practice and Acquisition: A Review

Abstract Aims Mental practice (MP) is an established method to enhance performance in other disciplines. The aim of this review is to assess whether the principles of MP are transferable to surgery and describe how it has been applied in our field so far. Methods A narrative review was conducted according to the four steps described by Demiris et. al. Results This review describes the different types of MP and their role on motor skill acquisition. The process of preparation, delivery and assessment of a MP session is described here in a reproducible manner; providing a ‘user guide’ to surgeons. MP has been shown in several reports to be an effective means in learning surgical skills, from basic surgical technique to the steps of a procedure. It has also been described as a technique applicable to both surgical trainees and established surgeons. Ten RCTs demonstrated a favourable effect of MP on technical skills and one trial showed that MP with MI is equivalent to additional physical practice. On the contrary two RCTs showed MP to be inferior or have no impact compared to other types of preparation. Reduced MP duration was identified as one of the possible reasons for a lack of positive results. Conclusion Mental practice is a feasible method for rehearsing surgical skills and procedures that has been demonstrated to enhance skills acquisition and surgical performance. Larger scale, randomised controlled trials are needed to standardise the duration, number of repetitions, and practical considerations for mental practice in surgery.