Assessment Of Technical Skills Scores Research Articles

Pilot Validation of a 3-Dimensional Printed Pituitary Adenoma, Vascular Injury, and Cerebrospinal Fluid Leak Surgical Simulator.

Endoscopic skull base surgery is a subspecialty field which would benefit significantly from high-fidelity surgical simulators. Giving trainees the opportunity to flatten their learning curve by practicing a variety of procedures on surgical simulators will inevitably improve patient outcomes. Four neurosurgeons, 8 otolarynologists, and 6 expert course faculty agreed to participate. All participants were asked to perform a transsphenoidal exposure and resection of a pituitary adenoma, repair a cerebrospinal fluid (CSF) leak, control a carotid injury, and repair a skull base defect. The content, face, and construct validity of the 3-dimensional printed model was examined. The heart rate of the participants significantly increased from baseline when starting the carotid injury simulation (mean 90 vs 121, P = .029) and significantly decreased once the injury was controlled (mean 121 vs 110, P = .033, respectively). The participants reported a significant improvement in anxiety in facing a major vascular injury, as well as an increase in their confidence in management of major vascular injury, resecting a pituitary adenoma and repair of a CSF leak using a 5-point Likert scale (mean 4.42 vs 3.58 P = .05, 2 vs 3.25 P < .001, 2.36 vs 4.27 P < .001 and 2.45 vs 4.0 P = .001, respectively). The mean Objective Structured Assessment of Technical Skills score for experienced stations was 4.4, significantly higher than the Objective Structured Assessment of Technical Skills score for inexperienced stations (mean 3.65, P = .016). We have demonstrated for the first time a validated 3-dimensional printed surgical simulator for endoscopic pituitary surgery that allows surgeons to practice a transsphenoidal approach, surgical resection of a pituitary adenoma, repair of a CSF leak in the diaphragma sellae, control of a carotid injury, and repair of skull base defect.

Developing a Training Model for Local Flaps Using Fresh Human Skin Excised During Tummy Tuck Procedures

Introduction: The proficient execution of local flaps poses a challenge for surgical residents. This study aimed to assess a training model for local flaps using fresh human skin excised during tummy tuck procedures. Methods: A questionnaire and a surgical skills evaluation, examining theoretical and procedural knowledge of local flaps, were administered before and after the training. All surgical procedures were performed on a simulation model utilizing freshly excised human skin. Skills were evaluated using a modified version of the Objective Structured Assessment of Technical Skills Score. SPSS version 21 was employed for comparing pre- and post-training results. Results: In the pretraining assessment, residents faced difficulties in flap design accuracy and wound coverage adequacy, indicating a need for surgical training beyond the operating theater. Post-training, there was a significant improvement in procedural skills, as reflected in the modified Objective Structured Assessment of Technical Skills score. The mean cumulative pretraining score was 26.81 ± 5.41, while the posttraining score was 43.59 ± 5.72 (P = 0.008). Theoretical knowledge also significantly improved in the posttraining evaluation, except for the indication of a Z-plasty (P = 0.257). The training model received positive feedback and was deemed highly useful and recommendable. Discussion: The presented model demonstrated improved surgical handling and understanding of tissue rotation under realistic conditions. The simulation model, using fresh human skin, is cost-effective and versatile for a broad range of flap procedures, advocating for its further adoption. Conclusions: The training model significantly enhanced surgical handling and comprehension of tissue rotation, replicating realistic conditions. The cost-effective simulation model, based on fresh human skin, offers versatility for various flap procedures, emphasizing the need for its wider implementation.

Benefits of lower limb angioplasty training using a virtual reality simulator among vascular surgical residents

BackgroundWe assessed the skill acquisition, operative competency, and confidence of vascular surgery residents during a limb angioplasty workshop and evaluated their surgical volume and retention rate at 1 year. MethodsFor 3 years (2018-2020), all residents and fellows in their final year of vascular residency at a teaching hospital were enrolled. Five residents in 2018 were enrolled in the control group (apprenticeship model). Twelve residents and fellows from 2019 (training group) and 2020 (coronavirus disease 2019 [COVID-19] group) were trained using the ANGIO Mentor (Simbionix Ltd, Airport City, Israel) in two workshops. The residents were evaluated using the Objective Structured Assessment of Technical Skills, simulator metrics, and a confidence questionnaire. A P value of < .05 was considered statistically significant. ResultsThe groups were similar in age, sex, and number of limb angioplasties performed (control group, 25.00 ± 5.52; training group, 23.16 ± 7.44; COVID-19 group, 24.50 ± 8.17; P = .91, Student t test). The residents of the training and COVID-19 groups showed significantly improved Objective Structured Assessment of Technical Skills scores after the first workshop (from 15.5 [interquartile range (IQR), 12.62-19.13] to 29.5 [IQR, 25.25-39.38]; and from 14.50 [IQR, 13.62-15.00] to 23.5 [IQR, 21.87-24]; P < .001]; respectively) and reported confidence improvement (from a median of 3 [IQR, 3-3] to 4 [IQR, 4-5]; P = .01). After 6 months, the retention rate was good. During that semester, each resident performed a median of 10.50 limb angioplasties (IQR, 7.00-13.25 limb angioplasties). The second workshop did not improve either the residents' scores or their confidence. At the end of the year, the control group scored worse than did the training and control groups (control group, 23.50 [IQR, 19.00-24.50]; training group, 37.0 [IQR, 36.50-39.37]; COVID-19 group, 34.75 [IQR, 30.75-38.75]; P = .005, Kruskal-Wallis test). The simulation metrics did not show significant differences among the groups. ConclusionsA 3-week limb angioplasty workshop can improve residents' skills and confidence. Performing 10 angioplasties per semester is sufficient to ensure the retention rate is good after 6 months, and a second workshop is unnecessary.

Intraoperative Adverse Events, Technical Performance, and Surgical Outcomes in Laparoscopic Radical Surgery for Gastric Cancer: A Pooled Analysis From 2 Randomized Trials.

To verify an intraoperative adverse event (iAE) classification (ClassIntra grade) to evaluate quality control and to predict the prognostic performance of laparoscopic radical surgery for gastric cancer. Surgical quality control is a key factor in the evaluation of surgical treatment for tumors. And, there is no recognized iAE classification for gastric cancer. We performed a retrospective post hoc analysis of previously collected data from the FUGES-001 study (NCT02327481) and a subset of the CLASS-01 study (NCT01609309). Patients were classified into the iAE and non-iAE groups. And iAE was further classified into 5 subgrades according to the ClassIntra grade (with I-V severity categories). Technical performance was evaluated using the Objective Structured Assessment of Technical Skills tool and the Generic Error Rating Tool. Overall, 528 gastric cancer patients were included in this study, with 105 patients (19.9%) in the iAE group and 423 (80.1%) in the non-iAE group. The survival curve showed that the overall, disease-specific, and recurrence-free survival of the non-iAE group were significantly better than those of the iAE group ( P =0.001). The prognosis of patients with ClassIntra grade ≥II was significantly worse than that of patients with ClassIntra grade ≤I. A higher ClassIntra grade, lower Objective Structured Assessment of Technical Skills score, and total gastrectomy were independent risk factors for severe postoperative complications. There was a significant increase in bleeding (grade IV) and injury with splenic hilar lymph node dissection during total gastrectomy. The ClassIntra grade is an effective prognostic and surgical quality control index for laparoscopic radical surgery for gastric cancer; therefore, it could be included in routine hospital care and surgical quality control.

Effectiveness of the world’s first 1-Day online hands-on laparoscopic suturing training during COVID-19 pandemic

We aimed to investigate the effectiveness of an online laparoscopic suturing training course conducted via an online meeting program. The mean needle loading, stitching, and knot-tying times were 77.3 s, 63.0 s, and 140.3 s, respectively on the initial test. Total laparoscopic suture time before the course was 273.8 s. After the course, time measures across all parameters decreased significantly (p < .001). The mean needle loading, suture passing, and knot tying times were 25.0 s, 31.0 s, and 34.6 s on the final test. The total intracorporeal suture time after the course was 90.0 s. The Objective and Structured Assessment of Technical Skills Scores significantly increased from 16.8 at the initial test to 25.4 at the final test (p < .001). IMPACT STATEMENT What is already known on this subject? Training models like box trainers and virtual reality simulators have frequently been shown to significantly improve laparoscopic skills. What the results of this study add? A 1-day online laparoscopic suturing course significantly reduces the intracorporeal suturing time. What the implications are of these findings for clinical practice and/or further research? Basis the results, online laparoscopic suturing training might become the new norm for training over conventional training given the benefits of cost and time savings.

Virtual Interactive Surgical Skills Classroom: A Parallel-group, Non-inferiority, Adjudicator-blinded, Randomised Controlled Trial (VIRTUAL)

This study evaluated the efficacy of virtual classroom training (VCT) in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training. This was a parallel-group, non-inferiority, prospective randomised controlled trial with three intervention groups conducted in 2021. There were three intervention groups with allocation ratio 1:1:1. Outcome adjudicators were blinded to intervention assignment. Interventions consisted of 90-minute training sessions. VCT was delivered via the BARCO weConnect platform, FFT was provided in-person by expert instructors and CBL was carried out by participants independently. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills score, adjudicated by two experts and adjusted for baseline proficiency. The assessed task was to place three interrupted sutures with hand-tied knots. This multicentre study recruited from five medical schools in London. Inclusion criteria were medical student status and access to a personal computer and smartphone. One hundred fifty-nine eligible individuals applied online. Seventy-two participants were randomly selected and stratified by subjective and objective suturing experience prior to permuted block randomization. Twenty-four participants were allocated to each intervention, all were analysed per-protocol. The sample was 65.3% female with mean age 21.3 (SD 2.1). VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI: 0.41-2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI: 0.20-2.29). The costs per-attendee associated with VCT, FFT and CBL were £22.15, £39.69 and £16.33 respectively. Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively. VCT provides greater accessibility and resource efficiency compared to FFT, with similar educational benefit. VCT has the potential to improve global availability and accessibility of surgical skills training.

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

IntroductionThe 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 methodsThe 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).ResultsThe 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.ConclusionWith 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.

Virtual Interactive Surgical Skills Classroom: Protocol for a Parallel-Group, Noninferiority, Adjudicator-Blinded, Randomized Controlled Trial (VIRTUAL).

BackgroundTraditional face-to-face training (FFT) for basic surgical skills is inaccessible and resource-intensive. Noninteractive computer-based learning is more economical but less educationally beneficial. Virtual classroom training (VCT) is a novel method that permits distanced interactive expert instruction. VCT may optimize resources and increase accessibility.ObjectiveWe aim to investigate whether VCT is superior to computer-based learning and noninferior to FFT in improving proficiency in basic surgical skills.MethodsThis is a protocol for a parallel-group, noninferiority, randomized controlled trial. A sample of 72 undergraduates will be recruited from 5 medical schools in London. Participants will be stratified by subjective and objective suturing experience level and allocated to 3 intervention groups at a 1:1:1 ratio. VCT will be delivered using the BARCO weConnect software, and FFT will be provided by expert instructors. Optimal student-to-teacher ratios of 12:1 for VCT and 4:1 for FFT will be maintained. The assessed task will be interrupted suturing with hand-tied knots.ResultsThe primary outcome will be the postintervention Objective Structured Assessment of Technical Skills score, adjudicated by 2 experts blinded to the study and adjusted for baseline proficiency. The noninferiority margin (δ) will be defined using historical data.ConclusionsThis study will serve as a comprehensive appraisal of the suitability of virtual basic surgical skills classroom training as an alternative to FFT. Our findings will assist the development and implementation of further resource-efficient, accessible, virtual basic surgical skills training programs during the COVID-19 pandemic and in the future.Trial RegistrationInternational Standard Randomized Controlled Trial Number ISRCTN12448098; https://www.isrctn.com/ISRCTN12448098International Registered Report Identifier (IRRID)PRR1-10.2196/28671

A Training Model for Local Flaps Using Fresh Human Skin Excised During Body Contouring Procedures

BackgroundThe safe execution of local flaps tends to be challenging for surgical residents. Thus, the purpose of the study was to evaluate a training model of local flaps based on fresh human skin excised from body contouring procedures. Materials and methodsA questionnaire and surgical skills evaluation—analyzing the theoretical and procedural knowledge about local flaps—were held both before and after the surgical skills training. All surgical procedures were executed on a simulation model based on fresh human skin. Skills evaluation was done according to a modified version of the Objective Structured Assessment of Technical Skills Score. Results before and after the training were compared using SPSS, version 21. ResultsIn pretraining evaluation, residents showed great difficulty regarding the accuracy of flap design and sufficiency of wound coverage indicating the need for surgical training outside the operating theater. After training, the procedural skills significantly improved as depicted by the modified Objective Structured Assessment of Technical Skills score with a mean cumulative pretraining score of 26.81 ± 5.41 and posttraining score of 43.59 ± 5.72 (P = 0.008). Also, theoretical knowledge significantly improved in the posttraining evaluation with exception to the indication of a Z-plasty (P = 0.257). The training model itself was generally regarded as highly useful and thus recommendable to others. ConclusionsSurgical handling and the understanding of tissue rotation clearly improved by the presented model which mimics very realistic conditions. The simulation model based on fresh human skin shows cost-effectiveness and allows a broad range for flap procedures wherefore its use should be further promoted.

Video-based self-assessment enhances laparoscopic skills on a virtual reality simulator: a randomized controlled trial.

Hysterectomy rates are decreasing in many countries, and virtual reality (VR) simulators bring new training opportunities for residents. As coaching interventions while training on a simulated complex procedure represents a resource challenge, alternative strategies to improve surgical skills must be investigated. We sought to determine whether self-guided learning using a video-based self-assessment (SA) leads to improved surgical skills in laparoscopic hysterectomy (LH) on a VR simulator. Twenty-four gynecology residents from two university hospitals were randomized into an SA group (n = 12) and a Control group (n = 12). Each participant's baseline performance on a validated VR basic task was assessed. Both groups then performed three virtually simulated LHs during which the participants received no guidance nor feedback. Following each LH, the SA group participants rated the video of their own performance using a generic and a procedure-specific rating scale, while the Control group participants watched an LH video demonstration. The LH videos of both groups' participants were blindly reviewed and rated by expert surgeons, using modified Objective Structured Assessment of Technical Skills scores (OSATS). Objective metrics recorded by the VR simulator were also compared. There was no difference between the groups' baseline performances on the VR basic task. For the first LH, the OSATS-derived scores did not differ between SA and Control groups (9 [7-13] versus 9 [8-14]; p = 0.728). For the third LH, the OSATS-derived scores were higher for the SA group than for the Control group (17 [15-21] versus 15 [11-17], p = 0.039). Between the two groups, the objective metrics did not differ from the first to the third LH. The use of a structured video-based SA leads to improved procedural skills in LH on a VR simulator compared to watching benchmark expert performance, in a population of residents with moderate experience in the operating room.

The Congenital Heart Technical Skill Study: Rationale and Design.

We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation. All surgeons contributing data to The Society of Thoracic Surgeons-Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality. Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as "very rewarding" and "less time consuming than anticipated." An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85). This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.

The Role of Deconstructive Teaching in the Training of Laparoscopy.

Background and Objectives:Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying.Methods:Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups.Results:Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs –4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance.Conclusion:Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.

Implementation and validation of a retroperitoneal dissection curriculum

Competency-based education requires educators to use simulation training for the purposes of education and assessment of resident trainees. Research demonstrates that improvement in surgical skills acquired in a simulated environment is transferrable to the operative environment. Laparoscopic retroperitoneal dissection, opening the retroperitoneal space and identifying the ureter, is a fundamental skill for gynecologists. Integrating simulation models into a formal and comprehensive curriculum for teaching ureterolysis could translate to increased surgical competency. Our goal was to validate a comprehensive curriculum for laparoscopic retroperitoneal dissection for the purpose of identification of the ureter by evaluating intraoperative performance. A comprehensive curriculum, encompassing didactic and technical skills components and using a previously developed pelvic model, was designed to teach laparoscopic ureterolysis. Novice surgeons (postgraduate years 3-5) were recruited. Participants completed precurriculum and postcurriculum multiple-choice questionnaires to evaluate a didactic component. Preperformance and postperformance on the model was video-recorded. As part of the technical component, participants received constructive feedback from expert surgeons on how to perform laparoscopic retroperitoneal dissection using the simulation model. Participants were then video-recorded performing laparoscopic retroperitoneal dissection in the operating room within 3 months of the curriculum. All videos were blindly assessed by an expert using the Objective Structured Assessment of Technical Skills tool. At the conclusion of the study, participants completed a course evaluation. Thirty novice gynecologic surgeons were recruited. High baseline knowledge of ureteric anatomy and injury (multiple-choice question score median and interquartile range) still significantly increased from 7 (5-7.25) precurriculum to 8 (7-9) postcurriculum (P< .001). The median (interquartile range) technical Objective Structured Assessment of Technical Skills score increased significantly from 24.5 (23-28.25) precurriculum to 30 (29.75-32) postcurriculum (P < .001). Video-recordings were completed for 23 participants performing laparoscopic retroperitoneal dissection in the operating room. Intraoperative Objective Structured Assessment of Technical Skills scores (median of 29 [interquartile range 27-32]) correlated with postcurriculum Objective Structured Assessment of Technical Skills scores on the model (r= 0.53, P= .01). The ureter was identified intraoperatively by 91% (n= 21/23) of participants. The majority of residents (81%, n= 21/26) were more comfortable completing a supervised retroperitoneal dissection as a result of participating in the curriculum. Residents believed that this model would be useful to enhance skills acquisition prior to performing the skill in the operating room (65%, n= 17/26). A comprehensive retroperitoneal dissection curriculum showed improvement in cognitive knowledge and technical skills, which also translated to competent performance in the operating room. In addition to the objective measures, residents believed that their skills acquisition was improved following course completion.

A Simulation Model to Support Laparoscopic Pyloromyotomy Teaching.

A key concern regarding laparoscopic pyloromyotomy (LP) lies with the process of learning this skill. The learning processes for open pyloromyotomy and LP appear to be different, with an earlier increased risk of perforation or incomplete pyloromyotomy (IP) for LP. Our aim was to develop a simple simulation tool to reduce these specific complications. A model of hypertrophic pyloric stenosis was created and inserted into a pediatric laparoscopic surgery simulator. A cohort of experts completed a six-item questionnaire, using a 4-point scale regarding the model's realistic nature and accuracy. Evaluation of the LP procedure was based on a dedicated Objective Structured Assessment of Technical Skills score. Surgical residents and students were enrolled for the final evaluation to assess the relative performance of trainees who had practiced with this model (Group 1) versus those who had observed its use (Group 2). Reproducibility of the model construction was considered to be satisfactory. The experts agreed that the model accurately simulated essential components of LP (mean 3.03 ± 0.7). They scored significantly better than the residents (27.2 ± 1.8 versus 22.8 ± 2.9; P < .001), with a lower rate of complications. Group 1 (39 trainees) performed significantly better than Group 2 (26 trainees), with a significant decrease in the risk of an IP (P < .05). This model appears to be sufficiently accurate to teach LP. In light of this, it can be considered to be an efficient tool for LP simulation teaching in our fellows' educational program.

Personalized video feedback improves suturing skills of incoming general surgery trainees

BackgroundThe American Board of Surgery encourages graduating medical students to prepare for surgical residency before day 1. We sought to determine the impact of personalized video feedback on an advance preparation task. MethodsWe conducted a nonrandomized study comparing video feedback versus no feedback. We sent incoming surgical interns a preparatory package 2 months before starting residency. Trainees video-recorded themselves performing a subcuticular wound closure, 3 times at 3-week intervals, and submitted these for appraisal. A staff surgeon provided personalized feedback on each video as a narrated voiceover. The voiced-over videos were then returned to trainees. We compared performance (time and completion rate) on suturing in a multistation assessment against residents from the previous year (no-feedback group). ResultsThe feedback group had a higher completion rate for the suturing assessment than the no-feedback group (23/28 [82%] vs. 8/27 [30%], P < .0001). The feedback group also completed the suturing station at a faster rate than those without feedback (hazard ratio 4.9 [95% confidence interval (CI): 2.2,11.2), P < .0001). Global rating scores were significantly higher for the feedback group (mean difference [5-point scale] = 0.7 [95% CI: 0.3, 1.1]). However, Objective Structured Assessment of Technical Skills scores indicated no significant difference between groups (mean difference [5-point scale] = 0.3 [95% CI: 0.0, 0.6]). Within the feedback group, we found significant improvement from baseline to final performances (mean difference = 109 seconds [95% CI: 79, 140]). ConclusionPersonalized narrated feedback as part of a home-based advance preparation package for incoming residents is associated with higher performance on early objective assessments.

The Fann Objective Structured Assessment of Technical Skills Score in Cardiothoracic Set Trainees Undertaking Coronary Anastomosis

Purpose: To evaluate the technical skills of SET trainees in cardiothoracic surgery whilst undertaking a simulated coronary anastomosis. Methodology: All 24 (2015) RACS Cardiothoracic SET trainees carried out two simulated coronary anastomoses. 2 mm diameter silicone vessels were anastomosed end to side using 7-0 prolene. Each procedure was captured using two opposing camera angles. The images were synchronised, edited and combined to provide the surgeon assessor with a single high definition movie comprising three views of the anastomosis. This movie was scored according to the Fann Objective Structured Assessment of Technical Skills (OSATS) score. Results: An independent sample t-test demonstrated the mean Fann OSATS score was significantly higher for SET4-6 trainees when compared with SET1-3 trainees. Mean Score (±SD) for SET1-3 = 20.83 ± 6.22 for SET4-6 = 24.15 ± 5.71 a difference of 3.32 (95% CI, -6.5 - -0.1), t(54) = -2.068, p = 0.043. Conclusion: We have applied an OSATS scoring system to a cohort of SET trainees and demonstrated that it is possible to differentiate between junior and senior trainees based on this scoring system. We believe this will provide a reliable quantitative method of assessing progress in training on a regular basis. Reference: Fann Jl et al., The Journal of Thoracic and Cardiovascular Surgery JTCVS 2008;136:1486.

Video Coaching as an Efficient Teaching Method for Surgical Residents—A Randomized Controlled Trial

As surgical training is evolving and operative exposure is decreasing, new, effective, and experiential learning methods are needed to ensure surgical competency and patient safety. Video coaching is an emerging concept in surgery that needs further investigation. In this randomized controlled trial conducted at a single teaching hospital, participating residents were filmed performing a side-to-side intestinal anastomosis on cadaveric dog bowel for baseline assessment. The Surgical Video Coaching (SVC) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon, during which constructive feedback was given. The control group went on with their normal clinical duties without coaching or debriefing. All participants were filmed making a second intestinal anastomosis. This was compared to their first anastomosis using a 7-category-validated technical skill global rating scale, the Objective Structured Assessment of Technical Skills. A single independent surgeon who did not participate in coaching or debriefing to the SVC group reviewed all videos. A satisfaction survey was then sent to the residents in the coaching group. Department of Surgery, HôpitalMaisonneuve-Rosemont, tertiary teaching hospital affiliated to the University of Montreal, Canada. General surgery residents from University of Montreal were recruited to take part in this trial. A total of 28 residents were randomized and completed the study. After intervention, the SVC group (n = 14) significantly increased their Objective Structured Assessment of Technical Skills score (mean of differences 3.36, [1.09-5.63], p = 0.007) when compared to the control group (n = 14) (mean of differences 0.29, p = 0.759). All residents agreed or strongly agreed that video coaching was a time-efficient teaching method. Video coaching is an effective and efficient teaching intervention to improve surgical residents' technical skills.

Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.

Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively. Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.

Randomized controlled trial comparing dynamic simulation with static simulation in trauma.

Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy but lacks practicality when hemorrhage control is the lifesaving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVSs). Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a noninferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n = 28) versus a cadaver arm (n = 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After the trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances. Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver (584 seconds vs. 751 seconds; difference, +167 seconds faster; 90% confidence interval [CI], +52 to +282 seconds), with a trend toward faster time to hemorrhage control (110 seconds vs. 148 seconds; difference, +38 seconds faster; 90% CI, -8 to +84). There was no significant difference in Objective Structured Assessment of Technical Skills scores (3.72 vs. 3.44; difference, +0.27 units better; 90% CI, -0.04 to +0.59). Training on a dynamic simulator resulted in noninferior time to completion of vascular shunt placement compared with training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.

Validation of a structured intensive laparoscopic course for basic and advanced gynecologic skills training.

To describe and validate a gynecologic laparoscopic-surgery training model. The present prospective observational study was conducted at the Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain, between January 2011 and June 2013. Novice gynecologists attended a 3-day course including simulation and animal training. Participants' were assessed before and after training using a virtual reality simulator; during training, gynecologists were timed and assessed using an Objective and Structured Assessment of Technical Skills score. The virtual reality simulator-assessed skills were eye-hand coordination, hand-hand coordination, and transference of objects. Participants were asked to rate various elements of the training program using a five-point scale. The study enrolled 21 gynecologists. Participants performed all tasks faster (P<0.001), using fewer movements (P<0.05 for left and right instruments), after receiving training. During participants' final animal and simulator training sessions, completion times were reduced (P<0.001) and assessment scores (P<0.001) increased for all techniques and tasks. Participants considered suturing to be the most useful aspect of the basic-skills training (4.95±0.22); animal training received a higher rating than simulator training for practicing new techniques (4.81±0.40 vs 4.05±0.86) and maintaining skills (4.76±0.54 vs 3.95±0.97). Combining proficiency-based physical simulation and animal training models under expert guidance is an efficient model for improving basic and advanced laparoscopic skills. Suturing and animal models were the preferred training components.