Intraoperative Teaching Research Articles

Advancing endovascular neurosurgery training with extended reality: opportunities and obstacles for the next decade.

Extended reality (XR) includes augmented reality (AR), virtual reality (VR), and mixed reality (MR). Endovascular neurosurgery is uniquely positioned to benefit from XR due to the complexity of cerebrovascular imaging. Given the different XR modalities available, as well as unclear clinical utility and technical capabilities, we clarify opportunities and obstacles for XR in training vascular neurosurgeons. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Studies were critically appraised using ROBINS-I. 19 studies were identified. 13 studies used VR, while 3 studies used MR, and 3 studies used AR. Regarding specific educational applications, VR was used for simulation in 10 studies and anatomical modeling in 3 studies. AR was only used for live intra-operative guidance (n = 3 studies). MR was only used for modeling and intra-operative teaching. Considering disease-specific uses, XR enhanced trainee understanding of intracranial aneurysms (n = 12 studies) and stroke (n = 7). XR trained surgeons in diverse neurosurgical procedures, including aneurysm coiling (n = 5 studies), diagnostic angiography (n = 5), and thrombectomy (n = 5). Anatomical modeling with VR and MR enhances neurovascular anatomy education with patient-specific, 3-D models from imaging data. AR and MR enable live intra-operative guidance, allowing experienced surgeons to remotely instruct novices, potentially improving patient care and reducing geographic disparities. AR overlays enhance instruction by allowing the surgeon to highlight key procedural aspects during training. Inaccurate tracking of surgical tools is an XR technological barrier for modeling and intra-operative training. Importantly, the most reported application of XR is VR for simulation-using platforms like the Mentice VIST and Angio Mentor. 10 studies examine VR for simulation, showing enhanced procedural performance and reduced fluoroscopy use after short training, although long-term outcomes have not been reported. Early-stage trainees benefited the most. Simulation improved collaboration between neurosurgeons and the rest of the surgical team, a promising role in interprofessional teamwork. Given the strength of VR for simulation, MR for simulation is an important gap in the literature for future studies. In conclusion, XR holds promise for transforming neurosurgical education and practice for simulation, but technological research is needed in modeling and intra-procedural training.

Trainee as trainer in paediatric laparoscopic appendicectomy.

Intraoperative teaching is an essential surgical skill, but there is little literature regarding trainees acting as trainers; we characterised these cases in paediatric laparoscopic appendicectomy. This is a retrospective review of casenotes over two years (2015-2017) in a single tertiary paediatric surgical centre in the UK. Operating were: paediatric surgery Core Trainees (CT) (postgraduate year (PGY)3-4), Junior Registrars (JR) (PGY5-6) and Senior Registrars (SR) (PGY7+); collectively described as trainees. A total of 53 (20.7%) of 256 appendicectomies were trainee as trainer (TT) cases; 22 cases (41.5%) were performed by a CT supervised by a Registrar, and 31 (58.4%) by a JR supervised by a SR. Among the cases, 17 (32.1%) were complex, 47 (88.7%) were in working hours (8am-5pm), and 50 (94.3%) took place Monday to Friday. Median (interquartile range) duration of surgery was 65 (52-77) minutes. In the first year, 60 (47%) appendicectomies were performed by JRs. JR 1 was TT in three cases (8.8%) and JR 2 in five cases (19.2%); in all cases, the learner was a CT. Overall, there were 26 (10.6%) negative appendicectomies, 8 (3%) conversions, 19 (7%) readmissions within 30 days of discharge and 3 (1.1%) required reoperation; there was no statistically significant difference in complications between TT and non-TT cases. Laparoscopic appendicectomy is an excellent model for trainees to act as trainer; case selection included simple cases during daylight hours. Our outcomes are comparable with published literature, suggesting that this teaching method is safe for patients.

Faculty Entrustment and Resident Entrustability

As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs. To assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs. This cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level. Observed resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients. A total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years' experience: 67 [20.9%]; 6-14 years' experience: 186 [58%]; ≥15 years' experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions. Faculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

Effect of video-based self-reflection on intraoperative skills: A pilot randomized controlled trial

BackgroundThe value of video-based self-assessment in enhancing surgical skills is uncertain. This study investigates the feasibility and estimates sample size for a full-scale randomized controlled trial to evaluate the effectiveness of video-based self-assessment to improve surgical performance of laparoscopic cholecystectomy in trainees. MethodsThis parallel pilot randomized controlled trial included general surgery trainees performing supervised laparoscopic cholecystectomy randomized 1:1 to control (traditional intraoperative teaching) or intervention group (traditional teaching plus video-based self-assessment). Operative performance was measured by the attending surgeon blinded to group assignment at the time of surgery using standardized assessment tools (Global Operative Assessment of Laparoscopic Skills and Operative Performance Rating System). The intervention group had access to their video recordings on a web-based platform for review and self-assessment using the same instruments. The primary outcome for the estimation of sample size was the difference in faculty-assessed final operative performance (third submitted case). Feasibility criteria included >85% participation, >85% adherence to case submission and >85% completion of self-assessment. ResultsOf 37 eligible trainees approached, 32 consented and were randomized (86%). There were 16 in the intervention group, 15 in the control group (55% male, 55% junior trainees), and 1 was excluded for protocol violation. Twenty-four (75%) of participants submitted 3 cases. Thirteen trainees (81%) accessed the platform and completed 26 (63.2%) case self-assessments. Fifty-five trainees per arm will be needed to power a full-scale laparoscopic cholecystectomy with Global Operative Assessment of Laparoscopic Skills and 130 trainees per arm with Operative Performance Rating System as the assessment tool. ConclusionThis pilot study contributes important data to inform the design of an adequately powered randomized controlled trial of video-based self-assessment to improve trainee performance of laparoscopic cholecystectomy. Although a priori trial feasibility criteria were not achieved, automated video capture and storage could significantly improve adherence in future trials.

Do Surgery Residents Prepare Enough for Surgical Cases?

This study aimed to identify both modifiable and nonmodifiable factors that affect intraoperative-specific surgical education and performance, with an overall goal of increasing cognizance of such factors to improve surgical training. To determine whether surgery residents prepare adequately for participation in surgical cases and to examine specific variables that affect resident preparation. This study is a retrospective survey-based study that included data from 1945 postoperative case evaluations completed by 59 different general surgery residents over a period of 8 years (2014-2022). A Midwestern medical school's general surgery residency program. Fifty-nine general surgery residents at Western Michigan University's medical school; 50 attending surgeons and faculty with whom residents regularly operate. The sample was comprised of residents and attendings who voluntarily filled out postoperative performance surveys after elective cases. This retrospective survey-based study included postoperative evaluation data from 1945 procedures performed by 59 different residents and 50 attendings. Participants included 36 male residents, 23 female residents, 39 male attendings, and 11 female attendings. All included data were for elective cases. Self-reported preoperative communication was worst at the PGY1 level with positive correlation of improvement yearly (r = 0.30, p < 0.001). Positive correlation was seen between overall preparedness and case complexity (r = 0.25, p < 0.001). Positive correlation was seen between case complexity and resident perception of intraoperative teaching quality (r = 0.53, p < 0.001). Preoperative communication initiated by residents was significantly worse when the attending surgeon was female, regardless of resident gender (p < 0.001); this effect was particularly profound with male residents. Male residents overall rated themselves as more prepared compared to their female counterparts (11.13 ± 1.96 vs. 10.84 ± 2.03, p = 0.003). There is a need to identify and address quantifiable gaps in communication between residents and faculty to optimize surgical education; one of the first steps is characterizing nonmodifiable factors that correlate with differences in pre-operative communication and case preparation.

Relationship between intraoperative teaching skills and surgeons’ cognitive load

Relationship between intraoperative teaching skills and surgeons’ cognitive load

High magnification versus optical magnification in hypospadias surgery: a randomized controlled trial

BackgroundHypospadias is the most common congenital abnormality of the urethra affecting live male births. The incidence is rising with the increasing pollution. During the last 50 years, developments in surgical instrumentation and optical systems allowed surgeons to increasingly undertake microsurgical procedures. Optical magnification is essential in pediatric surgery. Magnifying loupes are the most frequently used, although they often cause neck pain to the surgeon. Recent advances led to the development of a compact video microscope (VITOM; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) that displays high-definition magnified images on a flat screen.ObjectiveEvaluate VITOM as a potential substitute for loupes in complex open pediatric procedures and explore VITOM as an effective intraoperative teaching modality for open surgery.MethodsFifty-two patients enrolled in our study were divided into two groups: Group A (26): high magnification was used either (VITOM Karl Storz Endoscopy GmbH, Tuttlingen, Germany) or (Surgical microscope, Carl Zeiss Microscopy GmbH), along with microsurgical instruments. Vicryl 8-0 suture was used for urethroplasty. Group B (26): patients were operated upon by conventional instruments (fine tip but not microsurgical instruments), sutures, and magnification (3.5×). Vicryl 6-0 suture was used for urethroplasty, with loupes-assisted magnification.ResultsMore complications were found in group B. Using VITOM was accompanied by less neck pain, enhanced visualization, and an enhanced teaching environment.ConclusionOperating with high magnification tools minimizes post-operative complications in hypospadias surgery. They enhanced identification of the penile anatomy and topography which facilitated reconstruction techniques as well as enhanced the comfort of the surgeon.Level of evidenceI.

Perceptions and Guiding Strategies to Regulate Entrusted Autonomy of Residents in the Operating Room: A Systematic Literature Review

To provide a systematic literature review of intraoperative entrusted autonomy for surgical residents. Specifically, perceptions from residents and supervising surgeons, supervising behavior and influencing factors on intraoperative teaching and learning are analyzed. Increasing demands on surgical training and the need for effective development of technical skills, amplify the importance of making the most of intraoperative teaching and learning opportunities in the operating room. It is critical for residents to gain the greatest benefit from every surgical case and to achieve operative competence. A systematic literature search identified 921 articles from 2000 to 2022 that addressed surgical education/training, intraoperative supervision/teaching, autonomy and entrustment. 40 studies with heterogeneous designs and methodologies were included. Four themes were established in the analysis: patient safety, learner, learning environment and supervising surgeon. The patient is identified as the primary responsibility during intraoperative teaching and learning. Supervisors continuously guard patient safety as well as the resident's learning process. Ideal intraoperative learning occurs when the resident has optimal entrusted autonomy during the procedure matching with the current surgical skills level. A safe learning environment with dedicated time for learning are prerequisites for both supervising surgeons and residents. Supervising surgeons' own preferences and confidence levels also play an important role. This systematic literature review identifies patient safety as the overriding principle for supervising surgeons when regulating residents' entrusted autonomy. When the supervisor's responsibility toward the patient has been met, there is room for intraoperative teaching and learning. In this process the learner, the learning environment and the supervising surgeon's own preferences all intertwine, creating a triangular responsibility. This review outlines the challenge of establishing an equilibrium in this triangle and the broad arsenal of strategies supervising surgeons use to keep it in balance.

Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis

PurposeWork-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases. MethodsWe queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index. ResultsData were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p ​< ​0.001). There was a positive association between teaching cases and decreased wRVU index for all cases. ConclusionThe wRVU index was 24% lower for teaching cases when compared to non-teaching cases despite controlling for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU framework.

Matching intraoperative teaching and learning for medical undergraduates via modified briefing-intraoperative teaching-debriefing (BID) model

Intraoperative teaching is a challenging task. The briefing–intraoperative teaching–debriefing (BID) model, which is based on guided discovery learning at limited time intervals, has rarely been investigated. This study validated the benefits of the modified BID model on medical clerks. This study involved 37 first-year medical clerks enrolled from September 2019 to May 2020. Every learner scrubbed in one the totally implantable venous access device placement surgery and completed a pre-/posttest survey on surgical procedures and associated anatomy conducted through an intraoperative teaching questionnaire. Of these participants, 15 merely observed throughout the entire procedure (observation group), whereas the remaining 22 performed simple suturing under supervision (suturing group). All participants underwent an objective structured assessment of simple interrupted suturing skills at the end of the observership. Correlations were tested using a two‐tailed paired t-test, with a p-value < 0.05 indicating statistical significance. The response rate was 100% and participants could reconfirm the precise venous access, catheter tip location, and suture materials for portal fixation after totally implantable venous access device placement (p < 0.05). Although a relatively higher satisfaction of the intraoperative teaching environment and educator attitude was reported in the suturing group than in the observation group, the difference in scores on the objective structured assessment was not statistically significant (8.7 ± 1.8 vs. 7.2 ± 3.7; p = 0.104). Our findings indicate that the modified BID model with hands-on experience is a practicable module for matching intraoperative teaching and learning via learning perception enhancement for medical undergraduates during totally implantable venous access device placement.

The use of simulation in liver transplantation anesthesiology fellowship training: A survey of fellowship program directors in the United States.

Liver transplantation surgeries are challenging cases for anesthesiologists. While intra-operative teaching is paramount, simulation has emerged as an educational tool to augment clinical training. A variety of simulation modalities have been described in the literature, but no study has aimed to assess the use of simulation in liver transplantation fellowship training. A 20-question survey detailing the use of simulation, including simulation modalities used and barriers to simulation use, was developed and distributed to 22 program directors for liver transplantation anesthesiology fellowships. An exploratory analysis was performed on multiple-choice and free-text responses. Thirteen program directors completed the survey and were included in our analysis. Most programs (61.5%) did not report the use of simulation for liver transplantation fellow training. Of the programs that did use simulation, four required it as a mandatory component of their curriculum. Task trainers and screen-based simulators were more commonly used by these programs. Faculty availability and interest, as well as a lack of an established curriculum, were cited as major limitations to simulation use. Simulation is an important component of anesthesiology trainee education, as evidenced by the requirement for simulation during residency by the American Council for Graduate Medical Education. Our findings suggest that simulation is an underutilized educational tool that we believe could greatly augment the training of liver transplantation anesthesiology fellows by providing exposure to a wide range of clinical challenges.

Intervention for Intraoperative Teaching in Anesthesiology Using Weekly Keyword Program: Development and Usability Study

Learning in the operating room (OR) for residents in anesthesiology is difficult but essential for successful resident education. Numerous approaches have been attempted in the past to varying degrees of success, with efficacy often judged afterward using surveys distributed to participants. The OR presents a particularly complex set of challenges for academic faculty due to the pressures required by concurrent patient care, production pressures, and a noisy environment. Often, educational reviews in ORs are personnel specific, and instruction may or may not take place in this setting, as it is left to the discretion of the parties without regular direction. This study aims to determine if a structured intraoperative keyword training program could be used to implement a curriculum to improve teaching in the OR and to facilitate impactful discussion between residents and faculty. A structured curriculum was chosen to allow for the standardization of the educational material to be studied and reviewed by faculty and trainees. Given the reality that educational reviews in the OR tend to be personnel specific and are often focused on the clinical cases of the day, this initiative sought to increase both the time and efficiency of learning interactions between learners and teachers in the stressful environment of the OR. The American Board of Anesthesiology keywords from the Open Anesthesia website were used to construct a weekly intraoperative didactic curriculum, which was distributed by email to all residents and faculty. A weekly worksheet from this curriculum included 5 keywords with associated questions for discussion. The residents and faculty were instructed to complete these questions on a weekly basis. After 2 years, an electronic survey was distributed to the residents to evaluate the efficacy of the keyword program. A total of 19 teaching descriptors were polled for participants prior to and following the use of the intraoperative keyword program to assess the efficacy of the structured curriculum. The survey results showed no improvement in intraoperative teaching based on respondent perception, despite a slight improvement in teaching time, though this was statistically insignificant. The respondents reported some favorable aspects of the program, including the use of a set curriculum, suggesting that greater structure may be beneficial to facilitate more effective intraoperative teaching in anesthesiology. Although learning is difficult in the OR for residents, the use of a formalized didactic curriculum, centered on daily keywords, does not appear to be a useful solution for residents and faculty. Further efforts are required to improve intraoperative teaching, which is well known to be a difficult endeavor for both teachers and trainees. A structured curriculum may be used to augment other educational modalities to improve the overall intraoperative teaching for anesthesia residents.

A Paper-Based Simulation Model for Teaching Inguinal Hernia Anatomy

BackgroundInguinal hernias remain a challenging area of learning for medical students due to its relatively complex anatomy. Modern curriculum delivery methods are conventionally limited to didactic lectures and demonstration of anatomy intraoperatively. These strategies have limitations; lectures are inherently descriptive and based on 2-dimensional models, while intraoperative teaching is often unstructured and opportunistic.MethodsA paper-based model was developed comprising three overlapping paper panels simulating the anatomical layers of the inguinal canal which can be modified readily to further simulate various hernia pathologies and their surgical repair. These models were incorporated into a timetabled structured learning session for 3rd- and 4th-year medical students. Learners responded to fully anonymised surveys before and after the learning session.FindingsA total of 45 students participated in these sessions over a period of 6 months. Pre-learning session mean ratings for the learners’ confidence in their understanding of the layers of the inguinal canal, identifying indirect and direct inguinal hernias and in naming the contents of the inguinal canal were 2.5, 3.3 and 2.9, while post-learning session mean ratings were 8.0, 9.4 and 8.2, respectively. Paired samples Student’s t-tests for all three questions were statistically significant (p < 0.001). The mean rating for usefulness of the session was 9.6/10. Free comments from students emphasised the models’ usefulness as a visual learning aid.Discussion and ConclusionOur novel, low-cost paper model was associated with an improvement in learners’ perceived knowledge and understanding of inguinal canal anatomy and pathology.

The Whiteboard Time Out: A Novel Tool to Improve Resident Learning in the Operating Room

"Flipping the classroom" is a strategy that has been implemented in various educational environments to create a student-centered learning environment. Within this model of teaching, "first exposure" occurs prior to the classroom in a lower form of cognitive demand, allowing students to employ higher forms of cognition within the classroom. Surgical education has evolved over recent years to incorporate different modalities of learning; however, optimal educational approaches within the operating room (OR) have not been clearly defined. The Whiteboard Time Out (WBTO) utilizes the idea of "flipping the classroom" to make learning within the OR more resident centered. Residents complete most of the preoperative work prior to the case with a focus on the indications, steps of the procedure, and potential complications associated with the procedure. Residents then utilize a whiteboard located in the OR to outline, diagram, and discuss this information with the attending. Aims of the study are to enhance higher level intraoperative resident learning and attending teaching and improve resident knowledge and the ability to communicate surgical steps. Faculty and residents completed a preimplementation questionnaire aligned to the Student Evaluation of Educational Quality (SEEQ) in July 2021. Participants were assigned 3 digit codes to ensure anonymity. The questionnaire was composed of 6 questions with a 5-point Likert scale. Whiteboards were mounted in every operating room, 19 total, in both the general OR and an ambulatory surgical center. The residents were expected to go to the OR, prior to scrubbing the case, and use the whiteboard to outline the indications, key steps and potential complications. After the resident completed the white board, the resident and attending reviewed the white board together prior to the start of the case. After the procedure, residents uploaded a picture of the whiteboard with a self-evaluation and faculty provided resident feedback via an online Wufoo Survey link. The start of the utilization of the whiteboards occurred after the initial survey in July 2021. The SEEQ questionnaire was again administered in October 2021, 3 months post-WBTO implementation, to assess resident and attending satisfaction. SEEQ questionnaire results were compared using a t-test. Participants included surgical residents and attendings at Maimonides Medical Center (MMC). MMC is a 700-bed university-affiliated, academic, tertiary medical center in Brooklyn, New York. The General Surgery Residency is approved for up to 5 graduates annually. A total of 17 attendings and 17 residents filled out the questionnaire. The average number of whiteboards completed was highest amongst the PGY1 class with an average of 18 whiteboards per resident. However, the average number of whiteboards completed declined amongst more senior residents. There was a statistically significant increase in overall SEEQ survey score amongst residents and attendings after implementation of the WBTO suggesting that whiteboards were useful (p < 0.03 and p < 0.02, respectively). Residents found that the whiteboard was an effective means of teaching surgical education compared to the current curriculum (p < 0.04). The whiteboard timeout is a tool created to enhance resident education in the OR. This idea is centered on a "flipped classroom," an educational strategy to increase student engagement. Our data demonstrates that the whiteboard timeout is an effective method of intraoperative teaching.

ASA Global Health Overseas Training Programs: A Rwanda Update

Features| April 2023 ASA Global Health Overseas Training Programs: A Rwanda Update Shyamal R. Asher, MD, MBA; Shyamal R. Asher, MD, MBA Search for other works by this author on: This Site PubMed Google Scholar Ana Maria Crawford, MD, MSc, FASA Ana Maria Crawford, MD, MSc, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2023, Vol. 87, 22. https://doi.org/10.1097/01.ASM.0000924980.08965.a9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Shyamal R. Asher, Ana Maria Crawford; ASA Global Health Overseas Training Programs: A Rwanda Update. ASA Monitor 2023; 87:22 doi: https://doi.org/10.1097/01.ASM.0000924980.08965.a9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: rwanda, world health ASA's Committee on Global Health, in partnership with the Canadian Anesthesiologists' Society International Education Foundation (CASIEF), remains actively engaged in the University of Rwanda anesthesiology residency program. Established in 2006, this partnership continues to work on building capacity for safe anesthesia practices across Rwanda. Over the years, ASA volunteers have traveled to Rwanda and worked in close collaboration with local faculty to support resident didactics, intraoperative teaching, ICU rounds, and simulation workshops. ASA volunteers have learned much from Rwandan colleagues regarding innovation during shortages, cost containment, and providing clinical care with less environmental impact. Although the COVID pandemic forced a pause in travel to Rwanda in 2020 and 2021, there is renewed strength in the program with those returning to Rwanda and a number of first-time volunteers. Over 30 anesthesiologists have successfully graduated from the anesthesiology residency program, many remaining in Rwanda to expand safe anesthesia access. Some serve as... You do not currently have access to this content.

PD30-06 A NOVEL SYSTEM FOR TEACHING INTRAOPERATIVE LAPAROSCOPIC SKILLS USING STANDARDIZED COMMUNICATION AND AN ENDOSCOPIC MONITOR FRAME OF REFERENCE TOOL

You have accessJournal of UrologyCME1 Apr 2023PD30-06 A NOVEL SYSTEM FOR TEACHING INTRAOPERATIVE LAPAROSCOPIC SKILLS USING STANDARDIZED COMMUNICATION AND AN ENDOSCOPIC MONITOR FRAME OF REFERENCE TOOL Kikachukwu Otiono, Jennifer Hoogenes, Kevin Kim, Bobby Shayegan, Anil Kapoor, Kevin Piercey, and Edward D. Matsumoto Kikachukwu OtionoKikachukwu Otiono More articles by this author , Jennifer HoogenesJennifer Hoogenes More articles by this author , Kevin KimKevin Kim More articles by this author , Bobby ShayeganBobby Shayegan More articles by this author , Anil KapoorAnil Kapoor More articles by this author , Kevin PierceyKevin Piercey More articles by this author , and Edward D. MatsumotoEdward D. Matsumoto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003316.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Directional terminology in the operating room (OR) during laparoscopic surgery is a common source of confusion for trainees, as the spatial orientation of the on-screen operative field differs depending on the viewer’s perspective and frame of reference. We developed and evaluated the utility and feasibility of 2 endoscopic monitor screen overlays designed to standardize directional instruction. METHODS: For a baseline perspective on laparoscopic instruction, we video-recorded and qualitatively analyzed 20 teaching cases. We then designed and printed 2 transparent endoscopic monitor overlays: an alphanumeric grid (AG) and a clock. In a laparoscopic simulation lab, 63 medical students were randomized into 3 groups of 21: control, AG, and clock. AG and clock groups were given overlay-specific instructions. All groups completed 3 trials of 6 transfer tasks. Completion and error rates were recorded. We then trialed the overlays in 44 teaching cases in urology and general surgery (30 AG and 14 clock). All cases were video recorded, transcribed, and qualitatively analyzed. Participants completed follow-up experiential surveys with 6-point Likert scales of agreement and space for comments. RESULTS: In the baseline cases, instructors often used directional terms (e.g., screen left/right; up/down) and pointed to the screen during instruction. In the simulation study, the AG group demonstrated the lowest error rates which became significant by trial 3 (p=0.01). 6 instructors and 21 residents from urology (n=14) and general surgery (n=7) participated in the intraoperative evaluation of the overlays. Instructors rated the AG higher than the clock in improving efficiency and hand-eye coordination (p’s<0.001) and agreed that it should be used in the residency program. Trainees rated the AG higher in improving operative technique and confidence in the OR (p’s<0.001). Instructors were more likely to recommend use of the AG over the clock (p=0.004). CONCLUSIONS: We showed that an AG overlay used with standardized commands significantly improved instruction and learning during simulated and live laparoscopic cases. Further work will involve the evaluation of the economy of motion and errors while using the overlay. This could lead to the use of a heads-up display for laparoscopic and robotic training. Further exploration of instructor-trainee discourse is necessary when considering the development and implementation of new methods to improve intraoperative teaching in the era of competency-based medical education. Source of Funding: McMaster Surgical Associates, McMaster University, Hamilton, Ontario, Canada © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e833 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kikachukwu Otiono More articles by this author Jennifer Hoogenes More articles by this author Kevin Kim More articles by this author Bobby Shayegan More articles by this author Anil Kapoor More articles by this author Kevin Piercey More articles by this author Edward D. Matsumoto More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Virtual Resources and Effect of COVID-19 Pandemic on Plastic Surgery Residency and Training among Residents in Southern Nigeria.

Despite the increased usage of virtual, nonphysical resources for medical education during the coronavirus disease-2019 (COVID-19) pandemic, plastic surgical training still suffered adversely in some aspects. The aim of this study was to explore the overall impact of virtual resources and effect of the COVID-19 pandemic on plastic surgery training among residents in Southern Nigeria. This was a cross-sectional study conducted among senior plastic surgery residents in southern Nigeria using a well-structured online questionnaire carried out over a 3-month period. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. Measures were taken to significantly minimise response, answer order, and other survey research errors/bias. A pilot study was done. Consent was obtained from all participants. A total of 29 plastic surgery residents completed the questionnaire. Mean age was 35.15 years with standard deviation of 6.31. The response rate was 72.5%. According to a majority of the residents, there were no significant changes in the frequency of burn, hand, and facial injury cases during the pandemic; training courses on plastic surgery (44.3%) and operative cases decreased (48.3%), whereas there was a significant increase in intraoperative teaching (27.6%) as well as simulations and conferences (41.4%). Majority of the respondents also alluded to the significant financial and psychological impacts of the pandemic on residents and a significant decline in cases with general anaesthesia as compared with cases with local anaesthesia. The COVID-19 pandemic has caused a mixture of significant positive and negative changes in the plastic surgery training of residents.

Surgical Resident Perspectives on the Preferred Qualities of Effective Intraoperative Teachers: A Qualitative Analysis.

Intraoperative teaching is a critical component of surgery residents' education. Although prior studies have investigated best practices from the viewpoint of the expert educator, the perspective of the learner has been less explored. This study examined the ideal faculty teaching behaviors that optimize intraoperative teaching from the surgical residents' perspective. Using a grounded theory method, this study explored perspectives on intraoperative faculty teaching qualities of 5 focus groups of categorical clinical general surgical residents of the same postgraduate year from June to August 2021. Focus group discussions were recorded, transcribed, and coded. Emerging themes were identified, along with their corresponding subthemes. Thirty-nine general surgery residents participated in the focus groups. Overall, 6 themes emerged regarding resident priorities of intraoperative teaching, with 10 subthemes. Themes included the following: (1) character, with subthemes of caring, respect for resident, and self-control; (2) intraoperative skill, with subthemes of clinical and operative skill and modeling leadership in the operating room; (3) instructional approach; (4) feedback, with subthemes of content of feedback and debriefing; (5) discernment of resident needs, with subthemes of managing expectations, individualizing instruction, and autonomy; and (6) variety of teachers. Certain tangible strategies, such as demonstrating genuine care for the learner, using clear directional words, and giving actionable feedback, were considered vital by residents. In the development of great surgical educators, the emphasis should not be on conformity to a single idealized teaching style but should celebrate and encourage diversity of personas and teaching styles within a department or program.

Trainee Effect on Procedural Efficiency is Limited in Vascular Surgery Operations

Surgical residents prepare during their training for independent operating experience. However, there is a fine balance between supervised intraoperative teaching and the need to keep operations short since this is associated with improved patient safety. We aim to understand if the composition of the vascular surgical team-presence of anesthesia and surgical trainees as well as the number of circulating nurses-affects elective operative times at our institution. As a secondary aim, we analyzed how time of day affects overall operative time. We performed a retrospective review of all vascular surgery elective operations occurring between January 1, 2019, and October 15, 2021. Our reference operation between procedures was the construction of an arteriovenous fistula (AVF). Reference teams included circulating staff (fewer than two nurses), anesthesia (anesthesiologist with certified registered nurse anesthetist [CRNA]), and surgery (surgeon with nurse practitioner). The primary dependent variable was the time interval in minutes from wheels-in to wheels-out of surgery, which was divided into three subintervals: wheels-in to cut, cut to close, and close to wheels-out. Univariate analysis was performed to examine each surgical procedure's distribution of wheels-in to wheels-out time interval. Linear regression was performed to determine the effect of team composition and time of day on operative durations. We included a total of 853 vascular operations. Regarding overall operative time, different procedures took various amounts of time compared with the reference operation (AVF creation). Amputations and arteriograms were shorter (-30min, P=0.03, and -12min, P=0.05, respectively). Other procedures were longer: endarterectomy (+48min, P<0.01), rib resection (+78min, P<0.01), endovascular aorta repair (+120min, P<0.01), lower extremity bypass (+170min, P<0.01), and open aortic repair (+410min, P<0.01). No significant difference was found in carotid artery stent placement. Overall, there was a significant reduction in the close to wheels-out interval for anesthesiologists with a trainee (mean: -2.4min; 95%; CI: -4.7, -0.12; P=0.04). AVF took significantly more time with a surgical resident: wheels-in to cut time (mean: +4.2min; 95%; CI: 0.92, 7.4; P=0.01) and cut to close time (mean: +13min; 3.2, 23; P<0.01). Arteriogram wheels-in to cut time took longer with a surgeon alone (mean: +5.6; 95%; CI: 0.29, 11; P=0.04). There were no other statistically significant findings with change in composition of the surgical team or changes in start time. General surgery residents generally do not add time to vascular surgery cases but may do so in certain cases, perhaps when they are given more autonomy (i.e. AVF creation). Future studies should look at multiple centers, specific vascular procedures, and level of training to explore whether experience among residents (i.e., intern versus senior resident) and case complexity play a role in procedural length, as this may indirectly affect attending surgeon burnout and patient outcomes.

One size does not fit all: identifying differences in intraoperative teaching preferences of junior versus senior surgical residents

One size does not fit all: identifying differences in intraoperative teaching preferences of junior versus senior surgical residents