Operating Room Experience Research Articles

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards.Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing.Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p < 0.001). Graduates with guided operating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p < 0.001).The research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone.

The role of simulation in urological training – A quantitative study of practice and opinions

IntroductionOver the past few decades, simulation-based training has rapidly been adopted by many centres for effective technical and non-technical skills training, as a supplementary method to traditional operating room experience. The aim of this study is to assess the current practice in training and seek opinion regarding the future role of simulation in urological training. MethodsA cross sectional survey was designed and distributed amongst expert and trainee urological surgeons. The survey consisted of twenty-two questions that were split into three sections; Introduction (6), Technical Skills training in urology (10) and Non-technical skills training in urology (6). ResultsA total of 91 residents and 172 specialists completed the survey. In both groups, there was an agreed consensus that laparoscopic training and exposure was insufficient as only 21% of trainees and 23% of specialists believed that they had sufficient training in this area. Furthermore, both groups lacked simulation-based training in common urological procedures including nephrectomy (62%), cystoscopy (69–74%), ureteroscopy (47–59%), transurethral resection of the prostate (56–65%) and percutaneous renal surgery (76–73%). 90% of trainees and 70% of specialists believed (agreed and strongly agreed) that there is a role for non-technical skills simulation in urological training. ConclusionsSimulation training has been under-used thus far and trainees face an uphill challenge to enhance their skills and technical abilities in the operating room. Simulation is recommended by both trainees and specialists and may represent one of the solutions to the challenges of safe and effective urology procedural training.

Moral Courage in Practice: Implications for Patient Safety

This descriptive correlational study examined moral courage in response to a threat to patient safety. A mailed questionnaire was randomly distributed to Midwest perioperative registered nurses. Multiple regression analysis results indicate that the moral courage in perioperative nurses is significantly influenced by education level, certification, peer support, institutional culture and Magnet® designation, fear of reprisal and retaliation, and previous operating room experience. Significant findings clustered influencing factors of fear, previous experience, peer support, and institutional culture. Future research is indicated for supportive nursing management and policy creation promoting moral courage in situations that threaten patient safety in the perioperative area.

The use of a virtual reality surgical simulator for cataract surgical skill assessment with 6 months of intervening operating room experience

PurposeTo evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia).MethodsThis prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up.ResultsFour variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0–100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed.ConclusionAn interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool.

Method for Single Intravenous Anesthetic Infusion in a Rodent Model

Venous catheterization, endotracheal intubation, and mechanical ventilation are necessary for performing total intravenous general anesthesia in rats. Intubation and IV cannulation of the rat is challenging because of the animals’ small size and the lack of equipment specifically designed for the restricted anatomical dimensions. Here, we present methods for tail venous catheterization and intubation that are quickly learned by the provider with clinical operating room experience but lack experience in the lab. For tail venous catheterization, each rat (n = 20) was gently restrained in a rat chamber; its tail was placed in warm water for 10 minutes, and a 24 gauge intravenous catheter was inserted into the lateral tail vein. The catheter was fixed in place using tape and attached to a T-connector for drug administration. A bolus of propofol (n = 10), ketamine (n = 7), or etomidate (n = 3) was administered to achieve rapid deep anesthesia. Once anesthetized, rats were intubated with the aid of a modified pediatric laryngoscope. The standard miller blade 0 was cut on each side for approximately 2/3 of the total blade length to remove a total of half the width. After the ventilator was properly set, the rats’ vital signs and metabolic status were monitored. Throughout the one-hour infusion, the rats’ physiologic parameters were maintained within normal range. These results indicate that intravenous general anesthesia can be performed effectively and safely in small animals using the refined catheterization and intubation methods tested in this study. These techniques are easily reproducible and learned as they mimic the tools and strategies commonly used in the OR.

Effects of the reduction of surgical residents' work hours and implications for surgical residency programs: a narrative review.

BackgroundThe widespread implementation of resident work hour restrictions has led to significant alterations in surgical training and the postgraduate educational experience. We evaluated the experience of surgical residency programs as reflected in the literature from 2008 onward in order to summarize current challenges and identify key areas in need of further research.MethodsWe searched MEDLINE and EMBASE for English-language articles published from January 2008 to December 2011 related to work hour restrictions in surgical residency programs, including those pertaining to personal well-being, education and training, patient care, and faculty experiences.ResultsWe retrieved 240 unique abstracts and included 24 studies in the current review. Of the 10 studies examining effects on operating room experience, 4 reported negative or mixed outcomes and 6 reported neutral outcomes, although non-compliance was demonstrated in 2 of these studies. Effects on surgical faculty perceptions were consistently reported as negative, while the effect on patient outcomes and professionalism were found to be neutral and unchanged.ConclusionsFurther studies are needed to characterize operative experience at varying levels of training, particularly in the context of strict adherence to new work hours. Research that examines the effect of the work hour limitations on professionalism and non-operative educational activities, such as reading and simulation-based training, as well as sign-over practices, would also be of benefit.

Assessment of nursing students' stress levels and coping strategies in operating room practice

The aim of this study was to evaluate the stress levels and stress coping strategies of nursing students in their first operating room experience. This descriptive study was done with 126 nursing students who were having an experience in an operating room for the first time. Data were collected by using Personal Information Form, Clinical Stress Questionnaire, and Styles of Coping Inventory. The nursing students mostly had low clinical stress levels (M = 27.56, SD = 10.76) and adopted a self-confident approach in coping with stress (M = 14.3, SD = 3.58). The nursing students generally employed a helpless/self-accusatory approach among passive patterns as their clinical stress levels increased, used a self-confident and optimistic approach among active patterns as their average age increased, and those who had never been to an operating room previously used a submissive approach among passive patterns. The results showed that low levels of stress caused the nursing students to use active patterns in coping with stress, whereas increasing levels of stress resulted in employing passive patterns in stress coping. The nursing students should be ensured to maintain low levels of stress and use active patterns in stress coping.

Perceptions, Training Experiences, and Preferences of Surgical Residents Toward Laparoscopic Simulation Training: A Resident Survey

Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory. A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The simulation laboratory was most commonly used during work hours; lack of free time during work hours was most commonly cited as a reason for underutilization. Factors influencing use of the simulation laboratory in order of importance were the need for skill development, an interest in minimally invasive surgery, mandatory/protected time in a simulation environment as part of the residency program curriculum, a recommendation by an attending surgeon, and proximity of the simulation center. The most preferred simulation tool was the live animal model followed by cadaveric tissue. Virtual reality simulators were among the least-preferred (25%) simulation tools. Most residents (91.0%) felt that mandatory/protected time in a simulation environment should be introduced into resident training protocols. Mandatory and protected time in a simulation environment as part of the resident training curriculum may improve participation in simulation training. A comprehensive curriculum, which includes the use of live animals, cadaveric tissue, and virtual reality simulators, may enhance the laparoscopic training experience and interest level of surgical trainees.

ACGME and ABOS Changes for the Orthopaedic Surgery PGY-1 (Intern) Year

The Accreditation Council for Graduate Medical Education (ACGME) and American Board of Orthopaedic Surgery (ABOS) recently mandated major changes to curricular requirements for the PGY-1 (intern) year for categorical orthopaedic surgery residents. Since July 1, 2013, PGY-1 residents are required to have 6 months of orthopaedic surgery rotations, 6 months of nonorthopaedic surgery rotations, and complete a mandatory surgical skills curriculum [1, 2]. The ACGME and ABOS executed these changes in an effort to improve the quality and breadth of education for interns, preparing them for more advanced orthopaedic education. These changes were prompted by shifts in general surgery procedures (from open to laparoscopic), which have reduced the operating room experience of suturing and knot tying for interns, as well as by duty hour requirements that further reduce the operating room experience for interns. Together, these shifts in first-year resident experience have resulted in less surgical training for the orthopaedic surgery intern. The new ABOS requirements, which commence on July 1, 2014, seek to offset those losses [1, 2]. This column describes the changes mandated by the ABOS and ACGME for the orthopaedic intern year, discusses some limitations associated with these changes, and offers program strategies for effective implementation.

Northwestern University Feinberg School of Medicine Uses Operations Research Tools to Improve Surgeon Training

Since the advent of work-hour limitations for surgical trainees, medical faculties have been concerned by inadequacies in two areas of resident training programs: operating room experience, which residents need to develop competence and confidence during surgery, and continuity of patient care, which engenders in residents a sense of responsibility and accountability. Previous operations research literature on resident scheduling models has discussed the development of mathematical programming models that assign residents to rotations or shifts; however, this literature has neglected the educational component. In this work, we frame the problem from an educational perspective, and we also describe the mathematical details behind several ideas and analyses in the medical literature. In addition, we present the patient assignment system, which we piloted at a large academic medical center, and discuss the relationship between the logistical and cultural challenges faced in medical training.

Quantifying Factors Influencing Operating Theater Teaching, Participation, and Learning Opportunities for Medical Students in Surgery

Operating room experience offers a unique learning resource, potentially exposing medical students to surgical disease and treatments, use of anesthesia, basic science, team working, and communication skills. However, the alien nature of this environment to newcomers poses particular difficulties in harnessing this resource. This study aimed to assess the operating theater-based teaching and learning experiences of new medical graduates during their medical school course. A 41-item, self-administered questionnaire survey was distributed to newly qualified medical school graduates from 1 university consisting of 5 separate teaching hospitals. Results were analyzed using GraphPad Prism 5.0. Questionnaires were returned by 209 of 312 graduates (67%). Overall, 121 (59%) respondents attended ≤50% of opportunities available to attend operating theater; 47% felt they knew what was expected of them when attending and only 13% had specific learning objectives set. An interest in pursuing a surgical career was stated by 24 (12%) respondents; this group was more likely to have attended ≥50% of operating theater opportunities (p = 0.0064). Those not intending to pursue a surgical career were more likely to have been discouraged by their experiences (p = 0.0001). Active participation while scrubbed, knowing what was expected, being made to feel welcome, and being set learning objectives were all significantly positively correlated with attendance. Although female respondents felt equally welcome, in comparison with their male colleagues, they were more likely to receive negative comments (p = 0.0106). The majority of respondents (80%) stated that attendance at operating theater sessions should be a mandatory component of the curriculum. Although operating theater attendance is recognized as an important component of the medical school curriculum, overall attendance at sessions was low. Attendance could be increased by ensuring students knowing what is expected of them, making them feel welcome, setting learning objectives, and allowed them to actively participate. These results highlight the need to ensure that the time spent by medical students in the operating room is positive and maximized to its full potential through structured learning involving all members of the theater team.

Evaluation of the Orcamp Hybrid High-fidelity Environment for Simulation Training

e l l a “ e o a c c e c In the accompanying article examining operator appraisal of a high-fidelity procedure suite, Lonn et al (1) contend that simulation-based learning is enhanced by performing that training in a room that is made as close as possible to a real procedure suite or operating room by the use of a simulated procedural environment that includes a physical mockup of a C-arm and operating table. The authors describe face and content validity studies on an Orcamp room (Orzone, Gothenburg, Sweden), which housed a full-physics Vascular Instructional System Trainer virtual reality simulator (Mentice, Gothenburg, Sweden). (Full disclosure: I was the medical leader of the team that developed the Vascular Instructional System Trainer, but I have no conflicts of interest related to its invention.) The quantitative evaluation studies in this study (1) are performed on the space surrounding the simulator, not on the simulator itself, which has undergone numerous rigorous validity studies. Similar reports about the Orcamp system, but in the context of an operating room, have been reported at the Vascular and Endovascular Issues, Techniques and Horizons Symposium (2). The authors show high user ratings for the functionality and realism of the C-arm and “operating table” among a subject group of radiologists and cardiologists. Separately, they also show statistically significantly positive assessment ratings for the realism of the catheter, guide wire, fluoroscopy image, and physiologic readouts displayed by the simulator. However, these are two different categories of variable. The image display, fluoroscopic realism, physiologic monitoring, and catheter and guide wire realism are all components of the physics built into the simulator. Indeed, interactive real-time synthetic fluoroscopy was first created for this machine (3). Establishing face and content validity for the device that looks and acts like a C-arm and an operating table is the most base level of assessment of those objects. The authors conclude by stating that the hybrid operating room experience provides a higher fidelity level of training in a realistic context or the procedure suite (1). Yet,

The Value of Operating Room Experience in Post Operative Pain Management

Since the removal of perioperative nursing from the core undergraduate curriculum questions have been raised regarding the acquisition of pre and postoperative surgical knowledge including patient education, pre and postoperative care, asepsis and pain management.

Minimally Invasive Apical Sacropexy

Minimally invasive apical sacropexies (MI-APSC) can be performed using robotics or laparoscopy. We hypothesized that operative characteristics of MI-APSC, laparoscopic (LSC) and robotic (RSC), were similar. The objective of our study was to compare operative characteristics, objective prolapse outcomes, and robotic learning curve. Ninety-two women planning MI-APSC for treatment of apical pelvic organ prolapse from 2006 to 2010 were included in the study. The primary outcome was operative time. The secondary outcomes included estimated blood loss, rate of conversion, intraoperative complications, hospital stay, and objective prolapse outcome. We also analyzed the robotic learning curve. Statistical analysis included independent samples t test, Wilcoxon rank sum test, χ, and multiple logistic regressions; significance was set at P < 0.05. Learning curve was graphed with moving average and analyzed with moving block technique. Forty-eight RSCs and 43 LSCs were analyzed. Mean operative times were LSC, 238 ± 59 minutes; and RSC, 242 ± 54 minutes. Robotic MI-APSC setup was longer (P = 0.02). Complications, conversions, estimated blood loss and hospital stay were low and similar between groups. Patients' characteristics were similar. Concomitant procedures produced longer operative times. Operating room experiences with laparoscopic- and robotic-assisted approaches to MI-APSC were similar, but setup time is longer for the robotic-assisted approach. The robotic learning curve is short for surgeons who have experience with LSC.

Early Explorers: Exposing Pre-clinical Students to the Operating Room Experience

Early Explorers: Exposing Pre-clinical Students to the Operating Room Experience

Developing a model of competence in the operating theatre: Psychometric validation of the Perceived Perioperative Competence Scale-Revised

Aim This paper describes the development and validation of the Revised Perioperative Competence Scale (PPCS-R). Background There is a lack of a psychometrically tested sound self-assessment tools to measure nurses’ perceived competence in the operating room. Methods Content validity was established by a panel of international experts and the original 98-item scale was pilot tested with 345 nurses in Queensland, Australia. Following the removal of several items, a national sample that included all 3209 nurses who were members of the Australian College of Operating Room Nurses was surveyed using the 94-item version. Psychometric testing assessed content validity using exploratory factor analysis, internal consistency using Cronbach's alpha, and construct validity using the “known groups” technique. During item reduction, several preliminary factor analyses were performed on two random halves of the sample ( n = 550). Results Usable data for psychometric assessment were obtained from 1122 nurses. The original 94-item scale was reduced to 40 items. The final factor analysis using the entire sample resulted in a 40 item six-factor solution. Cronbach's alpha for the 40-item scale was .96. Construct validation demonstrated significant differences ( p < .0001) in perceived competence scores relative to years of operating room experience and receipt of specialty education. Conclusions On the basis of these results, the psychometric properties of the PPCS-R were considered encouraging. Further testing of the tool in different samples of operating room nurses is necessary to enable cross-cultural comparisons.

Effect of the ACGME Duty Hours Restrictions on Surgical Residents and Faculty: A Systematic Review

Educators in surgical training programs are concerned that the Accreditation Council for Graduate Medical Education (ACGME) duty hours limitations may adversely affect surgical residents' education, especially their operative experience, so the authors aimed to evaluate the impact of duty hours reductions on surgical residency. The authors searched English- and French-language literature (2000-2008) for articles about the impact of duty hours restrictions on surgical residents' education and well-being and on faculty educators. They used the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ERIC. The authors included every report that examined the effects of duty hours limits on surgical training, excluding opinion papers and editorials. Two reviewers independently performed data extraction and quality assessment for all reports and resolved disagreements by consensus. The authors retrieved 1,146 reports and included 56 in the study. They compiled positive and negative outcomes on (1) residents' education, (2) resident lifestyle, and (3) surgical faculty. Overall, the effects of duty hours reductions on residents' education and lifestyle were positive or neutral, but the effects on surgical faculty were negative. The 16 articles with the highest-quality scores had 27 positive themes and 11 negative themes. This is the largest and most current review of the literature addressing the effect of the ACGME duty hours limitations on surgical training. Limitations had a positive effect on residents but a negative effect on surgical faculty. Importantly, duty hours limitations did not adversely affect surgical residents' operating-room experience.

Leveraging Operating Room Experience to Improve Hospital Throughput and Quality

Leveraging Operating Room Experience to Improve Hospital Throughput and Quality

Content validation of a novel robotic surgical simulator

• To assess the content validity of an early prototype robotic simulator. Minimally invasive surgery poses challenges for training future surgeons. The Robotic Surgical Simulator (RoSS) is a novel virtual reality simulator for the da Vinci Surgical System. • Participants attending the 2010 International Robotic Urology Symposium were invited to experience RoSS. Afterwards, participants completed a survey regarding the appropriateness of the simulator as a teaching tool. • Forty-two subjects including surgeons experienced with robotics (n= 31) and novices (n= 11) participated in this study. • Eighty per cent of the entire cohort had an average of 4 years of experience with robot-assisted surgery. • Eleven (26%) novices lacked independent robot-assisted experience. The expert group comprised 17 (41%) surgeons averaging 881 (160-2200) robot-assisted cases. Experts rated the 'clutch control' virtual simulation task as a good (71%) or excellent (29%) teaching tool. • Seventy-eight per cent rated the 'ball place' task as good or excellent but 22% rated it as poor. • Twenty-seven per cent rated the 'needle removal' task as an excellent teaching tool, 60% rated it good and 13% rated it poor. • Ninety-one per cent rated the 'fourth arm tissue removal' task as good or excellent. • Ninety-four per cent responded that RoSS would be useful for training purposes. • Eighty-eight per cent felt that RoSS would be an appropriate training and testing format before operating room experience for residents. • Seventy-nine per cent indicated that RoSS could be used for privileging or certifying in robotic surgery. • Results based on expert evaluation of RoSS as a teaching modality illustrate that RoSS has appropriate content validity.

Educational value of the operating room experience during a core surgical clerkship

Background The amount and content of medical student teaching in the operating room and its alignment with clerkship goals was unknown. Methods A qualitative research design using field observations, followed by qualitative and quantitative data coding and analysis. Results A mean of 9.8% of the total case time (range 1.6%–20.2%) was spent teaching clerkship goals. Teaching strategies based on basic principles of learning were used during a mean of 66% of the total case time (range 30%–99%). The most common teaching strategy was active student participation (28%) followed by command (14%) and lecture (13%). Educational experience in the OR was rated 4.0 (out of 5) by faculty and 3.3 by students. No correlation existed between student satisfaction and time actively participating in the operation or time spent teaching to clerkship goals ( P = .66, P = .95, respectively). Conclusion Teaching in the OR is more focused on technical aspects of the operation than the goals of a core surgery clerkship.