Open Surgical Skills Research Articles

The influence of musical experience on laparoscopic surgical skill performance: an original investigation and literature review.

As the needs and curricula of surgical residencies evolve, recent studies have focused on identifying factors that may be related to faster and more efficient surgical skill acquisition, such as experience with playing video games, sports, and other dexterous activities. The aim of this study was to elucidate the relationship between instrumental musical experience and laparoscopic surgical skill performance as well as to provide an overview of the available literature on this topic. A query from database inception to January 2023 of the PubMed database for literature discussing the association of musical experience and surgical skills was conducted. One hundred and twelve publications were sorted for relevance, yielding 16 included studies. The details of these studies were organized in a table and further analyzed. Study participants answered several questions regarding their personal instrumental musical experience and rotated through two minimally invasive surgery (MIS) skills stations. Participants received a score for each station based on level of performance. Descriptive statistics as well as non-parametric analyses and Spearman's correlations were calculated when appropriate to determine any associations between musical experience and laparoscopic surgical skill performance. One hundred individuals participated in the study. Fifty-one of the participants indicated that they played at least one musical instrument, and twelve (9.0%) of these individuals played more than one instrument. There was no statistically significant difference or correlation in scores between individuals that played an instrument and those that did not (p > 0.05). Playing a greater number of instruments did not significantly correlate with increased performance (p > 0.05). There was also no statistically significant difference or correlation in scores within the group that played instruments based on instrument type or number of years playing an instrument (p > 0.05). Experience playing musical instruments did not confer an advantage in MIS skills tested in the present study.

The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training

PurposeThe purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents’ laparoscopic skills.MethodsThe study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data.ResultsThe hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training.ConclusionThe PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed.Trial registrationThis trial was retrospectively registered on clinicaltrials.gov (NCT06301230).

Transferability of motor skills from piano training to learning new laparoscopic surgical skills

There is a widely held belief that musicians make better surgeons based on the far transfer of their established fine motor skills when learning new surgical skills. There is, however, a deficit of quantified knowledge on the transfer of fine motor skills from one domain of expertise to another. In this study, pianists and controls were provided with daily laparoscopic training sessions for five consecutive days. Each session consisted of six tasks on a Train Anywhere Skill Kit laparoscopic training box. Performance was evaluated each day and retention was evaluated one week later by measuring the speed and accuracy of task completion. Except for the bead to peg transfer task, no statistical differences were found between participant groups. The only significant confounding variable was that the control group was more interested in surgery than the musician group (p = .037). This research addressed limitations of previous studies by measuring the long-term performance and retention of laparoscopic surgical skills. The results of this study demonstrate that, contrary to expectations, piano performance training did not far transfer to laparoscopic surgery. Our findings indicate that fine motor skills are domain specific to music and surgery, respectively.

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

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

Laparoscopic but not open surgical skills can be transferred to robot-assisted surgery: A systematic review and meta-analysis.

With an increase in robot-assisted surgery across all specialties, adequate training and credentialing strategies need to be identified to ensure patients safety. The meta-analysis assesses the transferability of technical surgical skills between laparoscopic surgery, open surgery, and robot-assisted surgery. A systematic search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Outcomes were categorized into time, process, product, and composite outcome measures and pooled separately using Hedges'g (standardized mean difference [SMD]). Subgroup analyses were performed to assess the effect of study design, virtual reality platforms and task difficulty. Out of 14,120 screened studies, 30 were included in the qualitative synthesis and 26 in the quantitative synthesis. Technical surgical skill transfer was demonstrated from laparoscopic to robot-assisted surgery (composite: SMD 0.40, 95%-confidence interval [CI] [0.19; 0.62], time: SMD 0.62, CI [0.33; 0.91]) and vice versa (composite: SMD 0.66, CI [0.33; 0.99], time [basic skills]: SMD 0.36, CI [0.01; 0.72]). No skill transfer was seen from open to robot-assisted surgery with limited available data. Technical surgical skills can be transferred from laparoscopic to robot-assisted surgery and vice versa. Robot-assisted and laparoscopic surgical skills training and credentialing should not be regarded separately, but a reasonable combination could shorten overall training times and increase efficiency. Previous experience in open surgery should not be considered as an imperative prerequisite for training in robot-assisted surgery. Recommendations for studies assessing skill transfer are proposed to increase comparability and significance of future studies. PROSPERO CRD42018104507.

Is participation enough? Impact of simulation curriculum structure on performance of basic surgical skills

PurposeThe optimal strategy for curricular construction and feedback implementation, both critical for skill acquisition, is unknown in the simulation curricula setting. To address this gap, we examined the impact of individual components of our basic surgical skills curriculum on intern performance.MethodsThe basic surgical skills curriculum consists of skills lab sessions, self-recorded “homework” exercises graded with a score and narrative feedback, and a scored final assessment. Using linear regression, we assessed the association between assessment performance (scores) and four other curricular components (skills lab attendance, homework submission, homework scores, and receipt of feedback on homework). Narrative feedback quality was graded by three raters for relevance, valence, and specificity. Pearson’s r was used to calculate the association of each feedback variable with the assessment score.ResultsAmong the 71 (73%) surgical interns who completed the curriculum, for each additional homework assignment that received structured feedback, assessment score increased by 0.54% (p < 0.001; effect size 0.16). For each percentage point increase in homework score, assessment score increased by 0.21% (p = 0.02; effect size 0.07). Pearson’s r revealed significant correlations between assessment score and relevant feedback (r = 0.26, p = 0.02), relevant feedback and corrective feedback (r = 0.70, p < 0.001), and between relevant and specific feedback (r = 0.74, p < 0.001). Relevant feedback comments were not correlated with reinforcing feedback (r = 0.01, p = 0.47).ConclusionsOur findings reiterate the value of practice when accompanied by relevant feedback. We identified a default to providing lower-quality reinforcing feedback and higher-quality corrective feedback. Future feedback training may yield positive results.

Effectiveness and learning experience from undergraduate nursing students in surgical nursing skills course: a quasi- experimental study about blended learning

BackgroundBlended learning is increasingly being adopted, and yet a gap remains in the related literature pertaining to its skill performance, learning engagement and inner experience in undergraduate surgical nursing skills course.ObjectivesTo investigate the changes in skills performance and learning engagement in the application of blended learning, and what it actually brings to nursing students.DesignThe study uses a historical control, two-armed, mixed and quasi-experimental design.MethodsThe blended learning version of the course was offered to the 2019 class of 334 nursing undergraduates. Quantitative and qualitative data were collected after the course to obtain a comprehensive understanding of the course effects compared with the 304 nursing undergraduates of grade 2017 who adapted traditional learning. Quantitative data were analyzed by descriptive and inferential statistics using IBM SPSS 26.0, and qualitative data were encoded using Nvivo11.0.ResultsThere were significant differences in skill performance and learning engagement between the class of 2017 and 2019 (p < 0.001). Combined with further analysis of the interview data, 3 first-level nodes and 8 secondary nodes were determined. Students’ opinions, comments and suggestions on the application of blended learning are refreshing.ConclusionMoving forward with blended learning: opportunities and challenges go hand in hand. Researchers need to continually modify their research designs to respond to variable educational environments.

A Study of Surgical Residents' Self-Assessment of Open Surgery Skills Using Gap Analysis.

Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments. We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills. The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study. We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15-18] vs. 20 [range, 19.75-22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75-14] vs. 15 and median 20.5 [range, 19-22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains. Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.

The transferability of laparoscopic and open surgical skills to robotic surgery

BackgroundWithin the last decades, robotic surgery has gained popularity. Most robotic surgeons have changed their main surgical activity from open or laparoscopic without prior formal robotic training. With the current practice, it is of great interest to know whether there is a transfer of surgical skills. In visualization, motion scaling, and freedom of motion, robotic surgery resembles open surgery far more than laparoscopic surgery. Therefore, our hypothesis is that open-trained surgeons have more transfer of surgical skills to robotic surgery, compared to surgeons trained in laparoscopy.MethodsThirty-six surgically inexperienced medical students were randomized into three groups for intensive simulation training in an assigned modality: open surgery, laparoscopy, or robot-assisted laparoscopy. The training period was, for all study subjects, followed by performing a robot-assisted bowel anastomosis in a pig model. As surrogate markers of surgical quality, the anastomoses were tested for resistance to pressure, and video recordings of the procedure were evaluated by two blinded expert robotic surgeons, using a global rating scale of robotic operative performance (Global Evaluative Assessment of Robotic Skills (GEARS)).ResultsThe mean leak pressure of bowel anastomosis was 36.25 (7.62–64.89) mmHg in the laparoscopic training group and 69.01 (28.02–109.99) mmHg in the open surgery group, and the mean leak pressure for the robotic training group was 108.45 (74.96–141.94) mmHg. The same pattern was found with GEARS as surrogate markers of surgical quality. GEARS score was 15.71 (12.37–19.04) in the laparoscopic training group, 18.14 (14.70–21.58) in the open surgery group, and 22.04 (19.29–24.79) in the robotic training group. In comparison with the laparoscopic training group, the robotic training group had a statistically higher leak pressure (p = 0.0015) and GEARS score (p = 0.0023). No significant difference, for neither leak pressure nor GEARS, between the open and the robotic training group.ConclusionIn our study, training in open surgery was superior to training in laparoscopy when transitioning to robotic surgery in a simulation setting performed by surgically naive study subjects.

Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-Based Novel Curriculum

The increase in minimally invasive surgical procedures has eroded exposure of general surgery residents to open operations. High-fidelity simulation, together with deliberate instruction, is needed for advanced open surgical skill (AOSS) development. To collect validity evidence for AOSS tools to support a shared model for instruction. This prospective cohort study included postresidency surgeons (PRSs) and second-year general surgery residents (R2s) at a single academic medical center who completed simulated tasks taught within the AOSS curriculum between June 1 and October 31, 2021. The AOSS curriculum includes 6 fine-suture and needle handling tasks, including deep suture tying (with and without needles) and continuous suturing using the pitch-and-catch and push-push-pull techniques (both superficial and deep). Teaching and assessment are based on specific microskills using a 3-dimensional printed iliac fossa model. The PRS group was timed and scored (5-point Likert scale) on 10 repetitions of each task. Six months after receiving instruction on the AOSS tasks, the R2 group was similarly timed and scored. The PRS group included 14 surgeons (11 male [79%]; 8 [57%] attending surgeons) who completed the simulation; the R2 group, 9 surgeons (5 female [55%]) who completed the simulation. Score and time variability were greater for the R2s compared with the PRSs for all tasks. The R2s scored lower and took longer on (1) deep pitch-and-catch suturing (69% of maximum points for a mean [SD] of 142.0 [31.7] seconds vs 77% for a mean [SD] of 95.9 [29.4] seconds) and deep push-push-pull suturing (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 85% for a mean [SD] of 141.4 [29.1] seconds) relative to the corresponding superficial tasks; (2) suture tying with a needle vs suture tying without a needle (74% of maximum points for a mean [SD] of 64.6 [19.8] seconds vs 90% for a mean [SD] of 54.4 [15.6] seconds); and (3) the deep push-push-pull vs pitch-and-catch techniques (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 69% of maximum points for a mean [SD] of 142.0 [31.7] seconds). For the PRS group, time was negatively associated with score for the 3 hardest tasks: superficial push-push-pull (ρ = 0.60; P = .02), deep pitch-and-catch (ρ = 0.73; P = .003), and deep push-push-pull (ρ = 0.81; P < .001). For the R2 group, time was negatively associated with score for the 2 easiest tasks: suture tying without a needle (ρ = 0.78; P = .01) and superficial pitch-and-catch (ρ = 0.79; P = .01). The findings of this cohort study offer validity evidence for a novel AOSS curriculum; reveal differential difficulty of tasks that can be attributed to specific microskills; and suggest that position on the surgical learning curve may dictate the association between competency and speed. Together these findings suggest specific, actionable opportunities to guide instruction of AOSS, including which microskills to focus on, when individual rehearsal vs guided instruction is more appropriate, and when to focus on speed.

TU6.4 Inspiring future surgeons: comparing open vs laparoscopic simulated surgical skills

Abstract Background Applications to surgical training are declining. Whilst early introduction to surgical specialities may develop interest, medical schools do not place enough emphasis on the growing trend towards performing laparoscopic procedures. We hypothesised that exposing medical students to laparoscopy would stimulate an interest in pursuing a surgical career. Methods Clinical medical students were randomised into two groups: Laparoscopic skills with box trainer and open surgical skills. Each session lasted one hour and was organised and conducted by the same tutors. Prior to participation in the teaching session, each student completed a pre and post event questionnaires regarding their speciality interest. Results A total of 45 students participated. 18 (33%) expressed an interest in a surgical career prior to the event. After the session, 15/23 (65%) of students who participated in the laparoscopic skills session expressed an interest in a career in surgery. The open surgical skills group had a positive response from 9/22 (41%) with respect to a career in surgery. Conclusions Participation in our surgical skills course increased interest in pursuing a surgical career amongst clinical medical students. Of note, our laparoscopic skills session increased interest more in comparison to an open surgical skills session. Our study highlights the importance of introducing laparoscopy simulation to the medical school curriculum in order to maintain interest towards the surgical specialities.

The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management.

Background/AimsTo produce an internationally developed rubric to assess surgical competency in open globe management.MethodsAn international expert panel of seven ophthalmologist educators developed a standardized competency-based rubric. The steps to perform an open globe repair were outlined. Based on a modified Dreyfus model, the experts agreed on the steps of surgery and certain global indices. They then assigned descriptors for the competency expected of a novice, beginner, advanced beginner, and competent surgeon. The tool was then vetted by another panel of ten ophthalmologists. The main outcome measure was the final version of the tool as agreed upon by the expert review panel.ResultsThe steps of open globe repair and key global indices were established. Descriptive wording for each step and global indices for novice, beginner, advanced beginner, and competent surgery were listed. All the expert comments were integrated to establish face and content validity.ConclusionThis standardized rubric to evaluate resident competency should be used globally in training programs to assess open globe repair surgical skills. Using a modified Dreyfus model, four different levels of training competency were defined allowing a non-biased, objective, numerical and simple assessment.

Developing a longitudinal database of surgical skills performance for practicing surgeons: A formal feasibility and acceptance inquiry

BackgroundWe explored the feasibility and surgeons’ perceptions of the utility of a longitudinal skills performance database. MethodsA 10-station surgical skills assessment center was established at a national scientific meeting. Skills assessment volunteers (n = 189) completed a survey including opinions on practicing surgeons’ skills evaluation, ethics, and interest in a longitudinal database. A subset (n = 23) participated in a survey-related interview. ResultsNearly all participants reported interest in a longitudinal database and most believed there is an ethical obligation for such assessments to protect the public. Several interviewees specified a critical role for both formal and informal evaluation is to first create a safe and supportive environment. ConclusionsParticipants support the construction of longitudinal skills databases that allow information sharing and establishment of professional standards. In a constructive environment, structured peer feedback was deemed acceptable to enhance and diversify surgeon skills. Large scale skills testing is feasible and scientific meetings may be the ideal location.

182 Surgical Simulator Design, What are Educators and Trainees Requirements?

Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to enable trainees to learn technical skills, practice skills and to be assessed in competency exams, need to be of the highest standard and to be of consistent design. Input into the design and makeup of task trainers used to teach surgical skills come from a multitude of sources. Enquiry into the perspectives of simulation has been described in the past but there is little description, in the literature, of the expectations of the desired features of the simulator itself.This study investigates the perceived requirements of simulation and simulators used to acquire skills in the surgical field, particularly in limb exploratory procedures in trauma.This study concentrated on the implementation and desired features of simulators for the acquisition of surgical technical skills.Semi-structured interviews were conducted until data saturation was achieved. An international group of 11 surgical educators and 11 surgical trainees, who had experience with surgical simulation, were interviewed via one-to-one video calls. The interviews focussed on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. This study concentrated on synthetic and virtual reality simulators for open surgical skills, as these types of simulators are open to design and redesign or adaptation. Interviews were recorded, transcribed and underwent thematic analysis. Ethical approval was obtained for this study.Analysis of the perspectives of surgical educators and surgical trainees on simulated training in open surgery yielded three main themes: (1) attitudes to simulation, (2) implementing simulation, (3) features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt that simulation could be improved with increased accessibility and a variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost-effectiveness, easy setup and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.There is a clear positive appetite for the incorporation of simulation into general surgical and limb trauma training. The findings of this will inform the optimal requirements for high-quality implementation of simulation into a surgical trauma curriculum. The findings will inform the optimal features desired in a simulator or task trainer design. The aim is to inspire a more considered design approach to optimize surgical skills training and ultimately lead to increased patient safety.

Combined subtemporal and pterional approach for clipping of multiple aneurysms

Background: Despite ongoing improvements in endovascular techniques, open surgical management of basilar apex aneurysms is occasionally necessary.[2] Critical dissection of perforating vessels from the aneurysm is facilitated by the lateral trajectory of the subtemporal approach.[1] Incorporation of additional trajectories can facilitate treatment of multiple aneurysms within the same procedure.Case Description: A 48-year-old woman presented with a Hunt and Hess 1 and Fisher Grade 3 subarachnoid hemorrhage from a small and broad-necked basilar apex aneurysm that was not amenable to endovascular management. An unruptured left A1-A2 anterior cerebral artery aneurysm was also noted on vascular imaging. The patient underwent a combined right subtemporal and pterional approach for sequential clipping of the basilar and anterior communicating artery aneurysms. The third nerve, running between the posterior cerebral artery and the superior cerebellar artery, guided dissection to the basilar artery in the subtemporal approach. A temporary clip was placed on a vessel-free zone of the basilar trunk during dissection of perforators off the posterior aspect of the aneurysm dome. A fenestrated clip around the right P1 segment was used to ensure complete occlusion of the aneurysm. Indocyanine green angiography was used to confirm successful clipping and patency of parent and perforating vessels. The unruptured A1-A2 aneurysm was clipped without difficulty from the pterional trajectory. The patient had an uneventful postoperative recovery with the exception of transient right third nerve palsy.Conclusion: As highlighted by this case, maintenance of open surgical skills for the treatment of complex aneurysms unamenable to endovascular therapies is critical.

Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees

BackgroundSimulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma.MethodsSemi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis.ResultsAnalysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.ConclusionThere is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design.

The Impact of Simulation Training on Operative Performance in General Surgery: Lessons Learned from a Prospective Randomized Trial

Practice in the simulated environment can improve surgical skills. However, the transfer of open complex surgical skills to the operating room is unclear. This study evaluated the effect of resident operative performance following a simulation experience on a hand-sewn small bowel anastomosis and determined the impact of utilizing proficiency-based training. Nine categorical interns performed a hand-sewn small bowel anastomosis in the operating room prior to (pre-test) and following (post-test) a 3-h simulation training session with an assessment at the end. Participants were randomly assigned to 1of 2 simulation training groups: proficiency-based or standard. Operative performance was videotaped. 2 independent, blinded faculty surgeons assessed performances by a global rating scale. Pre- and post-confidence levels were obtained on a 5-point Likert scale. Overall, pre-test and post-test operative performance was similar (3 [IQR, 2.5 -3.5] versus 3 [IQR, 3 -3], P=0.59). Furthermore, no difference was observed in the post-test performance with proficiency-based or standard training (3 [IQR, 3 -3] versus 3 [IQR, 3 -3], P=0.73). Self-reported confidence with the skills, however, significantly improved (median 1 versus 4, P=0.007). In this prospective, randomized study, we did not observe an improvement in operative performance following simulation instruction and assessment, with both training groups. Overcoming barriers to skills transfer will be paramount in the future to optimize simulation training in general surgery. These findings highlight the importance of continued study for the ideal conditions and timing of technical skills training.

Feasibility and Utility of Mobile Applications for the Evaluation of Urology Residents’ Surgical Competence

To provide real-time assessment and feedback on the competency of urology residents' surgical skill via mobile applications and examine their feasibility and utility. Two mobile application-based systems (SIMPL and myTIPreport) were sequentially implemented for the case-by-case assessment of residents' performance of surgical skills at a single institution. Data was collected regarding residents' perception of their feedback pre- and post-implementation of the applications. Faculty were surveyed after their implementation to determine their feasibility and utility. 297 individual evaluations were completed with SIMPL and 822 with myTIPreport over four and eleven months respectively. Post-implementation, residents showed significantly improved perceptions regarding the quantity and personalization of surgical skill feedback (P = .043 and .005 respectively). A majority (75%) of the faculty found the mobile applications feasible to use, an improvement compared to prior methods of resident evaluation, and would recommend continued use. This study represents the first documented use of real-time surgical competency assessment in urology. The use of mobile applications to evaluate urology residents' surgical competency in clinical practice is both feasible and useful. Their use may allow for more individualized surgical skill teaching during training and for the verification of the surgical skills necessary to practice autonomously.

Mind Games: When Do Medical Student Career Aspirations Correlate With Simulated Surgical Skills Station Performance?

A high level of technical ability is required of vascular surgeons. Medical students pursuing integrated vascular residency programs have limited surgical skills to demonstrate compared with traditional vascular surgery fellowship candidates. As the number of integrated vascular training programs continues to increase, it will become increasingly important to determine if the performance of basic surgical skills provides any indication of which integrated candidates have innate technical ability.

Learning Curve Analysis for Complex Open Abdominal Aortic Aneurysm Repair

Since endovascular repair has revolutionized aneurysm repair, the issue of training vascular surgeons in open complex abdominal aortic aneurysm (cAAA) surgery has received significant attention. Through learning curve analysis, we aimed to determine the number of cases needed for surgeons to achieve satisfactory open surgical skills for cAAA.