Open Surgical Skills Research Articles

Impact of the COVID-19 pandemic on surgical skills training in pediatric surgery residents.

PurposeTo analyze the initial impact of the SARS-CoV-2 pandemic on surgical skills training and performance of Pediatric Surgery Residents.MethodsRetrospective study considering the modifications on the Pediatric Surgery Residency training from March 1st–May 31st, 2020. Exposure to OR learning opportunities was compared to the same 2018–2019 trimesters. An anonymous survey about self-perception on surgical skills development was also performed.ResultsResidents performed 209 procedures as leading surgeons during the 2020 trimester with a mean number of surgeries per resident of 20.9, representing a reduction of 46% and 56.8% compared to the 2018–2019 averages, respectively. Reduction in both the number and the percentage of total procedures (n: 209, 56.8%) compared to both 2019 (n: 354, 68.7%, p: 0.000272) and 2018 (n: 420, 76.1%, p < 0,00,001) showed statistical correlation with no changes in their complexity pattern.From the survey (response rate: 100%), hours dedicated to simulation-based training were highly increased. More time was spent studying, but only 60% achieved better preparation for surgery and 70% perceived a decrease in surgical confidence.ConclusionsEven though the pandemic promoted new teaching strategies and the use of simulation-based training, it drastically reduced “on-the-job” learning opportunities with potential effects on residents’ performance and self-confidence during surgery.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00383-021-04961-8.

The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills-A Mixed-Method Study.

Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually. One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale. Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult. No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.

Influence of musical background on surgical skills acquisition

BackgroundThere is growing interest in identifying trainees with surgical aptitude predictive of eventual technical proficiency. Musical tasks involve complex, cerebral activity, and ambidextrousity, which may have a positive impact on the acquisition of surgical skill sets. The purpose of this study was to investigate the influence of prior musical experience on the performance of basic surgical skills. MethodsThis was a prospective cross-sectional study involving 51 novice undergraduate and medical school trainees with no prior surgical exposure. Musicality was assessed with a detailed survey and objectively with the Mini-Profile of Music Perception Skills test. Dexterity was assessed using the Purdue Pegboard test. Surgical skills were then evaluated by performing 2 timed suturing trials after observing tutorial video, followed by a timed laparoscopic peg transfer test. Outcomes included both speed and quality of performance. ResultsParticipants with prior musical experience performed better than nonmusicians on the Mini-Profile of Music Perception Skills test (P = .015), dominant hand dexterity (P = .05), suture quality (P < .03), and laparoscopic peg transfer speed (P < .01). There was no significant difference in the suturing speed between musicians and nonmusicians. The dexterity and Mini-Profile of Music Perception Skills scores were predictive of suture quality (P < .01). Among musicians, duration of musical training, inactivity, instrument type, and certification levels did not correlate with differences in surgical task performance. ConclusionMusical background is associated with better performance of fundamental surgical skills among surgical novices, particularly technique quality. Although this does not imply superior ultimate surgical ability, musicality may be a marker for basic surgical skill development useful in identifying suitable candidates for surgical training.

Purpose-built, head-mounted 3D display for ophthalmic microsurgery: surgical skill performance and evaluation: a pilot study

Purpose-built, head-mounted 3D display for ophthalmic microsurgery: surgical skill performance and evaluation: a pilot study

Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment.

The efficacy of simulation-based training in surgical education is well known. However, the development of training programs should start with problem identification and a general needs assessment to ensure that the content is aligned with current surgical trainee needs. The objective of the present study is to identify the technical skills and clinical procedures that should be included in a simulation-based curriculum in general surgery. A national, three-round Delphi process was conducted to achieve consensus on which technical skills and clinical procedures should be included in a simulation-based curriculum in general surgery. In total, 87 key opinion leaders were identified and invited to the study. Round 1 of the Delphi process had a response rate of 64% (56/87) and a total of 245 suggestions. Based on these suggestions, a consolidated list of 51 technical skills or clinical procedures was made. The response rate in Delphi round 2 was 62% (54/87) resulting in a pre-prioritized order of procedures for round 3. The response rate in Delphi round 3 was 65% (35/54). The final list included 13 technical skills and clinical procedures. Training was predominantly requested within general open surgical skills, laparoscopic skills, and endoscopic skills, and a few specific procedures such as appendectomy and cholecystectomy were included in the final prioritized list. Based on the Delphi process 13 technical skills and clinical procedures were included in the final prioritized list, which can serve as a point of departure when developing simulation-based training in surgery.

The Benefits of Tying Yourself in Knots: Unraveling the Learning Mechanisms of Guided Discovery Learning in an Open Surgical Skills Course.

Teaching technical skills through the use of guided discovery learning (GDL) is an ongoing topic of research. In this approach, learners practice and struggle before receiving formal instruction. This has shown promise in other domains of learning, yet in the realm of procedural skills, clarity is still needed. This study seeks to address these gaps by investigating efficacy and mechanisms relating to application for a GDL approach in teaching basic surgical skills. In 2018, young surgical trainees (N = 16) undertook a 6-week open surgical course applying the principles of GDL, each lesson beginning with a discovery phase before subsequent instruction and practice. A concurrent triangulation mixed-methods approach was used with direct observation and collection of semistructured interviews using a framework designed from productive failure literature. At the end of the course, all participants took a conceptual knowledge test and a performance-based skills test. Performance on the skills test was rated using global ratings and checklists. The GDL cohort outperformed the historical cohort on the written exam (F [1,65] = 4.96, P = .029, d = .62), as well as on the summative suturing test (F [1,65] = 6.23, P = .015, d = .68). Furthermore, 3 main themes that highlight the mechanisms and mediators of efficient GDL were: (1) building conceptual knowledge, (2) motivating self-regulated learning, and (3) the type of skill and psychological safety. GDL can be an efficient approach to teaching procedural skills. Implications for future research and curricular design are discussed.

Residents’ Views on the Impact of Robotic Surgery on General Surgery Education

The use of the da Vinci Robot has been fast growing in general surgery in the United States over the past decade. While the financial cost of robot-assisted procedures has been studied, there has been limited research on the educational cost of the robotic approach on general surgery trainees, and their surgical skills. Analysis of anonymous educational survey responses collected from residents, in addition to case logs which were used as a retrospective review for the 5 years preceding the survey. One thousand bed, tertiary care hospital general surgery residency program. Twenty-four enrolled general surgery residents in 2018. There has been a rapid expansion in the use of robotics in general surgery. In 2017 the total number of general surgery cases using the da Vinci robot increased 6 fold over that in 2013 (23 cases in 2013, 136 in 2017), while both open and laparoscopic procedures have witnessed about a 33% drop in the case volume during those years. Almost all residents would prefer a residency program which offers the da Vinci robot for care and training (95%), however, 38% of general surgery residents reported that the presence of robotic-assisted surgery had a "detrimental" effect on their surgical training. Senior residents were more likely to report a "detrimental" effect (56% vs 27%). A third of the residents believe that robotic surgery is impeding their ability to learn open and laparoscopic surgical techniques, and only 25% denied a negative impact. Senior residents are more likely to report this negative impact (67% vs 13%). Reforms in residency curricula need to be in place to accommodate the expansion of the use of the robotic platform in general surgery. A subjective survey of the residents suggests that robotic surgery can potentially impede the development of residents' open and laparoscopic surgical skills.

Impact of Implementing Curriculum for Resident Education in Surgical Technique (CREST): A Train-the-Trainer Simulation Course

Study Objective To evaluate the impact of a platform of educational resources on the surgical curriculum in Ob-Gyn residency programs. Design A website was created to house simulation resources modeling basic laparoscopic skills in preparation for the Fundamentals of Laparoscopic Skills (FLS) assessment. A hands-on, simulation-based seminar was developed to demonstrate training and performance of surgical skills while educating participants on optimizing access and use of these resources. Setting Seminars conducted at 7 regional ACOG meetings and 3 national meetings of AAGL, the Council for Resident Education in Obstetrics and Gynecology (CREOG), and the Association of Professors of Gynecology and Obstetrics (APGO). Patients or Participants 190 ObGyn residents and 125 residency program directors (PDs) or assistant PDs completed the seminars. Interventions Expectations were assessed before and after training groups of participants. Expert surgeon-trainers coached small groups in laparoscopic surgical tactics, demonstrating the use of text- and video-based resources as well as hands-on experience with skills simulations using commercially available instruments and materials. Participants rotated around six laparoscopy box trainer-stations, practicing each skill set while receiving expert feedback. Measurements and Main Results Participants completed pre- and post-intervention surveys (n=32 and 73, respectively), and were asked to review materials on the website. Before training, needs expressed included desire to learn tips and tricks to train residents (85%), acquire curriculum development skills (74%), and gain exposure to a simulated test environment (65%). Post-intervention, 86% of respondents reported their expectations were met. The average participant rating was 4.3 on a scale of 1 (not at all helpful) to 5 (very helpful). Monitoring of Post-intervention website visits, video review, and resource downloads data suggest continued interest and program sustainability. Conclusion With a reliable needs assessment prior to implementation, appropriate organization, and expert trainers, a well-planned surgical curriculum program can deliver sustainable impact.

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

<scp>AORN</scp> Position Statement on Managing Distractions and Noise During Perioperative Patient Care

The Usefulness of Procedure-Based Assessments in Postgraduate Surgical Training Within the Intercollegiate Surgical Curriculum Programme; A Scoping Review

Workplace-based assessments are a mandatory component of postgraduate surgical training within the United Kingdom and Ireland. Procedure-based assessments (PBAs) and direct observation of practical skills (DOPS) are integrated within the Intercollegiate Surgical Curriculum Programme online platform and aim to assess trainees' performance in practical surgical skills; no reviews have previously investigated their educational usefulness in postgraduate surgical training. Usefulness was defined by the 5 criteria detailed by Van der Vleuten for determining the usefulness of educational assessment tools: validity; reliability; acceptability to learners and faculty; impact on future learning and practice; and costs (to the individual trainee, the institution, and society at large). Scoping review methodology was used to examine the educational usefulness of PBA and DOPS assessments in postgraduate surgical training. A literature search of Ovid MEDLINE, EMBASE, and Web of Science databases was undertaken. The preferred reporting items for systematic reviews and meta-analyses standards for systematic reviews were followed. Ten studies met the inclusion criteria, with 1368 trainees and trainers included. A variety of study methodologies were identified. Although there is some evidence for the validity and reliability of both PBA and DOPS assessments, further work is required in both these domains including on the number of assessments required to ensure satisfactory reliability. This is a research priority, especially if these assessments become a component of summative assessment of trainee competency. The literature indicates that these assessments are generally acceptable to learners and faculty but their acceptability is negatively impacted upon by uncertainty over whether these assessments constitute a formative or summative assessment of trainees. With regards to costs, correct use of PBAs does require allocated time and resources to ensure their correct use and this must be factored into trainer and trainee job plans. PBA and DOPS assessments are educationally useful tools in postgraduate surgical training. Further research is required to determine the number of assessments required to ensure adequate reliability. To ensure the educational benefits of these assessments are not diminished, clarification from postgraduate training schemes is required regarding whether these assessments an assessment for learning or an assessment of learning.

Skills in Open Surgery do not Predict Arthroscopic Skills in Medical Students

Teaching of basic open surgical skills like skin closure has been well established in medical schools' surgical curricula. The same cannot be said for basic arthroscopic skills even though the importance of arthroscopic surgery in Orthopaedics has been well documented. The goal of this study was to evaluate the relationship between basic skills in open surgery and basic arthroscopic skills in a cohort of medical students. Our hypothesis was that performance in open surgical skills does not correlate with skills in arthroscopic surgery. The performance of medical students in basic tasks in open surgery (porcine model: subcutaneous and skin suturing) and arthroscopic surgery (bench top model: arthroscopic triangulation and object transfer) was assessed. For both surgical techniques an introductory course was given followed by a standardized assessment. After 1 week both open and arthroscopic tasks were reassessed. All procedures were recorded and scored by 2 independent observers in a blinded fashion. The study was performed at the skills lab of the Clinic for Orthopaedics and Tumororthopaedics at University Hospital Muenster in Muenster Germany. A cohort of 21 medical students (average age 22.2 years) participated in this study. The cohort consisted of 17 female (81%) and 4 male (19%) students. All students were in the clinical part of their study and had not received any prior surgical education. Interobserver reliability was very high for the arthroscopic tasks and high for the open surgery tasks. No correlation was found between open and arthroscopic skills. For the first assessment the correlation coefficient was r = 0.197 (p = 0.391). For the second assessment the correlation coefficient was r = 0.212 (p = 0.356). Significant improvement from first to second assessment was only found for the arthroscopic tasks (p < 0.0001) while improvement in the open surgery performance failed to reach statistical significance (p = 0.184). The results of this study suggest that performance in open surgical skills does not correlate with performance in arthroscopic skills and should be taught independent from each other. Arthroscopic skills can effectively be taught with bench top training systems in a time- and resource efficient manner, with measurable results even in a 1-day-course setup. Arthroscopic skills training may be offered in undergraduate curricula in addition to open surgical skills training to students with an interest in Orthopaedics.

Development of Surgical Competence in Veterinary Students Using a Flipped Classroom Approach.

Clinical skills laboratory (CSL) training was recently introduced in the renewed veterinary curriculum at Ghent University, using models and simulators for teaching practical skills. However, time in the CSL is restricted due to the large number of students combined with limited availability of personnel. Therefore, a flipped classroom (FC) model was introduced to maximize learning experiences. The goal of the present study was to evaluate the effect of flipped classroom CSL training on students' self-efficacy and practical surgical skills. Flipped classroom CSL training was implemented for the third-year pre-clinical students (n = 196) in the 6-year veterinary medicine program. Prior to CSL sessions, students studied online 'learning paths,' including text, pictures, videos of the skills, links to background information, a forum, and a compulsory pre-class quiz. A pre- and post-test were administered before and after flipped classroom CSL training. The tests consisted of a self-efficacy scale consisting of 20 items and an objective structured clinical examination (OSCE) test of surgical skills performance. Flipped classroom CSL training resulted in significantly higher self-efficacy (score/100, pre-test 55 ± 14 vs. post-test 83 ± 8, p< .001) and surgical skills performance (score/20, pre-test 5 ± 3 vs. post-test 17 ± 3, p< .001). In conclusion, this study demonstrated the feasibility and value of implementing a flipped classroom approach in combination with CSL training.

Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor

BackgroundTraining using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents’ laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students. Materials and methodsSixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer–virtual reality (MIST-VR) simulator, finalizing a questionnaire. ResultsMore Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students’ performance in the MIST-simulator. No such correlations were found in the LapMentor group. ConclusionsResults indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students’ performance in the MIST-VR simulator, with some gender-specific differences.

Towards Development of an Open Surgery Competency Assessment for Residents (OSCAR) Tool – A Systematic Review of the Literature and Delphi Consensus

Competency-based education has mandated accurate intra-operative assessment tools. We aimed to define consensus-based open surgical skills perceived by experts as critical for assessment. A mixed-method design was employed: systematic review and e-Delphi methodology. The study was performed at McGill University-affiliated large tertiary academic centers in Montreal, Quebec, Canada. Per PRISMA guidelines, a peer-reviewed search strategy was employed. Studies published in English and those describing technical skill assessment of open abdominal surgery were included; subspecialty-specific skills, conference abstracts, academic memoirs were excluded. Most-cited skills were subjected to e-Delphi methodology to identify those deemed essential by experts, based a 3-point Likert scale. Eighteen McGill University-affiliated general surgeons, representing a variety of subspecialties of General Surgery, were invited to answer the questionnaire. Around 120 of 4285 references were retained for analysis. The 12 most cited skills included suturing, tissue and instrument handling, movement economy, instrument knowledge, knot tying, flow, knowledge of procedure, completion time, dissection technique, knowledge of anatomy and sterile technique; 6 of these achieved high or perfect scores and agreement after 2 rounds of survey: suturing, sterile technique, knot tying, knowledge of anatomy, knowledge of procedure, and tissue handling. Median standard deviation decreased (0.495 to 0.450) from first to second round, indicating improvement in consensus. These results will help develop and validate the OSCAR (objective structured clinical assessment rubric) assessment tool for immediate intra-operative feedback of open technical skills for surgical trainees.

A Joint Curriculum for Surgical Skills Performance and Resident-as-Teacher Training

PROBLEM: The simulation experience for residents at our institution does not include longitudinal teaching and assessment of surgical skills. Residents frequently teach during surgical procedures, but do not receive training nor feedback on these teaching skills. INTERVENTION: Develop simulation curriculum to improve surgical skills and surgical teaching skills through structured practice, feedback and assessment of all residents, with an emphasis of senior residents as surgical teachers. CONTEXT: Needs assessment of faculty and current/graduated residents, was performed to assess perceived surgical abilities of residents, define basic surgical skills, and define relevant teaching skills needed in the operating room. The results were used to define didactic content and to create a supplemental gynecologic surgical skills video. The curriculum backbone included General Surgery videos on surgical skills. Among residents who completed pre and post surveys, 52.1% noted an improvement (≥1 level of confidence) in ≥50% of surgical skills surveyed; 17.4% noted an improvement in all surgical skills surveyed. Nine PGY 3-4 residents completed pre and post surveys pertaining to teaching skills; five (55.6%) noted improvement in all teaching skills surveyed. Six of nine (66.7%) noted improvement in at least one teaching skill. OUTCOME/LESSONS LEARNED: Sessions resulted in improvements in self-perceived surgical and teaching skills. Challenges to implementation include faculty and resource availability. We plan to repeat the sessions later in the year, with PGY-2 and PGY-3 acting as teachers. A follow-up survey to query residents on their self-perceived surgical skills, and a survey to query faculty on perceived resident surgical technique will be completed.

Verification of Proficiency in Basic Skills for PGY-1 Surgical Residents: 10-Year Update

The American College of Surgeons and the Association of Program Directors in Surgery developed a curriculum in 2001 that involved instructional modules for 11 basic surgical skills and a standardized Verification of Proficiency (VOP) evaluation instrument. Our institution continues to employ a modified version of this curriculum and the purpose of this study was to provide a 10-year update on our VOP evaluation instrument used to assess postgraduate year 1 (PGY-1) residents on surgical skills. All PGY-1 surgical residents over the past 10 years at our institution have completed the American College of Surgeons/the Association of Program Directors in Surgery-adapted basic surgical skills curriculum and VOP assessment. Retrospective analysis of VOP data for all residents was subjected to statistical analysis for internal validity and level of correlation. Department of Surgery at Southern Illinois University School of Medicine located in Springfield, Illinois. All PGY-1 surgical residents (per year: 4 general surgery, 3 orthopedic surgery, 2 plastic surgery, 2 urology, 2 ENT, 1 vascular surgery, and 1 neurosurgery) over the past 10 years. One hundred and thirty five residents underwent VOP evaluation over 10 years; 92 (68%) failed at least 1 module and 40 (30%) failed at least 2 modules. Residents who failed to demonstrate proficiency were mandated to complete remediation and retested until their scores were considered proficient. Performance on checklist items showed moderate internal consistency (⍺ ≥ 0.50) on 9 of 11 modules. Poor internal consistency (⍺ < 0.30) was noted for overall proficiency across all modules. Combined performance on checklist items and economy of time and motion demonstrated significant positive correlation (p < 0.05) with overall proficiency in every module. The VOP instrument offers an internally valid means of assessing distinct basic skills of PGY-1 residents at basic surgical skills. The instrument provides critical formative and summative feedback on surgical skill performance to trainees.

Electroencephalography correlates of transcranial direct-current stimulation enhanced surgical skill learning: A replication and extension study

Transcranial direct-current stimulation (tDCS), an increasingly applied form of non-invasive brain stimulation, can augment the acquisition of motor skills. Motor learning investigations of tDCS are limited to simple skills, where mechanisms are increasingly understood. Investigations of meaningful, complex motor skills possessed by humans, such as surgical skills, are limited. This replication and extension of our previous findings used electroencephalography (EEG) to determine how tDCS and complex surgical training alters electrical activity in the sensorimotor network to enhance complex surgical skill acquisition. In twenty-two participants, EEG was recorded during baseline performance of simulation-based laparoscopic surgical skills. Participants were randomized to receive 20 min of primary motor cortex targeting anodal tDCS or sham concurrent to 1 h of surgical skill training. EEG was reassessed following training, during a post-training repetition of the surgical tasks. Our results replicated our previous study suggesting that compared to sham, anodal tDCS enhanced the acquisition of unimanual surgical skill. Surgical training modulated delta frequency band activity in sensorimotor regions. Next, the performance of unimanual and bimanual skills evoked unique EEG profiles, primarily within the beta frequency-band in parietal regions. Finally, tDCS-paired surgical training independently modulated delta and alpha frequency-bands in sensorimotor regions. Application of tDCS during surgical skill training is feasible, safe and tolerable. In conclusion, we are the first to explore electrical brain activity during performance of surgical skills, how electrical activity may change during surgical training and how tDCS alters the brain to enhance skill acquisition. The results provide preliminary evidence of neural markers that can be targeted by neuromodulation to optimize complex surgical training.

Comparison of Personal Video Technology for Teaching and Assessment of Surgical Skills.

Improvements in personal technology have made video recording for teaching and assessment of surgical skills possible. This study compared 5 personal video-recording devices based on their utility (image quality, hardware, mounting options, and accessibility) in recording open surgical procedures. Open procedures in a simulated setting were recorded using smartphones and tablets (MOB), laptops (LAP), sports cameras such as GoPro (SC), single-lens reflex cameras (DSLR), and spy camera glasses (SPY). Utility was rated by consensus between 2 investigators trained in observation of technology using a 5-point Likert scale (1, poor, to 5, excellent). A total of 150 hours of muted video were reviewed with a minimum 1 hour for each device. Image quality was good (3.8) across all devices, although this was influenced by the device-mounting requirements (4.2) and its proximity to the area of interest. Device hardware (battery life and storage capacity) was problematic for long procedures (3.8). Availability of devices was high (4.2). Personal video-recording technology can be used for assessment and teaching of open surgical skills. DSLR and SC provide the best images. DSLR provides the best zoom capability from an offset position, while SC can be placed closer to the operative field without impairing sterility. Laptops provide best overall utility for long procedures due to video file size. All devices require stable recording platforms (eg, bench space, dedicated mounting accessories). Head harnesses (SC, SPY) provide opportunities for "point-of-view" recordings. MOB and LAP can be used for multiple concurrent recordings.

Surgical skill levels: Classification and analysis using deep neural network model and motion signals

Background and ObjectivesCurrently, the assessment of surgical skills relies primarily on the observations of expert surgeons. This may be time-consuming, non-scalable, inconsistent and subjective. Therefore, an automated system that can objectively identify the actual skills level of a junior trainee is highly desirable. This study aims to design an automated surgical skills evaluation system. MethodsWe propose to use a deep neural network model that can analyze raw surgical motion data with minimal preprocessing. A platform with inertial measurement unit sensors was developed and participants with different levels of surgical experience were recruited to perform core open surgical skills tasks. JIGSAWS a publicly available robot based surgical training dataset was used to evaluate the generalization of our deep network model. 15 participants (4 experts, 4 intermediates and 7 novices) were recruited into the study. ResultsThe proposed deep model achieved an accuracy of 98.2%. With comparison to JIGSAWS; our method outperformed some existing approaches with an accuracy of 98.4%, 98.4% and 94.7% for suturing, needle-passing, and knot-tying, respectively. The experimental results demonstrated the applicability of this method in both open surgery and robot-assisted minimally invasive surgery. ConclusionsThis study demonstrated the potential ability of the proposed deep network model to learn the discriminative features between different surgical skills levels.

Novel Use of Household Items in Open and Robotic Surgical Skills Resident Education

Background The aim of this study was to investigate the effectiveness of surgical simulators created using household items and to determine their potential role in surgical skills training. Methods Ten urology residents attended a surgical skills workshop and practiced using surgical simulators and models. These included a wound closure model, an open prostatectomy model, a delicate tissue simulation, a knot-tying station, and a laparoscopic simulator. After the workshop, the residents completed a 5-point Likert questionnaire. Primary outcome was face validity of the models. Secondary outcomes included usefulness as a training tool and ability to replicate the models. Results All models were easily created and successfully represented the surgical task being simulated. Residents evaluated the activities as being useful for training purposes overall. They also felt confident that they could recreate the simulators. Conclusion Low-fidelity training models can be used to improve surgical skills at a reasonable cost. The models will require further evaluation to determine construct validity and to determine how the improvements translate to OR performance. While high-fidelity simulators may continue to be utilized in formal surgical training, residents should be encouraged to supplement their training with innovative homemade models.