Simulation Training Model Research Articles

FEATURES OF SIMULATION TRAINING IN CONDITIONS OF HIGH RISK OF THE SPREAD OF A NEW CORONAVIRUS INFECTION

Conducting trainings for team building is an important component of professional development of obstetric and pediatric service specialists. Conducting simulation trainings during a period of high risk of the spread of a new coronavirus infection has some peculiarities. Pedagogical research made it possible to carry out a comparative analysis of the level of formation of team interaction skills in training specialists using the traditional and adapted to new conditions simulation training model.

Validation of laparoscopy and flexible ureteroscopy tasks in inanimate simulation training models at a large-scale conference setting

ObjectiveSimulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve. However, validation studies of surgical simulators are often limited by small numbers. We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible ureteroscopy (FURS) rapidly at a large-scale conference setting for residents. MethodsSeventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016. Residents performed the peg transfer task from the fundamentals of laparoscopic surgery (FLS) and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an endourological model. Each participant's experience (no experience, 1–30 or >30 procedures) in laparoscopy, rigid ureteroscopy (RURS) and FURS was self-reported. ResultsMedian time taken to complete the laparoscopic task decreased with increasing laparoscopic experience (209 s vs. 177 s vs. 145 s, p=0.008) whereas median time taken to complete the FURS tasks reduced with increasing FURS experience (405 s vs. 250 s vs. 163 s, p=0.003) but not with RURS experience (400.5 s vs. 397 s vs. 331 s, p=0.143), demonstrating construct validity. Positive educational impact of both tasks was high, with mean ratings of 4.16/5 and 4.10/5 respectively, demonstrating face validity. ConclusionOur study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting. Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.

Validity of a low-cost Lichtenstein open inguinal hernia repair simulation model for surgical training

PurposeSimulation training allows trainees to gain experience in a safe environment. Computer simulation and animal models to practice a Lichtenstein open inguinal hernia repair (LOIHR) are available; however, a low-cost model is not. We constructed an inexpensive model using fabric, felt, and yarn that simulates the anatomy and hazards of the LOIHR. This study examined the fidelity, and perceived usefulness of our developed simulation model by surgical residents and expert surgeons.MethodsA total of 66 Dutch surgical residents and ten international expert surgeons were included. All participants viewed a video-demonstration of LOIHR on the simulation model and subsequently performed the surgery themselves on the model. Afterward, they assessed the model by rating 13 statements concerning its fidelity (six model, three equipment, and four psychological) and six usefulness statements on a five-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare to the neutral value of 3.ResultsThe fidelity was assessed as being high by residents [model 4.00 (3.00–4.00), equipment 4.00 (3.00–4.00), psychological 4.00 (3.00–4.00); all p’s < 0.001] and by expert surgeons [model 4.00 (3.00–4.00), p = 0.025; equipment 4.00 (3.00–5.00), p < 0.001; psychological 4.00 (3.00–4.00), p = 0.053]. The usefulness was rated high by residents and experts, especially the usefulness for training of residents [residents 4.00 (4.00–5.00), p < 0.001; experts 4.50 (3.75–5.00), p = 0.015].ConclusionOur developed Lichtenstein open inguinal hernia repair simulation model was assessed by surgical residents and expert surgeons as a model with high fidelity and high potential usefulness, especially for the training of surgical residents.

Comparison of Simulation Models for Training a Diverse Audience to Perform Resuscitative Endovascular Balloon Occlusion of the Aorta

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock is increasing, but questions remain about who to train and how best to train them. We developed a REBOA training curriculum and performed a pilot course teaching the technique to surgeons and non-surgeons using four different simulation models.&#x0D; Methods: A REBOA curriculum was created incorporating four simulation models: 1)virtual reality, 2)mannequin, 3)large animal live tissue, and 4)perfused cadaver. The course was taught to n=6 military personnel, including two surgeons, two emergency medicine physicians, and two non-physicians, none with prior REBOA experience. Performance using each model was recorded, and pre and post-course tests and surveys were administered. Simulation models were compared based on capabilities, learner preferences, and cost.&#x0D; Results: Learners gained confidence, and were successful performing REBOA in the perfused cadaver models. Higher-fidelity live tissue and cadaver models were preferred, and learners rated them as the most realistic. Virtual reality and mannequin simulation were rated the least realistic and most dispensable methods of learning. All simulation models required significant resource investment.&#x0D; Conclusions: A simplified curriculum, focusing only on the skills necessary to perform REBOA, may provide even non-medical personnel the confidence and competence to perform the procedure. Higher-fidelity perfused cadaver and live tissue models are preferred by learners, and future work is required to improve the usefulness of mannequin and virtual reality simulation for training. Though REBOA simulation education is expensive, it has the potential to help revolutionize military and civilian prehospital hemorrhage control.

Development and Validation of a Low-Fidelity Cost-Effective Model for Bronchoscopy Simulation Training

Development and Validation of a Low-Fidelity Cost-Effective Model for Bronchoscopy Simulation Training

Validation of Animal Models for Simulation Training in Pediatric Laryngotracheal Reconstruction

To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. 3b.

Emergency Department Thoracotomy: A Cost-Effective Model for Simulation Training

Simulation provides a safe learning environment where high-stakes, low-frequency procedures can be practiced without the fear of being unsuccessful or causing harm. Emergency department thoracotomy (EDT) is one such procedure. Realistic thoracotomy models are expensive and not readily available. Our objective is to describe a cost-effective, realistic, reproducible, and reusable thoracotomy model for simulation training. We modified a commercially available clothes mannequin torso to expose the chest and abdominal cavity. A plastic skeleton composed of a spinal cord and ribs was placed inside the torso. Tubing was used to simulate the aorta and esophagus; both tubes were secured to the distal spine with zip ties. Commercially available lungs and heart were placed inside the chest cavity. A small rubber ball simulated the left lung to be able to maneuver the lung. The heart was covered with plastic wrap to simulate the pericardium. Thick tape was used to simulate the pleural cavity. Yoga mats were used to simulate the intercostal muscles, subcutaneous tissue, and skin. This model was tested with Emergency Medicine (EM) residents during a simulation session. A voluntary survey was available for residents to provide feedback. Survey results confirmed that the model provided valuable education, with overall positive feedback. This EDT model provides a valuable teaching opportunity to EM residents who otherwise might not have the opportunity to perform this procedure. Residents agreed that the model improved their confidence and is an effective method in providing the opportunity to practice this low-frequency, high-stakes procedure.

Validation of a new artificial model for simulated training of a laparoscopic vesicourethral anastomosis

ObjectiveThe aim of this study is to prove the effectiveness of a low cost, artificial model for training of a laparoscopic urethrovesical anastomosis. Materials and methodsThis study included urologists who attended specialised courses on laparoscopic radical prostatectomy (LRP) held during the period 2015–2017. They were divided into 2 groups according to their previous experience in laparoscopic surgery.The tasks performed on the artificial simulator were prostate resection, “task 1”, and urethrovesical anastomosis, “task 2”. Once these exercises were completed, the study participants filled in an anonymous questionnaire regarding their demographic data and experience level in laparoscopic surgery (LS). In addition, they gave their opinions about the didactic capacity of the artificial organ and evaluated its usefulness as a tool for LRP training.To demonstrate face and content validity, the participants judged the texture, consistency, morphology and evaluated its similarity to the real organ. The assessment was made with a five-point Likert scale. ResultsThe students were divided into 2 groups: 10 experts (Group E) and 12 novices (Group N). The only significant difference between the scores of novices and experts was regarding the inclusion of this tool in the training programs (Group E=5 points versus group N=4.4±0.59, p=0.024). The experts’ group rated all the items with higher scores than the novices’ one. Regarding the general assessment of the simulation model, the novice participants gave an average score of 8.00±0.91 points out of 10, while the experts’ group granted higher scores of 9.4±0.51. ConclusionThis artificial model has shown to have an elevated face, content and construct validity, as well being an optimal didactic tool for training in the techniques of prostate resection and laparoscopic urethrovesical anastomosis.

Introduction to the Sixth Edition of the JEVTM

Dear Readers,&#x0D; Welcome to the sixth edition of the JEVTM!&#x0D; In 1866, the Great Russian surgeon and scientist Nikolai Pirogov wrote: “A new era for surgery will begin, if we can quickly and surely control the flow in a major artery without exploration and ligation”. This era has now arrived and it is called EVTM! Our mission has been to maximize the benefits of endovascular technologies for trauma and bleeding patients: from the first attempts of REBOA by Carl Hughes in the 1950s with hand-made aortic balloon occlusion catheters used in our department since the early 1990s to modern successful cases of out-of-hospital REBOA use in combat and civilian casualties for ruptured aneurysms, post-partum hemorrhage and trauma.&#x0D; In this edition, you will find articles related to a new strategy of damage control interventional radiology (DCIR), partial REBOA in elderly patients and in ruptured aortic aneurysms, thrombolysis for trauma-associated IVC thrombosis, simulation models for training of REBOA, contemporary utilization of Zone III REBOA and more.&#x0D; As a continuation of EVTM development, Russian surgeons, emergency physicians, anesthetists, and others will be involved in the world of EVTM, participating in expanding the horizons of trauma care and cultivating the endovascular mindset. Also published in this edition are some of the abstracts that will be presented at the EVTM conference in Russia, St. Petersburg (7/06/2019). More than 35 oral and 30 poster presentations will make this conference a scientific feast for our audience! By adopting these new techniques for bleeding management, we are following Pirogov’s motto – to achieve fast endovascular hemorrhage control – which can only be done as part of an interdisciplinary approach.&#x0D; &#x0D; We look forward to seeing you in Saint Petersburg at the EVTM-Russia meeting!&#x0D; www.evtm.org

Implementation of Low-Cost Obstetric Hemorrhage Simulation Training Models for Resident Education.

Simulation is beneficial training for low frequency high acuity events such as management of obstetric hemorrhage. Our objective was to evaluate perceived competency in management of obstetric and pelvic hemorrhage following training with low fidelity task trainers using inexpensive and common medical supplies. This was a prospective observational study of training residents for management of obstetric and pelvic hemorrhage using a brief didactic instruction and low-cost task trainers with inexpensive common medical supplies. Participants practiced placement of a uterine tamponade balloon, uterine packing with gauze, pelvic parachute packing and temporary abdominal closure. Following training, participants completed a self-report survey regarding perceived competency with each technique. The Wilcoxon Signed-Rank Test was used to compare results before and after training. Eighteen of 23 residents completed the training and completed the survey on perceived competencies. There was a statistically significant improvement in perceived competency for all participants before and after training, with scores improving by 1.5 points for Bakri placement, from 1.94 to 3.44 (p < 0.001), improving by 1.67 points for uterine packing, from 1.78 to 3.44 (p < 0.001), improving by 1.95 for pelvic parachute packing, from 1.16 to 3.11 (p < 0.001), and improving by 1.89 for temporary abdominal closure, from 1.22 to 3.11 (p < 0.001). Low-cost supplies and task trainers can be utilized to simulate postpartum hemorrhage and improve perceived competency in managing obstetric and pelvic hemorrhage. Similar training programs can be used in small community programs with limited resources.

A Low-Cost, Easily Accessible Simulation Model for Microsurgery Training.

A Low-Cost, Easily Accessible Simulation Model for Microsurgery Training.

106 A Low-Cost Simulation Model and Instructional Video for Escharotomy Training

106 A Low-Cost Simulation Model and Instructional Video for Escharotomy Training

A model for embedding high-fidelity simulation training within core medical training (soon to be internal medicine training)

Feedback obtained from the General Medical Council survey of trainees within Oxford Deanery, now Health Education Thames Valley (HETV), from 2014 to 2016, supplemented by local surveys of Frimley Health’s outgoing cohorts of core medical trainees (CMTs), highlighted a dire lack of procedural exposure across CMT programmes both locally and nationwide. We aimed to develop and embed a sustainable simulation training programme tailored to the ‘essential and desirable procedures’ and ‘emergency presentations’ outlined in the Royal College of Physicians / Joint Royal Colleges of Physicians Training Board curriculum for core medical trainees which provided them with the necessary skill set to develop as …

10: Validation of an educational simulation model for vaginal hysterectomy training

Our aim was to evaluate the validity and reliability of the Miya Model for vaginal hysterectomy skills assessment and training. Video recordings of physicians at varied levels of training and experience were objectively assessed performing vaginal hysterectomy upon the Miya model using a modified 10-item Vaginal Surgical Skills Index (VSSI). Participants included OB/GYN residents and faculty gynecologists from 5 different institutions. The research protocol was reviewed by each IRB participating in the study and found to be exempt. Surgeons were instructed to perform a vaginal hysterectomy. Each participant was given a maximum of 60 minutes and had one surgical assistant. All procedures involving the simulated vaginal hysterectomy were video recorded and then assessed by a group of experienced surgeons. The surgeons evaluating the video performances were divided into groups such that none would be evaluating participants from their separate institutions. All evaluating surgeons were blinded to the participant’s level of training. A total of 54 surgeons were assessed. The average composite score was 24.1, (SD 10.4; (range1 to 40). The internal consistency of the VSSI was excellent (Cronbach's alpha = 0.97). Convergent validity was very good. The composite VSSI score correlated highly with the GRS (Pearson r = 0.92, P < .001). Using a cutoff of 27 as the lowest passing score, agreement was very good with the current pass/fail result. Of 126 assessments, 2 failed under the current standard but had a composite score >=27, and 13 passed under the current standard but had a composite score <27, for an 88% overall agreement. Interrater reliability of VSSI, as measured by the intra-class correlation coefficient, was moderate to good and ranged from .485 to .951. In comparison, interrater reliability of GRS ranged from .50 to .87. Both scales were able to discriminate not only between novice and expert surgeons but also discriminated between training levels (table 1). The correlation between the VSSI total score and training level was .81 (p<001) and between the GRS scores was .74 (p<0.001). This study demonstrates the Miya Model is a useful tool for assessing vaginal hysterectomy skills. We successfully demonstrated good interrater reliability and validity of the MIYA model as an assessment and training tool. We were able to demonstrate that experts were more skillful at performing vaginal hysterectomies than novices as assessed using VSSI and the global rating scales. VSSI and GRS scores were also correlated with postgraduate years, which was significant.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Anterolateral Thigh Flap in a Chicken Model: A Novel Perforator Training Model.

Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.

Current State of Surgical Simulation Training in Otolaryngology: Systematic Review of Simulation Training Models

The review article presents an expansive list of otolaryngology-specific surgical simulation training models as described in Otolaryngology literature as well as evaluates recent advances in simulation training in Otolaryngology.

The effectiveness of box trainers in improving laparoscopic suturing skills in surgery

Background: Simulation training is an integral part of the laparoscopic training curriculum. To recognize the role of laparoscopy in modern surgery, residency programs rapidly incorporated it into their training regimen. Box trainers are useful to practice laparoscopic skills. Laparoscopy requires a long-learning curve. The simulation training model gives opportunities to practice the procedures efficiently until competency is achieved without exposing the live patient to undue risk. Hence, this study was conducted to assess the overall effectiveness of the box training to improve the skills in laparoscopic suturing. Materials and Methods: This was a prospective and observational study conducted over a period of 6 months including 30 residents of the surgery department. The department of surgery has an indoor laboratory that consists of an isolated room with two box-trainers. Participants were given a task to perform suturing by using box trainers for 2 h/week for 6 months. For the quantitative and qualitative assessment, a direct observation checklist was prepared, i.e., task-specific checklist having a maximum score of 15. Each participant performed a suturing task. Pre- and posttraining score was calculated and was compared to see the efficacy of the box trainers. Results: Around 30 participants’ surgery, residents were enrolled. Twenty-six male and 4 female residents were included in the training, with the age of all residents ranges from 26 to 30 years. The mean pretraining score was 3.1667, and it is improved significantly to 12.3667 after training. The unpaired t-test was calculated (20.5050). The two-tailed P is less than 0.0001; hence, it is statistically significant. Conclusions: This study proves the efficacy of box trainers in improving laparoscopic suturing skills.

Development and evaluation of a high-fidelity canine laparoscopic ovariectomy model for surgical simulation training and testing.

OBJECTIVE To develop and evaluate a high-fidelity simulated laparoscopic ovariectomy (SLO) model for surgical training and testing. DESIGN Evaluation study. SAMPLE 15 veterinary students (novice group), 5 veterinary surgical interns or residents (intermediate group), and 6 veterinary surgeons (experienced group). PROCEDURES Laparoscopic surgery experience was assessed by questionnaire and visual analog scales. Basic laparoscopic skills were assessed with a commercial training model. A commercial canine abdomen model was customized with a high-fidelity simulated canine female genital tract. Each subject's SLO performance (laparoscopic entry, dissection along marked planes, and left ovariectomy) was evaluated by measurement of surgical time and errors (splenic puncture and deviation from dissection marks) and with global and operative component rating scales. Construct and concurrent validity were assessed by correlation of SLO results with self-estimated measures of experience level and with basic laparoscopic skills test results, respectively. Face validity was assessed with a questionnaire completed by intermediate and experienced group participants. RESULTS 13 participants (3/15, 5/5, and 5/6 in the novice, intermediate, and experienced groups, respectively) completed SLO within the preset time. No difference in errors was found among groups. Completion time was significantly correlated with self-estimated experience level (r = -0.626), confirming construct validity, and with basic laparoscopic skills scores (r = -0.552) and global (r = -0.624) and operative component (r = -0.624) rating scale scores, confirming concurrent validity. Overall mean face validity score was low (64.2/100); usefulness of the model for surgical training received the highest score (8/10). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested the SLO model may be a useful surgical training tool. Further studies are needed to confirm usefulness of the model in veterinary laparoscopy training.

Virtual Simulation Training and Education in the Context of Mass Entrepreneurship and Innovation

In recent years, under the guidance of the policy of “Mass Entrepreneurship and Innovation”, the educational institutions have paid more attention to innovation and entrepreneurship education, gradually proposed a variety of innovation and entrepreneurship education means and established some supporting policies for innovation and entrepreneurship education. As a new type of teaching mode, virtual simulation training and education integrates knowledge, creativity and practicability, which can make up for the deficiency of current practical education in management disciplines and promote the development of innovation and entrepreneurship education. Firstly, this paper sorted out the relevant national policy guidelines, further analyzed the content of virtual simulation training and the significance of the model, on this basis, explored several specific measures for the implementation of the model, and elaborated its effectiveness in detail. To promote the development of innovation and entrepreneurship education, virtual simulation training should be integrated into the system, supported by various resources, and the virtual simulation training model should be improved.

Comparison of bench-top simulation versus traditional training models in diagnostic arthroscopic skills training.

This study aims to compare the efficacy of existing training models for acquisition of arthroscopic skills and to investigate the most effective training method or combination of methods for residents. A total of 100 fifth-year students from medical school (40 males, 60 females; mean age 23.7 years; range, 22 to 33 years) volunteered to participate in the study and were randomly divided into five education groups (E1-5): group E1 (trained on bench-top simulator), group E2 (read surgical technique), group E3 (read surgical technique and watched surgical video), group E4 (watched surgical video only), and group E5 (control group). After completion of the pre-training, each student was individually asked to perform an arthroscopy practice. A checklist containing the tasks to be performed was given to students and students were asked to complete the tasks on the checklist in five minutes. In group E1, the mean rate of successful achievement of tasks was significantly higher than other groups in both knee and shoulder arthroscopy models. Rate of each task was statistically similar for groups E2, E3, E4 and E5. In group E1, mean durations for completion of tasks in both arthroscopy models were significantly shorter than other groups. There was no statistically significant difference in terms of gender between those who successfully completed the tasks in both arthroscopy models. A basic arthroscopic bench-top simulator may be a low-cost and effective training method to increase arthroscopic skill levels in resident training compared to traditional methods.