Surgery Education Research Articles

A Near-Peer Teaching Module to Supplement Current Undergraduate Teaching in ENT Surgery.

Near-peer teaching (NPT) has been successfully used in other medical specialties but not in ear, nose and throat surgery (ENT). Historically, undergraduates receive limited ENT exposure and subsequently report low confidence in ENT competencies. This has been a posited cause of high referral rates to the specialty. This study aimed to see if NPT could be implemented as an adjunct to traditional ENT teaching. Learners received a short NPT module that was focused on clinical ENT. Pre- and post-module questionnaires collected data on students' confidence and knowledge. One hundred twenty-five undergraduate learners received the intervention. There was a significant percentage increase in both confidence (24.2%, p = < 0.001) and knowledge (35.9%, p = < 0.001) of learners. In a supervised setting, NPT could be a valuable adjunct to traditional undergraduate ENT education.

Development of a program for teaching practical skills in visceral and digestive surgery by simulation.

Up until 2013 in France, practical training for DES/DESC (advanced level) residents in visceral and digestive surgery was not standardized. Since 2017, the third cycle of medical studies has been restructured around three major thematic axes: academic knowledge, and technical and non-technical skills. The curriculum now includes a practical training program by means of simulation outside the operating theater, and it is structured, uniformized and standardized nationwide. Development of this training program is derived from the deliberations of a national consensus panel working under the umbrella of the French college of visceral and digestive surgery, program presenting a training guide to all future surgeons in the specialty. Four consensus conference sessions bringing together an eight-member commission have led to the drafting of a "Resident's manual for practical teaching in visceral and digestive surgery". As a reference document, the manual details in 272 pages the objectives (phase I), the learning resources for each skill (phase II) and, lastly, the means of evaluation for the cornerstone phases as well as the in-depth phases of an advanced degree (DES) in visceral and digestive surgery. As a complement to the manual, we have conducted a review of the structuring and implementation of the program as of November 2017 on a nationwide scale; the conclusions of the review are detailed at the end of this article.

Anatomy theaters in the history and teaching of surgery.

The study of anatomy has played a large part in the progress of scientific observation throughout the centuries and was pivotal in elevating anatomy from the magical thinking of the Hippocrates era and freeing it from subservience to medicine which was all-powerful in the past. Anatomy theaters appeared in Northern Italy in the 14th century and developed in Western Europe from the early 16th century to the beginning of the 19th century. Anatomy theaters lived their golden age in France during the 18th century when the Royal Academy of Surgery (Académieroyaledechirurgie) was created in 1743. These theaters were open to the public, and therefore offered the double vocation of teaching and public entertainment: they were used to teach anatomy and surgery to students and surgeons and offered distraction for the well-informed public that was fascinated by death, ever-present and familiar to all. Anatomical dissection accomplished a double ritual: the "profane" ritual of valorization of scientific knowledge and the "sacred" ritual, where mankind, obsessed with death, respected the human body considered as a divine image. Anatomy theaters declined as they became overshadowed by progress in anatomical teaching using well-illustrated works in well-equipped medical schools while exhibition of anatomic oddities for public amusement was relegated to fairs and circus sideshows. Nonetheless they opened the way to modern anatomo-clinical methods and surgery.

Residency training in robotic surgery: The role of simulation.

Simulation has become increasingly important in surgical teaching in recent years and the French National Authority for Health (HAS) recently underlined the goal and ethical priority: "never the first time on the patient". Simulation programs have been tested and validated for laparotomy and for laparoscopy, but there is not yet a validated program specific for robotic surgery. Due to substantial advances in this new technology, we have developed a program in Nancy dedicated to outside-the-operating room (OR) teaching of robotic surgery using the Da Vinci robot. This teaching is based on a combined program of theoretical teaching (e-learning) and learning of practical skills using virtual simulators (DV-Trainer®, Robotic Mentor®, DVSS®), mechanical simulators (Dome, Applied® abdominal simulators), microsurgery and wet lab using ex vivo animal organs, anesthetized animals, and cadavers. This program also emphasizes team training. The course is intended for residents in surgical training and is integrated into the specialized study diploma (DES) program for Visceral and Digestive Surgery; it also can be used by qualified surgeons who can integrate it with the Inter-University Diploma (DIU) in General Robotic Surgery for basic techniques and also for DIUs in other surgical specialties (digestive and gynecologic surgery) for robotic uses within their specialty. These courses are based on the concept of step-by-step skills acquisition and verification allowing a transition to safe clinical activity.

The pioneer ophthalmologist Johann Friedrich Horner (1831–1886) and the clinical anatomy of the homonymous syndrome

Johann Friedrich Horner is remembered in ophthalmology due to his brief report in the German scientific journal ‘Klinische Monatsblatter fur Augenheilkunde’, in which emphasized the clinical value of a cluster of external signs of damage to the cervical sympathetic nerve. Although J .F .Horner was not the first to describe such a syndrome, he was credited with the nomination. For the French, Francois Pourfour du Petit was the pioneer in that case. Born in Zurich, travelled Europe to be further educated, becoming later on Professor and Director of the University Clinic of Ophthalmology in his native city. In conclusion, J .F .Horner’s adamantine character, hard work, assiduous teaching and skills in eye surgery made him one of the main contributors for the evolution of ophthalmology in the nineteenth century Central Europe.

FR02-01 THE GREAT CIVILIZATIONS OF ANTIQUITY DEMONSTRATE A SURPRISING AMOUNT OF UROLOGICAL KNOWLEDGE

INTRODUCTION AND OBJECTIVE: Evidence exists for Urological procedures and diseases for 5780 years. The objective of this study was to review the extent and breadth of Urologic disease and intervention during various periods of antiquity. METHODS: A comprehensive literature search of Pubmed, Ovid, Google Scholar and the Internet was undertaken RESULTS: The first reference to a Urological surgical procedure is circumcision in the Old Testament, indicating that this has been performed for over 5780 years. Additional reference to this is next in hieroglyphic reliefs from 3400 BC. Homer (1102 BC) in the Odyssey claims that Egyptian men are the most skilled of any in medicine and mentions the genitourinary organs. Kidneys were thought to be sacred and left in situ for embalming. This allowed for the study of mummies revealing renal abscesses, vesicovaginal fistulae, and stone disease dating back for 3200 BC. In 1550 BC, the Ebers Papyrus makes mention of Priapism, long before there is any suggestion of Priapus, the Greek God (400 BC). Urinary retention was treated with assorted catheters. Spinal cord injury was associated with incontinence. There is also mention of gonorrhea, schistosomiasis, enlarged prostate, stricture, bladder stones and hydroceles. Different descriptions of circumcision exist. Susruta, treated strictures, infections and stone disease, in India around 1000 BC as well as being responsible for the Susruta Samhita, the earliest text for the systematic teaching of surgery. He also demonstrated an understanding of the medical management of this disease, STDs and urinary tract infections. He performed sequential urethral dilatations. Urinary calculous disease was first mentioned by Hippocrates 460 BC, and later treated via the perineum by Ammonias (283 BC) and Celsus, however this approach was similar to that described nearly 400 years earlier by Susruta. Hippocrates also wrote about analyzing urine to interpret body function and incontinence. Excellent documentation for the use of the catheter and its potential complications for fistulae, kidney inflammation and bladder paralysis exists in 360 CE from Oribasius a Byzantinian. CONCLUSIONS: There is evidence that all great ancient powers identified and attempted to treat Urological disease. The extent of the understanding and attempts to render treatment is rather surprising and common to these civilizations. Each attempted to build upon and not just copy earlier civilizations findings. The literature strongly supports the recognition of the urinary tract and efforts to treat various entities during these times. Source of Funding: none

Global Health Microsurgery Training With Cell Phones.

Lack of surgical care for trauma, burns, congenital anomalies, and other surgical diseases is a growing portion of global disability and death accounting for 30% of the global disease burden. Global surgical and anesthesia care aim to achieve excellence and equality of clinical care through leadership, innovation, teaching, research, and advocacy. Stanford University Division of Plastic Surgery faculty partnered with ReSurge International to teach reconstructive microsurgery in low- and middle-income countries. Global surgery teaching and training are challenged by limited resources. Surgical loupes and operating microscopes used to perform complex microsurgery magnify the surgical field are very expensive. Our goal was to identify low-cost alternatives to teach and practice microsurgery suturing. Use cell phone camera with zoom capacity to teach and practice microsurgery suturing. Cell phones with zoom feature are widely available even in low- and middle-income countries. A cell phone was placed on a stand over a microsurgery practice station. The camera was used to zoom and focus on the suturing station to mimic a surgical field with loupes or microscope magnification. Nine attending surgeons and 7 residents practiced microsurgery with microsurgical instruments and 9-0 nylon suture under the magnification of a cell phone camera. The Stanford Microsurgery and Resident Training Scale was used to track their progress. A feedback survey was given to the participants to identify the usefulness of the cell phone setup for microsurgery suture practice. Global surgery teaching and training face many challenges especially limited resources. Identifying low-cost alternative is crucial. Cell phone camera with zoom is a low-cost alternative to loupes or operating microscope for microsurgical teaching and training.

Plastic surgery in the German second medical licensing examination

There are 230 defined objectives in the national competency-based catalogue of learning goals in surgery (NKLC) for undergraduate surgical education in Germany. These teaching objectives should be met by the students at the end of their undergraduate education, regardless of their career choice afterward. Assessment drives learning, and thus, alignment of the second state examination and the learning objectives of the NKLC seems reasonable. This study analyses the amount of plastic surgery-based learning objectives in the NKLC. Subsequently, we compared these results with the plastic surgery questions of the German second medical licensing examination compiled by the Central German Institute for Medical and Pharmaceutical Examinations (IMPP). Plastic surgery teaching objectives in the NKLC were identified by five plastic surgeons. Exam questions from autumn 2009 to autumn 2014 (number of exams = 11) were retrospectively analyzed, and all exam questions addressing plastic surgery-related objectives were evaluated. The analysis included the total number of questions, mean number of questions for each examination, and the number of questions for each learning objective. Thirty-four learning objectives of the NKLC were identified as "plastic surgery-related" (14.8 % of all NKLC learning objectives). One of these was classified as "only covered by plastic surgery". Ninety-six questions (2.8 % of the total number of 3480 questions) addressed plastic surgery related objectives. Per exam, an average of 8.7 ± 4.0 questions (minimum, 4; maximum, 15) addressed plastic surgery-related learning objectives. During the study period, six learning objectives were not tested at all (2.6 % of all NKLC learning objectives). Questions focusing on plastic surgery-related learning objectives are not frequent in the second medical licensing examination. Presumably, medical students do not prioritize these objectives and might not have sufficient knowledge of the topics at the beginning of their medical career. A better adjustment of the state examinations and the NKLC seems desirable for plastic surgery-related learning objectives.

AB172. Educational theory and general surgery: creating a culture of reflective learning in a busy general surgery department

Background: Teaching in general surgery can often be sparse due to busy wards. A culture of education may not exist in many surgical departments, and it can be difficult for juniors to meaningfully and critically engage with the evidence behind daily practice. We established a weekly general surgical teaching programme using educational theory to create a space for critical learning, reflection and the development of clinical educators.

A city-wide survey of dental students' opinions on undergraduate oral surgery teaching.

This study aimed to carry out a city-wide survey to evaluate undergraduate students' opinions on their oral surgery training by measuring their self-confidence. A cross-sectional survey of 383 3rd year, 412 4th year and 363 5th year undergraduate dental students from six dental schools in Istanbul with a mean age of 22.73±1.55 was conducted towards the end of the academic year. A web link to the questionnaire was sent to the contact person at the participating dental schools. The questionnaires were anonymously evaluated. Descriptive statistics were calculated, and Chi-square tests were performed to examine the data. A P-value of <.05 was considered to be statistically significant. In total, 1158 responses were returned, representing 67% of the overall students in the 2018-2019 academic year. The male respondents were significantly more self-confident than females in the general aspects of surgical skills. More than half of the respondents (53%) felt confident in oral surgery knowledge to undertake independent practice. Although 5th year respondents felt more confident in the general aspect of the questionnaire, their ability of differentiation of odontogenic and non-odontogenic pain was lower than their counterparts. The majority (86%) of the participants disagreed that the only knowledge required for oral surgery was that of tooth and jaw anatomy. This survey revealed perceived confidence in tooth and retained root extraction. The male respondents were found to be more self-confident. There is a need for improvement in surgical skills, recognition of malignancies and differentiation of the origin of the pain.

Joint Report on Terminology for Surgical Procedures to Treat Stress Urinary Incontinence in Women.

Standardized terminology for surgical procedures commonly performed to treat stress urinary incontinence in women is needed to facilitate research, clinical care, and teaching in female pelvic medicine and reconstructive surgery. This report combines the input of members of the American Urogynecologic Society and the International Urogynecological Association, assisted by external referees. Extensive searches of the literature were performed, including Instructions for Use brochures and original source documents where possible. Historical context was considered along with procedural modifications, and expert opinion was included when appropriate. A terminology report for the procedures commonly performed to treat stress urinary incontinence in women was produced. Included procedures are midurethral sling, retropubic colposuspension, pubovaginal sling, urethral bulking, and artificial urinary sphincter. Appropriate figures have been included to supplement and help clarify the text. Ongoing review will be performed periodically to keep the document updated and widely acceptable. This document is a literature and consensus-based terminology report for surgical procedures to treat stress urinary incontinence in women. Future publications in female pelvic medicine and reconstructive surgery should use this standardized terminology whenever possible.

Development of Distance Teaching System for College Professional Courses Based on 5G Network

5G (the Fifth Generation Network) refers to the fifth generation mobile communication network. 5G has three important advantages: large bandwidth, low latency, and large connections. At present, 5G is being implemented in 4K / 8K coding and other technologies in remote consultation, remote monitoring, emergency rescue, remote surgery, and remote teaching scenarios, and has achieved good application results. We can foresee that the future of professional course teaching will be closely integrated with 5G technology, and the informationization of medical course teaching will also continue to increase. To further promote the construction of medical education and information technology. This paper mainly studies the development of distance education system for professional courses based on 5G network. In this paper, the system test in the student results query, class results query, time answer query, student information query and teacher information query test, the connection failure times were 22, 11, 9, 6, 9 respectively, and the successful connection success rate was 99.78%, 99.89%, 99.91%, 99.94%, 99.91%, the database connection success rate is high, and the system can be used.

Application research of self-rating scale of self-directed learning in nursing training

Objective To analyze the reform of improving the teaching effects of nursing college students' practical training. Methods Cluster sampling method was used to select 396 nursing college students in a higher nursing school as the research objects, with 197 in experimental group and 199 in control group. Self-directed learning was adopted in practical teaching of surgical nursing in the students in experimental group, and traditional surgery teaching was adopted in control group. Self-rating scale of self-directed learning (SRSSDL) was used every 3 months during the period. The students' self-directed learning ability was measured dynamically, and the scores of practical examination and course satisfaction were compared between the two groups. The data were statistically analyzed by repeated measures analysis of variance and independent sample t-test using SPSS 17.0. Results The scores of repeated measurement of SRSSDL in the experimental group were higher than those in the control group (F=16.237, P=0.016). Except for the common surgical instruments module (P=0.056), the scores of practical training examination in the experimental group were higher than those in the control group, and the differences were statistically significant (P<0.01 for the operating room nursing module, P=0.005 for the wound nursing module, P<0.01 for the enterostomy nursing module). The students' satisfaction with the overall curriculum in the experimental group was higher than that in the control group. Conclusion Self-directed learning in the teaching of nursing practice can effectively enhance comprehensive ability and quality of students based on self-directed learning ability, and improve the teaching effect of practical training courses. Key words: Self-rating scale of self-directed learning; Nursing training; Educational reform

Current State of Otolaryngology Head and Neck Surgery Teaching in Canadian Medical Schools

Background: Ear, nose and throat diseases can account for nearly 50% of primary care physician visits. This study aimed to evaluate the current state of Otolaryngology - Head and Neck Surgery (OtoHNS) teaching within Canadian medical schools. Method: Undergraduate OtoHNS course directors from all 17 Canadian medical schools were invited to participate in this cross-sectional study. The survey contained 41 questions, and evaluated both qualitative and quantitative aspects of the undergraduate OtoHNS curriculum. Results: Ten schools completed the survey; 59% response rate. Ninety percent of schools reported a dedicated pre-clerkship OtoHNS curriculum, with an average of 24.2 hours spent (SD 16.8, range 6 to 50 hours). During clerkship, a rotation in OtoHNS was offered across all schools, but only mandated in two. Teaching modalities such as simulation and web-based modules were frequently used. One of the major barriers to achieving the ideal curriculum was identified as lack of dedicated time for OtoHNS. Conclusion: There appears to be a discrepancy in dedicated OtoHNS curricular time, especially during clerkship as reflected by mandatory rotations in only 20% of schools. The usage of simulation and web-based modules may serve to reduce this discrepancy, and enhance the learning experience for all undergraduate medical students.

Logical Beauty Harmony and Natural Shape zones (NSz)

The concept of beauty in the world is certainly influenced by ethnicity and cultural factors, but generally harmony, balance and simmetry are common characteristics positively considered by every population. Logical Beauty Harmony is an innovative System for using filler and botulinum toxin in aesthetic medicine based on Natural Shape zones (NS zones). These compartment consist of strategic sequential injection areas that allow creating, improving or restoring adequate volumes, guaranteeing natural results and expressiveness. Starting from the recent acquisitions of Functional Anatomy, Physiology of Aging, Product Rheology and considering the objective analysis of the characteristics of harmony of each individual we have developed an approach that uses injectables in a targeted way using Support and Lifting vectors at the level of Upper, Middle and Lower Third of the face, injecting first deep and then passing to the surface. The face is divided into vertical and horizontal proportions. These simply but fundamental principle of facial proportion, modified by recent anthropometric studies, have found their way into the teaching and practice of cosmetic facial medicine and surgery. The series of data that can be detected by applying the previous parameters offers the chance of identify the variants that the face can present, so as to make eventually those changes that lead closer to the ideal model. In planning the treatment, the study of the different parameters, proportions, lines, ideal movements and angles linked to the comparison of the measurements of the different parts of the face will be more useful in determining type and extent of the corrections to be made. 9 treatment protocols for the face have been precisely established.

Educational note: teaching and training in robotic surgery. An opinion of the Minimally Invasive and Robotic Surgery Committee of the Brazilian College of Surgeons.

With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.

The perceptions and attitudes of medical students towards orthopaedic and trauma surgery teaching in Makurdi, Nigeria

Aim: The aim of this study was to assess the perceived educational value of orthopaedic and surgery learning opportunities among medical students and to evaluate the students' motivating factors in pursuing a future career in the specialty. Methodology: A questionnaire was designed to assess undergraduate medical students' perception of learning environments in orthopaedic and trauma surgery, career intent and motivation towards a future career in the specialty. A 5-point Likert scale was employed. Results: Seventy-four students completed the questionnaire. Learning opportunities considered useful for orthopaedic and trauma surgery were bedside teaching with a consultant (n = 39, 52.7%), seeing patients in clinic (n = 36, 48.6%) and formal lectures (n = 35, 47%). Fifteen respondents (20.3%) expressed an interest in pursuing a career in the specialty, with watching or assisting open surgery being the most significant motivating factor (P = 0.001) for choice of the specialty. Conclusion: Bedside teaching with a consultant and seeing patients in outpatient clinics were found to be the most useful learning environments. A fifth of the respondents indicated an interest in a future orthopaedic and trauma surgery career, with watching or assisting open surgery being the most statistically significant motivating factor. Students may be better served incorporating the findings in future curriculum design.

Application effect of mixed reality in the teaching of hepatobiliary surgery

Objective To explore the application effect of mixed reality technology in the teaching of hepatobiliary surgery. Methods A total of 120 professional postgraduates majored in surgery who had received the four-month standardized training of residents in hepatobiliary surgery department of the First Affiliated Hospital of Army Military Medical University and the First Affiliated Hospital of Chongqing Medical University during 2016-2018 were selected and were equally allocated into the control group and the research group via random number table method. Students in the control group were trained with traditional surgical teaching mode and in the research group were trained with three-dimensional visualization model which was constructed by mixed reality. Students in both groups received assessment and questionnaires at the end of training. Results Scores of theoretical examination and surgical operation assessment of students in the research group were higher than those in the control group (P<0.05). The error rate for separating gallbladder artery and bile duct in the laparoscopic simulated system of students in the research group was significantly lower than that in the control group (P<0.05). Students-teacher satisfaction degree in the research group was higher than that in the control group (P<0.05). Conclusion Using mixed reality technology to construct a three-dimensional visualization model and to implement hepatobiliary surgery teaching enables the trainees to better master anatomical key points in the hepatobiliary system and the hepatobiliary surgical approach, with good feedback. Key words: Kirkpatrick model; Mixed reality; Three-dimensional visualization model

Multimaterial and multicolor 3D-printed model in training of transnasal endoscopic surgery for pituitary adenoma.

The aim of the present study was to investigate the practical value of a multimaterial and multicolor 3D-printed model in anatomical teaching, surgical training, and preoperative planning of transnasal endoscopic surgery for pituitary adenoma. Multimodality neuroimaging data were obtained in a 42-year-old healthy male volunteer and a 40-year-old female patient with an invasive nonfunctional pituitary adenoma. Three 3D-printed models were produced: a monomaterial and monocolor model, a monomaterial and multicolor model, and a multimaterial and multicolor model. The effects on anatomical teaching and surgical training for exposing the vidian nerve were assessed by 12 residents, and the training effect was validated on cadavers. The practical values for preoperative planning were evaluated by 6 experienced neurosurgeons. All evaluations were based on 5-point Likert questionnaires. The multimaterial and multicolor model was superior to the monomaterial models in surgical training for exposing the vidian nerve (Fisher test; p < 0.05). In addition, the multimaterial and multicolor model was superior to the monomaterial models in anatomical teaching and preoperative planning (Friedman test; p < 0.05). Multimaterial and multicolor 3D printing technology makes it convenient and efficient to produce a practical model for simulating individualized and complex anatomical structures in the sellar region. Furthermore, the multimaterial model can provide a more realistic manipulative experience for surgical training and facilitate the preoperative planning.

Application of the flipped classroom based on micro-class in animal surgery teaching: An case study of debridement course

Objective To investigate the application of the flipped classroom based on micro-class versus traditional class in animal surgery teaching, and to provide new thinkings for animal surgery teaching. Methods A total of 120 undergraduates from Navy Medical University were randomly divided into control group (class A) and experimental group (class B). The students in class A received traditional teaching, and those in class B received flipped classroom teaching. Questionnaire survey and course assessment were performed after teaching, and a comparative analysis was also performed. Results The self-assessment survey showed that 88.3%, 73.3%, 71.6%, 48.3%, and 73.3% of the students in class A (traditional teaching) filled in the questionnaire with Very Helpful and Helpful, while 91.7%, 85.0%, 83.3%, 78.3%, and 75.0% of the students in class B (flipped classroom teaching) filled in with Very Helpful and Helpful; class B gave better overall evaluation of teaching model than that of class A. The mean total score of class B was 0.91, higher than that of class A (8.43 vs. 7.52, P<0.05), and the mean total score of examination papers in class B was 10.92, higher than that in class A (101.13 vs. 90.21, P<0.05). Conclusion Flipped classroom based on micro-class could improve the teaching effect of debridement course on animal surgery and increase students' self-learning ability. Key words: Micro-class; Flipped classroom; Animal surgery; Debridement