Surgical Knowledge Research Articles

Performance of 5 Prominent Large Language Models in Surgical Knowledge Evaluation: A Comparative Analysis

Performance of 5 Prominent Large Language Models in Surgical Knowledge Evaluation: A Comparative Analysis

Surgical smoke knowledge and practices before and after onset of COVID-19: A national survey of OR personnel

BackgroundAt the start of the COVID-19 pandemic, new recommendations to evacuate surgical smoke were made due to unknown viral hazards. We evaluated perioperative registered nurses’ and surgical technicians/technologists’ knowledge of surgical smoke and determined smoke evacuation practices before and after the onset of COVID. MethodsAn electronic survey was developed, validated, and distributed nationally. Means and percentages were used for analysis of descriptive data. For comparison analyses, repeated measures were conducted on continuous variables with paired t-tests and mixed factor ANOVAs. ResultsWe found gaps in knowledge regarding surgical smoke hazards, low evacuation device usage, lack of smoke evacuation policies, and little to no air quality or exposure monitoring in ORs. Smoke evacuation practices did not change significantly following the onset of COVID-19. ConclusionsImplications for leadership, education, and research may provide perioperative personnel with improved work environments without surgical smoke hazards.

CO-RELATION OF ANCIENT YANTRA AND MODERN SURGICAL INSTRU-MENTS-A REVIEW

Introduction-Ayurveda is an ancient medical science, and Surgery is one of Ayurveda’s oldest modalities of the medical system; it is believed that ancient Indian scientists explored essential knowledge of Shastrakarma.Ayurveda contains detailed descriptions of the techniques and practices of the great ancient surgeon Sushruta.Who has considerable surgical knowledge that is relevant even today also. The ancient surgical science was known as ShalyaTantra.Sushrut Samhita elaborates on Yantra and Shastras, used for various Shastra karma. Shalyas affect both Manas and Shareera; Yantras are used to remove this Shalya. Now a day’s same techniques are used for pain management. Efforts in this article are to correlate Sushrutokta Ancient Yantra with modern surgical instruments/equipment. Materials and methods: Ayurvedic and Modern Texts and Websites. Result: Many Yantras are like modern surgical Instruments in appearance, and modern ones with different names now adopt Funclikeh. Conclusion: As time progressed and new metals (like stainless steel and copper) were invented, the shape and length of instruments changed. But the aim of the instruments remains the same,i.e., the removal of Shalya.

DISTINCTIVE SURGICAL PRACTICES IN ANCIENT SURGICAL ARENA: A REVIEW

Sushruta Samhita the first document of surgical knowledge incorporates the details of surgical diseases. This classic has detailed method of examination (trividha Pareeksha), presentation and treatment principles of surgical diseases. Emergency and complicated conditions like Chidrodara (peritonitis), Baddhagudodara (Intestinal obstruction), and Bhagnas (Fractures and dislocations) were treated surgically. Treatment principles and postsurgical care with wound management are extensively documented. Reconstructive surgeries in sadyovrana (trauma) as well as cosmetic approaches are mentioned. Yantra (Blunt instruments), Shastra (Sharp instruments), Seevana prakara (method of suturing), materials used for the surgical procedures and surgical principles are true even today. Concepts like Vranitagara (place for wounded), Taila droni (oil tub), Pranashta shalya nirharana upayas (technique of removal of foreign bodies) are unique of their kind. The ancient surgical knowledge and emergency care were exemplar and astonishing.

POSNA Leadership Program (PLP): Developing surgeon leaders for patients, organizations, and our society

POSNA initiated a Leadership Program in 2022. The POSNA Leadership Program (PLP) is designed to enhance emotional intelligence (social skills, empathy, communication, self-regulation, and self-awareness) and in-depth leadership skill development for selected participants in a year-long seminar. Disruptive behaviors detrimental to health care professionals, patients, and care delivery organizations can be identified and lessened through education.Most surgeons rightfully focus their learning intently on specific surgical knowledge and technical expertise, especially in the early and middle career stages. Despite this, surgical errors still occur secondary to limitations of non-technical surgical skills (NOTSS): decision making, communication, leadership and teamwork. More senior surgeons are also prone to leadership and communication errors. By gaining education and expertise in NOTSS, improved team building with more professional staff engagement, empowerment, and trust can result in lower risk.POSNA is focusing on subspecialty specific leadership education for mid-career pediatric orthopaedic surgeons to foster an enhanced future for our local and national organizations. The PLP leaders understand leadership is not about their own “fame and fortune”, but rather the success of “those they are privileged to lead” through career and programmatic development that enhances our mission of improving musculoskeletal care for children. The JPOSNA Leadership series will bring the PLP knowledge and expertise to the entire membership. Key concepts(1)leadership, followership, emotional intelligence, non-technical surgical skills

Immersive virtual reality in orthopedic surgery as elective subject for medical students : First experiences in curricular teaching.

Virtual reality (VR) simulators have been introduced for skills training in various medical disciplines to create an approximately realistic environment without the risk of patient harm and have improved to more immersive VR (iVR) simulators at affordable costs. There is evidence that training on VR simulators improves technical skills but its use in orthopedic training programs and especially in curricular teaching sessions for medical students are currently not well established. The aim of this study was to describe the implementation of aVR operating theater as an elective course for undergraduate medical students and to evaluate its effect on student learning. An elective course for 12students was implemented during the summer semester of 2023. Using Oculus Quest2 headsets (Reality Labs, Meta Platforms, USA) and controllers and the PrecisionOS platform, they were able to train five different surgical procedures. The courses were accompanied by weekly topic discussions and instructional videos. Students were assigned to two groups: group VR vs. group non-VR. The groups were switched after 5 weeks. User feedback and performance development (theoretical and procedural surgical knowledge) after VR training were assessed using three questionnaires. The students highly appreciated the implementation of VR training into their curriculum and 91% stated that they would opt for further VR training. All students stated that VR training improved their understanding of surgical procedures and that it should be obligatory in surgical training for undergraduate medical students. After 5 weeks of training, students in the VR group achieved significantly better results (100 out of maximum 180 points) than the non-VR group (70points, p = 0.0495) in procedural surgical knowledge. After completion of the VR training the VR group achieved 106 points and the non-VR group 104 points (p = 0.8564). The procedural knowledge for non-VR group after 5 weeks significantly improved after VR training from 70to 106 points (p = 0.0087). The iVR can be easily integrated into the curriculum of medical students and is highly appreciated by the participants. The iVR statistically improves the procedural knowledge of surgical steps compared to conventional teaching methods. Further implementation of iVR training in curricular teaching of medical students should be considered.

Evaluating the Personal Protective Equipment and Surgical Hand-Washing Knowledge Levels of Nursing Students in the Preoperative Period

Evaluating the Personal Protective Equipment and Surgical Hand-Washing Knowledge Levels of Nursing Students in the Preoperative Period

Sustaining Military Surgeons and the Joint Trauma System: Current Efforts, Unique Challenges, and Proposed Strategies in an Era of Global Uncertainty.

Mini abstract US military assets have been integral to the response to global pandemics, natural disasters, civilian casualties, and combat care. Strategies are being implemented to strengthen the military health care system and curtail the erosion of relevant surgical skills and knowledge during periods of low combat intensity. However, additional challenges remain. We describe these strategies and obstacles but also explore potential solutions that may strengthen the readiness of military surgeons and combat trauma teams.

Techniques for Thyroidectomy and Functional Neck Dissection.

Thyroidectomy is a commonly performed surgery for thyroid cancer, Graves' disease, and thyroid nodules. With the increasing incidence of thyroid cancer, understanding the anatomy and surgical techniques is crucial to ensure successful outcomes and minimize complications. This review discusses the anatomical considerations of the thyroid and neck, including lymphatic drainage and the structures at risk during thyroidectomy. Emphasis is placed on the significance of cautious dissection to preserve critical structures, such as the parathyroid glands and recurrent laryngeal nerve. Neck dissection is also explored, particularly in cases of lymph node metastasis, in which its proper execution is essential for better survival rates. Additionally, this review evaluates various thyroidectomy techniques, including minimally invasive approaches, highlighting their potential benefits and limitations. Continuous surgical knowledge and expertise updates are necessary to ensure the best results for patients undergoing thyroidectomy.

Online versus in-person surgical near-peer teaching in undergraduate medical education during the COVID-19 pandemic: A mixed-methods study.

The coronavirus disease 2019 (COVID-19) pandemic stimulated a paradigm shift in medical and surgical education from in-person teaching to online teaching. It is unclear whether an in-person or online approach to surgical teaching for medical students is superior. We aim to compare the outcomes of in-person versus online surgical teaching in generating interest in and improving knowledge of surgery in medical students. We also aim the quantify the impact of a peer-run surgical teaching course. A six-session course was developed by medical students and covered various introductory surgical topics. The first iteration was offered online to 70 UK medical students in March 2021, and the second iteration was in-person for 20 students in November 2021. Objective and subjective knowledge was assessed through questionnaires before and after each session, and also for the entire course. Data were analyzed from this mixed-methods study to compare the impact of online versus in-person teaching on surgical knowledge and engagement. Students in both iterations showed significant improvement of 33%-282% across the six sessions in knowledge and confidence after completing the course (p < 0.001). There was no significant difference in the level of objective knowledge, enjoyment, or organization of the course between online and in-person groups, although the in-person course was rated as more engaging (mean Likert score 9.1 vs. 9.7, p = 0.033). Similar objective and subjective surgical teaching outcomes were achieved in both iterations, including in "hands-on"topics such as suturing, gowning, and gloving. Students who completed the online course did not have any lower knowledge or confidence in their surgical skills;however, the in-person course was reported to be more engaging. Surgical teaching online and in-person may be similarly effectiveand can be delivered according to what is most convenient for the circumstances, such as in COVID-19.

The changing face of surgical education: transfer of surgical and endovascular knowledge to young surgeons.

The goal of vascular surgery education is to provide the best possible training to vascular residents and fellows and to assure the highest standards of care for patients with vascular disease. In the USA, the currently used Vascular Surgery Milestones Program includes milestones as set targets at five levels, from novice to expertise, to assess the trainees' performance in knowledge, skills, attitudes, and other attributes of competencies. Competencies are broad and foundational domains of ability, the most important being the care of the patient. The soon to be introduced Entrustable Professional Activities (EPA) Project, a competency-based assessment, appears to be the best way to evaluate that trainees are ready to practice independently. Transferring surgical and endovascular skills to trainees has been, however, a challenge, because of the decreased number of open surgical procedures, the increasing number of the endovascular interventions, the decreased work hours for residents and that learning on patients in the operating room is no longer acceptable. Simulation laboratories, using 3D reconstructions of real patient's aneurysms has been most helpful to teach even complex endovascular procedures. In open or endovascular simulation laboratories, deliberate practice with focused attention and specific goals of improving performance should be combined with expert feedback. Greatness is not coded into our DNA but comes from deliberate practice, dedication and perseverance.

Semantic-Preserving Surgical Video Retrieval With Phase and Behavior Coordinated Hashing.

Medical professionals rely on surgical video retrieval to discover relevant content within large numbers of videos for surgical education and knowledge transfer. However, the existing retrieval techniques often fail to obtain user-expected results since they ignore valuable semantics in surgical videos. The incorporation of rich semantics into video retrieval is challenging in terms of the hierarchical relationship modeling and coordination between coarse- and fine-grained semantics. To address these issues, this paper proposes a novel semantic-preserving surgical video retrieval (SPSVR) framework, which incorporates surgical phase and behavior semantics using a dual-level hashing module to capture their hierarchical relationship. This module preserves the semantics in binary hash codes by transforming the phase and behavior similarities into high- and low-level similarities in a shared Hamming space. The binary codes are optimized by performing a reconstruction task, a high-level similarity preservation task, and a low-level similarity preservation task, using a coordinated optimization strategy for efficient learning. A self-supervised learning scheme is adopted to capture behavior semantics from video clips so that the indexing of behaviors is unencumbered by fine-grained annotation and recognition. Experiments on four surgical video datasets for two different disciplines demonstrate the robust performance of the proposed framework. In addition, the results of the clinical validation experiments indicate the ability of the proposed method to retrieve the results expected by surgeons. The code can be found at https://github.com/trigger26/SPSVR.

Evaluating capabilities of large language models: Performance of GPT-4 on surgical knowledge assessments

BackgroundArtificial intelligence has the potential to dramatically alter health care by enhancing how we diagnose and treat disease. One promising artificial intelligence model is ChatGPT, a general-purpose large language model trained by OpenAI. ChatGPT has shown human-level performance on several professional and academic benchmarks. We sought to evaluate its performance on surgical knowledge questions and assess the stability of this performance on repeat queries. MethodsWe evaluated the performance of ChatGPT-4 on questions from the Surgical Council on Resident Education question bank and a second commonly used surgical knowledge assessment, referred to as Data-B. Questions were entered in 2 formats: open-ended and multiple-choice. ChatGPT outputs were assessed for accuracy and insights by surgeon evaluators. We categorized reasons for model errors and the stability of performance on repeat queries. ResultsA total of 167 Surgical Council on Resident Education and 112 Data-B questions were presented to the ChatGPT interface. ChatGPT correctly answered 71.3% and 67.9% of multiple choice and 47.9% and 66.1% of open-ended questions for Surgical Council on Resident Education and Data-B, respectively. For both open-ended and multiple-choice questions, approximately two-thirds of ChatGPT responses contained nonobvious insights. Common reasons for incorrect responses included inaccurate information in a complex question (n = 16, 36.4%), inaccurate information in a fact-based question (n = 11, 25.0%), and accurate information with circumstantial discrepancy (n = 6, 13.6%). Upon repeat query, the answer selected by ChatGPT varied for 36.4% of questions answered incorrectly on the first query; the response accuracy changed for 6/16 (37.5%) questions. ConclusionConsistent with findings in other academic and professional domains, we demonstrate near or above human-level performance of ChatGPT on surgical knowledge questions from 2 widely used question banks. ChatGPT performed better on multiple-choice than open-ended questions, prompting questions regarding its potential for clinical application. Unique to this study, we demonstrate inconsistency in ChatGPT responses on repeat queries. This finding warrants future consideration including efforts at training large language models to provide the safe and consistent responses required for clinical application. Despite near or above human-level performance on question banks and given these observations, it is unclear whether large language models such as ChatGPT are able to safely assist clinicians in providing care.

Developing a Training Model for Local Flaps Using Fresh Human Skin Excised During Tummy Tuck Procedures

Introduction: The proficient execution of local flaps poses a challenge for surgical residents. This study aimed to assess a training model for local flaps using fresh human skin excised during tummy tuck procedures. Methods: A questionnaire and a surgical skills evaluation, examining theoretical and procedural knowledge of local flaps, were administered before and after the training. All surgical procedures were performed on a simulation model utilizing freshly excised human skin. Skills were evaluated using a modified version of the Objective Structured Assessment of Technical Skills Score. SPSS version 21 was employed for comparing pre- and post-training results. Results: In the pretraining assessment, residents faced difficulties in flap design accuracy and wound coverage adequacy, indicating a need for surgical training beyond the operating theater. Post-training, there was a significant improvement in procedural skills, as reflected in the modified Objective Structured Assessment of Technical Skills score. The mean cumulative pretraining score was 26.81 ± 5.41, while the posttraining score was 43.59 ± 5.72 (P = 0.008). Theoretical knowledge also significantly improved in the posttraining evaluation, except for the indication of a Z-plasty (P = 0.257). The training model received positive feedback and was deemed highly useful and recommendable. Discussion: The presented model demonstrated improved surgical handling and understanding of tissue rotation under realistic conditions. The simulation model, using fresh human skin, is cost-effective and versatile for a broad range of flap procedures, advocating for its further adoption. Conclusions: The training model significantly enhanced surgical handling and comprehension of tissue rotation, replicating realistic conditions. The cost-effective simulation model, based on fresh human skin, offers versatility for various flap procedures, emphasizing the need for its wider implementation.

Association between game metrics in a simulation game and nursing students’ surgical nursing knowledge – a quasi-experimental study

BackgroundSimulation games are effective for acquiring surgical nursing knowledge during education by offering possibilities to learn theoretical knowledge through practical patient scenarios, thus preparing students for demanding surgical nursing care. Game metrics stored in the game system enable assessment of students’ behaviour while gameplaying. Combining game metrics with the assessment of a student’s surgical nursing knowledge allows versatile information to be obtained about the student’s learning outcomes. However, studies on game metrics stored in systems and their relationship with learning outcomes are scarce.MethodsThe aim here was to evaluate the association between game metrics in a simulation game and nursing students’ surgical nursing knowledge. Nursing students from three universities of applied sciences in Finland participated in a one-week simulation gameplaying intervention that included five surgical nursing scenarios. Students’ surgical nursing knowledge was investigated with a quasi-experimental, one-group, pre- and post-test design using a surgical nursing knowledge test. In total, 280 students filled in the knowledge tests. In addition, cross-sectional game data were collected at a single time point between pre- and post-tests. The data were analysed with descriptive statistics and multivariate analysis methods.ResultsStudents’ surgical nursing knowledge improved with the intervention. The total number of playthroughs was 3562. The mean maximum score was 126.2 (maximum score range 76–195). The mean playing time of all playthroughs by all players was 4.3 minutes (SD = 81.61). A statistically significant association was found between mean score and knowledge test total score (p < 0.0072), but no significant association emerged between mean playing time and knowledge test total score.ConclusionThe results indicated that the higher the mean score the better the students’ surgical nursing knowledge in the knowledge test. This study did not show that the time spent playing had an impact on students’ post-playing knowledge. Our findings support the idea that game metrics can be used in performance evaluation and the results can be used to improve nursing students’ readiness for challenging preoperative and postoperative clinical situations.

Pulmonary Fissures Including Accessory and Azygos Fissures and their Clinical Significance

Introduction: The lungs are divided into lobes by oblique and horizontal fissures. Knowledge of extent of completeness of fissures is important for surgical planning. This study highlights the variation in Pulmonary fissures including accessory and azygos fissure and their clinical relevance. Materials and Methods: The sample consists of fifty (50) lung specimens (25 right and 25 left), collected from formalin fixed cadavers, which were dissected during undergraduate teaching. The lungs were observed for complete, incomplete, and absent fissures. Additional fissures including accessory and azygos fissures were also observed and findings compared with previous studies. Results: Accessory fissure was found in 35% right and 40% left lungs. Horizontal fissure was found to be absent in 30% right lungs. Oblique fissure was found absent in 5% right and left lungs. Four right lungs had azygous fissure. Inferior accessory fissures were found in 15% right lungs. 20% left lungs had both inferior accessory and left minor fissures. Conclusion: It is important to assess the incompleteness or absence of fissures, when planning any surgical procedure. Lung fissure variations are frequently encountered during surgical procedures and knowledge of pattern of these fissures is important to avoid and reduce associated mortality and morbidity.

Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK–Uganda partnership

IntroductionThe extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is,...

The 30th Albanian Surgical Conference &amp; the 7th Albanian Congress of Trauma and Emergency Surgery

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; The 30th Albanian Surgical Conference (ACS 2023) and the 7th Albanian Congress of Trauma and Emergency Surgery (ACTES 2023) represent a significant milestone in the medical community. These concurrent events provide a platform for the exchange of knowledge, collaboration, and the advancement of surgical science in Albania.&#x0D; ACS 2023 &amp; ACTES 2023 gather experts, scholars, practitioners, and enthusiasts from the field of surgery, both in traumatic and non-traumatic areas, in the vibrant city of Tirana. The comprehensive program encompasses a diverse range of surgical topics, from abdominal and chest injuries to vascular injuries, emergency surgery, and the challenge of nurse services in the new millennium.&#x0D; The theme of this year's events, "Surgery and not only...," reflects the commitment to innovation, best practices, and groundbreaking discoveries. The programs include plenary sessions with renowned experts, scientific presentations, panel discussions, networking opportunities, an industry exhibition, poster awards, cultural and social activities, and Continuing Medical Education (CME) credits.&#x0D; Participants can expect a professionally enriching experience that also offers personal rewards. ACS 2023 &amp; ACTES 2023 value the role of each attendee in contributing to the advancement of surgical knowledge and patient care. The events promise to chart new horizons in the field of surgery and foster international collaboration.&#x0D; The 30th Albanian Surgical Conference and the 7th Albanian Congress of Trauma and Emergency Surgery are poised to create lasting memories, and their success hinges on the active participation of every attendee. It is an opportunity to inspire, collaborate, and make a lasting impact on surgical care worldwide.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

The Society of Thoracic Surgeons General Thoracic Surgery Database: 2023 Update on Outcomes and Research

The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) continues its trajectory of growth and enhancement, solidifying its stature as a premier global thoracic surgical database. The past year witnessed a notable expansion with the inclusion of 10 additional participating sites, now totaling 287, augmenting the database's repository to more than 800,000 procedures. A significant stride was made in refining the data audit process, thereby elevating the accuracy and completeness metrics, a testament to the relentless pursuit of data integrity. The GTSD further broadened its research apparatus, with 15 scholarly publications, a 50% uptick from the preceding year. These publications underscore the database's instrumental role in advancing thoracic surgical knowledge. In a concerted effort to alleviate data entry exigencies, the GTSD Task Force also instituted streamlined data submission protocols, a move lauded by participant sites. This report delineates the recent advancements, volume trajectories, and outcome metrics and encapsulates the prolific research output emanating from the GTSD, reflecting a year of substantial progress and academic fecundity.

Editorial

As we mentioned in 2020 for its 60th anniversary, the Journal continues to achieve its foundational objectives: ensuring an adequate circulation of surgical knowledge through a rigorous selection of articles, with an educational purpose for authors and readers1. Nowadays, surgical knowledge has become increasingly complex and voluminous due to the introduction of new techniques and the fact of managing a greater amount of information.