Acquisition Of Surgical Skills Research Articles

Medical–surgical activity and the current state of training of urology residents in Spain: Results of a national survey

ObjectivesTo determine the actual state of medical–surgical activity and training for urology residents in Spain. Material and methodWe designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015–January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. ResultsThe total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20h a week, and 43 of these even less than 10h. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. ConclusionsEfforts should be directed toward standardizing the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Randomized Trial of Self-Paced vs. Group Introduction to Open Surgical Skills Curriculum [34I

INTRODUCTION: At UT Southwestern/Parkland residency program, incoming interns are traditionally taught core open surgical skills in a group setting by viewing 12 instructional videos consecutively followed by individual pre-testing. We sought to determine if introduction to open surgical skills via self-paced viewing of video tutorials, as opposed to traditional group viewing, results in improved surgical skill acquisition in OBGYN interns as measured by higher proficiency score with decreased workload stress and anxiety. METHODS: A randomized control trial was conducted in which OBGYN PGY-1 residents in 2015 and 2016 (N=36) were introduced to basic open surgical skills, such as knot tying and suturing, by viewing 12 video tutorials produced at UTSW (http://www.utsouthwestern.edu/education/medical-school/departments/surgery/minimally-invasive-surgery/simulation-training/video-tutorials.html). Residents were randomized to two groups: group viewing versus self-paced viewing. Validated proficiency score was measured based on time and accuracy while workload and anxiety were measured by pre-and post-testing surveys using the NASA-TLX and STAI-6 questionnaires. RESULTS: There was no significant difference in proficiency score between the group versus self-paced viewing in 8 out of 12 tasks using the Wilcoxon signed rank test (P>0.10). There was no statistically significant differences in workload stress based on the NASA-TLX questionnaire (P=0.399) or self-reported anxiety based on the STAI-6 questionnaire (P=0.607). CONCLUSION: Contrary to recent educational data suggesting self-paced learning may improve outcomes, viewing instructional videos in a group setting continues to be a time efficient method to introduce basic open surgical skills to incoming OBGYN interns.

Practice does not always make perfect: need for selection curricula in modern surgical training.

It is hypothesized that not all surgical trainees are able to reach technical competence despite ongoing practice. The objectives of the study were to assess a trainees' ability to reach technical competence by assessing learning patterns of the acquisition of surgical skills. Furthermore, it aims to determine whether individuals' learning patterns were consistent across a range of open and laparoscopic tasks of variable difficulty. Sixty-five preclinical medical students participated in a training curriculum with standardized feedback over forty repetitions of the following laparoscopic and open technical tasks: peg transfer (PT), circle cutting (CC), intracorporeal knot tie (IKT), one-handed tie, and simulated laparotomy closure. Data mining techniques were used to analyze the prospectively collected data and stratify the students into four learning clusters. Performance was compared between groups, and learning curve characteristics unique to trainees who have difficulty reaching technical competence were quantified. Top performers (22-35%) and high performers (32-42%) reached proficiency in all tasks. Moderate performers (25-37%) reached proficiency for all open tasks but not all laparoscopic tasks. Low performers (8-15%) failed to reach proficiency in four of five tasks including all laparoscopic tasks (PT 7.8%; CC 9.4%; IKT 15.6%). Participants in lower performance clusters demonstrated sustained performance disadvantage across tasks, with widely variable learning curves and no evidence of progression towards a plateau phase. Most students reached proficiency across a range of surgical tasks, but low-performing trainees failed to reach competence in laparoscopic tasks. With increasing use of laparoscopy in surgical practice, screening potential candidates to identify the lowest performers may be beneficial.

Actividad médico-quirúrgica y estado actual de la formación de los residentes de urología en España: Resultados de una encuesta nacional

ObjectivesTo determine the actual state of medical-surgical activity and training for urology residents in Spain. Material and methodWe designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. ResultsThe total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. ConclusionsEfforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Effectiveness of an Integrated Video Recording and Replaying System in Robotic Surgical Training

This study evaluated the effectiveness of using a video recording and replaying system in robotic surgical training. Robotic surgical videos are reviewed to accelerate the acquisition of robotic surgical skills. However, few professional recording and replaying systems have been used during robotic surgical training. The effectiveness of these professional video systems should be investigated and validated. A randomized study was conducted to analyze the performance of 60 participants, who were unfamiliar with surgical robotics, in a robotic simulator. Participants were enrolled in 2 groups to perform 2 exercises on a Mimic dV-Trainer. One group was trained with the new protocol based on a recording and replaying system (controller of events on simulator and robot) and the other group was trained with the conventional method. The overall scores were automatically evaluated by the simulator. The number of additional requests for reviewing the videos or watching the trainer's demonstration and the learning curves based on the overall scores were compared between the 2 groups. The group trained with controller of events on simulator and robot presented a significantly improved learning curve in both exercises (P < 0.001) with more additional requests (P < 0.001) in comparison with the group trained with the conventional method. In robotic skills training, the use of a recording and replay system is beneficial and more efficient than the conventional training method.

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition: a randomized clinical trial

Effects of transcranial direct-current stimulation on laparoscopic surgical skill acquisition: a randomized clinical trial

The Use of Smart Glasses for Surgical Video Streaming.

Observation of surgical procedures performed by experts is extremely important for acquisition and improvement of surgical skills. Smart glasses are small computers, which comprise a head-mounted monitor and video camera, and can be connected to the internet. They can be used for remote observation of surgeries by video streaming. Although Google Glass is the most commonly used smart glasses for medical purposes, it is still unavailable commercially and has some limitations. This article reports the use of a different type of smart glasses, InfoLinker, for surgical video streaming. InfoLinker has been commercially available in Japan for industrial purposes for more than 2 years. It is connected to a video server via wireless internet directly, and streaming video can be seen anywhere an internet connection is available. We have attempted live video streaming of knee arthroplasty operations that were viewed at several different locations, including foreign countries, on a common web browser. Although the quality of video images depended on the resolution and dynamic range of the video camera, speed of internet connection, and the wearer's attention to minimize image shaking, video streaming could be easily performed throughout the procedure. The wearer could confirm the quality of the video as the video was being shot by the head-mounted display. The time and cost for observation of surgical procedures can be reduced by InfoLinker, and further improvement of hardware as well as the wearer's video shooting technique is expected. We believe that this can be used in other medical settings.

The importance of laparoscopic simulation in the continuing medical education of community surgeons

One well-established challenge for medical educators and surgeons is maintaining patient safety during a period of widespread surgical skill acquisition. The incongruity between evidence-based recommendations and real-world practice highlights the inadequacy of our current continuing medical education (CME) tradition, which consists of short courses and preceptored practice. The effectiveness of short courses for surgical skill training has been questioned many times since the beginning of the laparoscopic revolution. Laparoscopic simulation trainers also offer pedagogical advantages over other CME formats because they are learner centric, allowing for skill acquisition and improvement without the responsibility of patient care. Ongoing research is providing new evidence that simulation is of paramount importance to continuing professional development as it has been in graduate medical education. After briefly outlining the limitations of our current surgical CME paradigm, this paper will suggest that medical simulation using laparoscopic simulation trainers is a powerful yet underutilized adjunct to the current methods of surgical training for the practicing community surgeon. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice-based learning and improvement.

Comparación entre 3 modelos para el entrenamiento en el cierre de una herida superficial

IntroductionMedical simulation has been used as a teaching aid in diagnostic and therapeutic procedures, medical concepts, decision making, ethical aspects, and teamwork with undergraduates, doctors, and other health professionals. ObjectivesTo develop a skin simulator for surgical training in basic skills in medical undergraduates.To evaluate the acquisition of basic skills in surgery in a group of undergraduates. MethodsA group of 90 second year medical students of the Faculty of Medicine of the Autonomous Unviversity of Mexico were evaluated during two periods on the acquisition of basic skills and management instruments for closing a simulated shallow wound. They were divided into three groups, according to the use of biological/non-biological models. Statistical analysisComparison of the groups using the analysis of variance with a factor, ANOVA test. ResultsA total of 6 simulators were constructed for each silicone cartridge, obtaining a surface sheet 2-4mm thick, with elastic behaviour and a soft, smooth, flexible and resilient consistency. The final evaluations of the three groups were compared. A difference was found between using a skin simulator and pig leg compared to the use of rabbit in the final evaluation of Sarnoff and subdermal sutures. ConclusionsA better acquisition of surgical skills was observed when using a non-biological simulator, probably because of the constant training and easy manipulation of the model.

Can Fatigue Affect Acquisition of New Surgical Skills? A Randomized Prospective Trial of Pre- and Post-Call General Surgery Residents Using the Da Vinci Surgical Skills Simulator

Can Fatigue Affect Acquisition of New Surgical Skills? A Randomized Prospective Trial of Pre- and Post-Call General Surgery Residents Using the Da Vinci Surgical Skills Simulator

Evaluation of Dry Lab Training on Residents Knowledge of Robotic Instrumentation and Surgical Preparation

BACKGROUND: Current studies of robotic surgery training are focused primarily on education and evaluation of surgical skills acquisition. However, a component not well studied is knowledge of instrumentation and surgical preparation (port placement, docking, and console knowledge). METHODS: Evaluation of residents knowledge was completed by a short pre and post-test consisting of 16 questions on patient positioning (maximum of 2 points), docking/patient cart information (maximum of 16 points) and the surgeon console (maximum of 12 points). The total score is calculated as the sum of these three components (range: 0–30). Residents demographics, pre-test, post-test and recall test total scores are summarized by descriptive statistics. The comparison of scores before and after training is made by the Wilcoxon signed-rank test and through regression on the ranks of the scores. Rank regression models allow adjustment of residents demographics characteristics on the change in scores. RESULTS: Twenty-seven residents participated in the dry lab training session. There was a significant increase in test scores after the dry lab in comparison to test scores before (pre-test score: median=24, range (7–28) versus post-test score: median=29, range (22–30); Wilcoxon rank sum test P=.002). DISCUSSION: Test scores after the dry lab significantly increased in comparison to before the lab. However, tests at 3–4 months were lower than tests after the lab, especially for more junior residents. This indicates that although there was knowledge attained from the dry lab, it may need more reinforcement throughout the year.

Predicting surgical skill acquisition in preclinical medical students

BackgroundThe purpose of this study was to identify factors that predict medical student success in acquiring invasive procedural skills. We hypothesized that students with interest in surgery and with prior procedural experience would have higher rates of success. MethodsPreclinical students were enrolled in a simulation course comprised of suturing, intubation, and central venous catheterization. Students completed surveys to describe demographics, specialty interest area, prior experience, and confidence. Using linear regression, variables predictive of proficiency were identified. ResultsForty-five participants completed the course. Under univariate analysis, composite pretest score was inversely associated with confidence (P = .039). Under multivariable analysis, female gender was associated with higher pretest suturing score (P = .016). Male gender (P = .029) and high confidence (P = .021) were associated with greater improvement in suturing. ConclusionsAmong novices, higher confidence can predict lower baseline technical proficiency. Although females had higher pretest suturing scores, high confidence and male gender were associated with the greatest degree of improvement.

Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery.

Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency.

Impact of seductive details on the acquisition and transfer of laparoscopic suturing skills: Emotionally interesting or cognitively taxing?

A common strategy to increase learner engagement is to interweave educational material with interesting but slightly tangential tidbits of information (eg, "war stories" and funny anecdotes), known as seductive details. Our objective was to examine the impact of seductive details on initial acquisition and transfer of basic laparoscopic surgical skills. Novices (first- to fourth-year medical students) were randomized into control (N=47) or seductive details (N=42) groups. Curricula consisted of a baseline skills assessment (Fundamentals of Laparoscopic Surgery Task 1), instructional video on intracorporeal laparoscopic suturing (Fundamentals of Laparoscopic Surgery Task 5), multiple choice quiz, practice, and assessment on both primary and transfer tasks. Two separate instructional videos were used for Task 5; 20% of the seductive details group's instructional video consisted of seductive details, whereas the control group's video included no seductive details. Participants completed questionnaires of mental workload and task engagement after training. We also conducted a mediation analysis, which is a statistical approach to identify causal paths among a group of variables. Baseline skill scores (control: 112±52; standard deviation: 118±56; 0=lowest possible score; 600=highest possible score) and knowledge scores (control: 76±19; standard deviation: 74±16; 0=lowest possible score; 100=highest possible score) were similar for both groups. The control group demonstrated better (higher) performance on both the primary (434±193 vs 399±133, P<.05) and transfer (184±74 vs 149±91, P<.05) suturing tasks. Mental workload, as measured by the National Aeronautics and Space Administration-Task Load Index, was more demanding (higher) for the seductive details group (3.8±0.5 vs 3.4±0.7, P<.01; 1=low workload; 5=high workload) and was investigated as the possible mechanism by which group assignment impacted performance. Mediational paths using hierarchical regression were significant (P<.05), suggesting that trainees in the seductive details group performed worse because of their increased workload. Our findings suggest that the inclusion of seductive details may be detrimental to the acquisition and transfer of laparoscopic surgical skills due to increased mental workload for trainees.

Surgical Education’s 100 Most Cited Articles: A Bibliometric Analysis

Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed. Thomson Reuters Web of Science was interrogated using the keyword search terms "surgery" and ("learning" or "skills" or "competence" or "assessment" or "training" or "procedure-based assessments" or "performance" or "technical skills" or "curriculum" or "education" or "mentoring"] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin. A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40). Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education.

The Sex Difference in Basic Surgical Skills Learning: A Comparative Study

Very little is known of sex-related differences among medical students in the acquisition of basic surgical skills at an undergraduate level. The aim of this study was to investigate the sex differences in basic surgical skills learning and the possible explanations for sex disparities within basic surgical skills education. A didactic description of 10 surgical skills was performed, including knot tying, basic suture I, basic suture II, sterile technique, preoperative preparation, phlebotomy, debridement, laparotomy, cecectomy, and small bowel resection with hand-sewn anastomosis. The students were rated on a 100-point scale for each basic surgical skill. Later during the same semester all the students took the final theoretical examination. A total of 342 (male = 317 and female = 25) medical students participated in a single skills laboratory as part of their third-year medical student clerkship. The mean scores for each of the 10 surgical skills were higher in female group. The difference in sterile technique, preoperative preparation, cecectomy, and small bowel resection with hand-sewn anastomosis reached the significant level. Compared with male medical students, the mean theory examination score was significantly higher in female medical students. Approximately 76% of the (19 of 25) female students expressed their interest in pursuing a surgical career, whereas only 65.5% (207 of 317) male students wanted to be surgical professionals (p = 0.381). Female medical students completed basic surgical skills training more efficiently and passed the theoretical examination with significantly higher scores than male medical students. In the future, studies should be done in other classes in our institution and perhaps other schools to see if these findings are reliable or valid or just a reflection of this 1 sample.

The assessment of surgical skills as a complement to the training method. Revision

Context and objectiveThe acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyze the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. Acquisition of evidenceScientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. Summary of the evidenceAfter conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. ConclusionsWe believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

The effect of stress on learning in surgical skill acquisition

Background: An excessive level of stress and anxiety in medical education can have a negative impact on learning. In particular, the interaction between attending surgeons and trainees in the operating room could induce stress on trainees that is counterproductive, especially if the teaching style or feedback is unduly harsh or critical.Aim: To characterize the effects of stress resulting from attending–trainee interaction during surgical skill acquisition.Methods: Forty medical students learned to perform the FLS pattern-cutting task for the first time in one of four scenarios. In the control condition, no mentor was present. In the three experimental conditions, participants were observed, encouraged, or criticized by an expert surgeon.Results: Task performance, as well as physiological and subjective indicators of stress, were measured. Taking both speed and accuracy into account, participants who were criticized performed the worst on the task, and those who were encouraged performed best. Physiological and subjective measures indicated that the criticized participants experienced the highest level of stress and anxiety.Conclusion: Even though providing constructive criticism to trainees is inevitable during the course of teaching, an exceedingly critical and negative mentoring style by attending physicians could be detrimental to trainees’ acquisition of surgical skills.

The mapping of preferred resources for surgical education: Perceptions of surgical trainees at the Advanced International Minimally Invasive Surgery Academy (AIMS), Milan, Italy

Abstract Objectives Surgical training courses provide the trainees with anatomical knowledge and manual dexterity. This study aimed to capture the learning styles and training preferences of participants attending a masterclass training centre. This data can facilitate the program directors in tailoring the course contents to enhance the learning environment. Methods Between 2010 and 2013, a questionnaire was administered to all participants at the end of each course at the Advanced International Minimally Invasive Surgery Academy (AIMS) in Milan, Italy. The instrument explored the feedback of participants regarding their surgical experiences, learning needs and desired surgical educational resources in minimally invasive surgery. Results Of 636 respondents, 606 (95%) performed some laparoscopic procedures at their workplaces. Of the respondents, 467 (73%) preferred ‘direct experience in the operating room’, 424 (66%) preferred ‘tutoring with skilled colleague’, and 275 (43%) wanted ‘hands-on training on animals in their own countries’. Female respondents favoured national congresses as educational resources more than males, with mean ranks of 207.22 vs. 176.51, respectively (p 0.022). The respondents serving hospitals preferred international congresses (mean rank 189.21) more than the respondents serving universities (mean rank 181.72) and private clinics (mean rank 127.45). Conclusion This study shows that surgical trainees prefer hands-on training in operating rooms, tutoring by skilled colleagues and short fellowships to learn and enhance their surgical skills. Surgical educators can focus on these preferred surgical educational resources to enhance students' acquisition of surgical skills.

Skill acquisition and stress adaptations following laparoscopic surgery training and detraining in novice surgeons.

Surgical training and practice is stressful, but adaptive changes in the stress circuitry (e.g. perceptual, physiological, hormonal, neural) could support skill development. This work examined skill acquisition and stress adaptations in novice surgeons during laparoscopic surgery (LS) training and detraining. Twelve medical students were assessed for skill performance after 2h (BASE), 5h (MID) and 8h (POST) of LS training in weeks 1-3, and then after 4weeks of no training (RETEST). The stress outcomes included state anxiety, perceived stress and workload, heart rate (HR), heart rate variability (HRV), and salivary testosterone and cortisol concentrations. Functional near-infrared spectroscopy was used to assess cortical oxygenation change, as a marker of prefrontal cortex (PFC) activity. Skill performance improved in every session from BASE (p<0.01), with corresponding decreases in state anxiety, stress, workload, low- and high-frequency HRV in the MID, POST and/or RETEST sessions (p<0.05). Left and right PFC were symmetrically activated within each testing session (p<0.01). The stress and workload measures predicted skill performance and changes over time (p<0.05), with state anxiety, mean HR and the HRV measures also showing some predictive potential (p<0.10). A 3-week LS training programme promoted stress-related adaptations likely to directly, or indirectly, support the acquisition of new surgical skills, and many outcomes were retained after a 4-week period without further LS training. These results have implications for medical training and education (e.g. distributed training for skill development and maintenance, stress resource and management training) and highlighted possible areas for new research (e.g. longitudinal stress and skill profiling).