Transfer Of Surgical Skills Research Articles

Procedural simulators for teaching and learning vasectomy techniques: a scoping review.

Procedural simulators can facilitate teaching and improve learning vasectomy surgical techniques. The objectives of this scoping review were to identify available vasectomy simulators (scrotal models), and to assess their characteristics and potential suitability for optimal transfer of surgical skills of most recommended techniques in clinical practice. We performed searches up to December 2023 using PubMed and Google search engines to identify existing vasectomy simulators. Articles and Web pages reporting vasectomy simulators were also examined using a snowball strategy. In addition, we asked members of the Vasectomy Network, an international Google discussion group, if they knew any other simulators. Two members of the research team performed the initial evaluations of the physical and functional characteristics of retrieved simulators. All team members made consensus on final evaluations. We retrieved 10 relevant scrotal models through PubMed (n=2), Google (n=4), and the Vasectomy Network (n=4). Three were commercially available simulators produced by Gaumard® in the USA and seven were homemade models. All had limited visual and haptic realism of internal and external structures. Most, however, were suitable for simulating some basic skills of the no-scalpel technique to deliver the vas deferens. Fascial interposition could not be simulated with any model. Commercially available models had no advantage over homemade models. Most vasectomy simulators currently available allow learning some basic surgical skills of the procedure but have limitations for optimal learning of the recommended techniques and skill transfer in clinical practice. There appears to be a need to develop and evaluate new simulators with enhance visual and haptic characteristics for teaching and learning vasectomy techniques.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR).

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

A surgical instrument motion measurement system for skill evaluation in practical laparoscopic surgery training.

This study developed and validated a surgical instrument motion measurement system for skill evaluation during practical laparoscopic surgery training. Owing to the various advantages of laparoscopic surgery including minimal invasiveness, this technique has been widely used. However, expert surgeons have insufficient time for providing training to beginners due to the shortage of surgeons and limited working hours. Skill transfer efficiency has to be improved for which there is an urgent need to develop objective surgical skill evaluation methods. Therefore, a simple motion capture-based surgical instrument motion measurement system that could be easily installed in an operating room for skill assessment during practical surgical training was developed. The tip positions and orientations of the instruments were calculated based on the marker positions attached to the root of the instrument. Because the patterns of these markers are individual, this system can track multiple instruments simultaneously and detect exchanges. However due to the many obstacles in the operating room, the measurement data included noise and outliers. In this study, the effect of this decrease in measurement accuracy on feature calculation was determined. Accuracy verification experiments were conducted during wet-lab training to demonstrate the capability of this system to measure the motion of surgical instruments with practical accuracy. A surgical training experiment on a cadaver was conducted, and the motions of six surgical instruments were measured in 36 cases of laparoscopic radical nephrectomy. Outlier removal and smoothing methods were also developed and applied to remove the noise and outliers in the obtained data. The questionnaire survey conducted during the experiment confirmed that the measurement system did not interfere with the surgical operation. Thus, the proposed system was capable of making reliable measurements with minimal impact on surgery. The system will facilitate surgical education by enabling the evaluation of skill transfer of surgical skills.

Laparoscopic but not open surgical skills can be transferred to robot-assisted surgery: A systematic review and meta-analysis.

With an increase in robot-assisted surgery across all specialties, adequate training and credentialing strategies need to be identified to ensure patients safety. The meta-analysis assesses the transferability of technical surgical skills between laparoscopic surgery, open surgery, and robot-assisted surgery. A systematic search was conducted in Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Outcomes were categorized into time, process, product, and composite outcome measures and pooled separately using Hedges'g (standardized mean difference [SMD]). Subgroup analyses were performed to assess the effect of study design, virtual reality platforms and task difficulty. Out of 14,120 screened studies, 30 were included in the qualitative synthesis and 26 in the quantitative synthesis. Technical surgical skill transfer was demonstrated from laparoscopic to robot-assisted surgery (composite: SMD 0.40, 95%-confidence interval [CI] [0.19; 0.62], time: SMD 0.62, CI [0.33; 0.91]) and vice versa (composite: SMD 0.66, CI [0.33; 0.99], time [basic skills]: SMD 0.36, CI [0.01; 0.72]). No skill transfer was seen from open to robot-assisted surgery with limited available data. Technical surgical skills can be transferred from laparoscopic to robot-assisted surgery and vice versa. Robot-assisted and laparoscopic surgical skills training and credentialing should not be regarded separately, but a reasonable combination could shorten overall training times and increase efficiency. Previous experience in open surgery should not be considered as an imperative prerequisite for training in robot-assisted surgery. Recommendations for studies assessing skill transfer are proposed to increase comparability and significance of future studies. PROSPERO CRD42018104507.

Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study.

Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs' successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the "College des Ophtalmologistes Universitaires de France" in order to set up a future "licence to operate." Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. ClinicalTrial.gov identifier: NCT05722080.

Ticket to perform: an explorative study of trainees’ engagement in and transfer of surgical training

BackgroundResearch suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees’ engagement in and perceptions of transfer of surgical skills training.MethodsWe conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation.ResultsWe interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants’ altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer.ConclusionsOur findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees’ narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.

Wet Laboratory Training in Ophthalmology as a Tool for Formative Assessment.

Surgical skills training and assessment have always remained a critical issue for both trainees and trainers. Ophthalmology being a microsurgical specialty, its training in the operating theater further faces a lot of challenges. Wet laboratory training and simulation training were, therefore, developed so that residents acquired certain basic skills in controlled laboratory settings before they could operate on patients and patient safety could thereby be ensured. Unfortunately, most literature focuses on the benefits such practice has on operating room performance; but not much attention has been paid to the use of such training for formative assessment, feedback, and its importance in effective learning. In this article, we highlight the challenges faced in surgical skill transfer and also give an insight into how wet or dry laboratory training can be of formative value in postgraduate training.

The transferability of laparoscopic and open surgical skills to robotic surgery

BackgroundWithin the last decades, robotic surgery has gained popularity. Most robotic surgeons have changed their main surgical activity from open or laparoscopic without prior formal robotic training. With the current practice, it is of great interest to know whether there is a transfer of surgical skills. In visualization, motion scaling, and freedom of motion, robotic surgery resembles open surgery far more than laparoscopic surgery. Therefore, our hypothesis is that open-trained surgeons have more transfer of surgical skills to robotic surgery, compared to surgeons trained in laparoscopy.MethodsThirty-six surgically inexperienced medical students were randomized into three groups for intensive simulation training in an assigned modality: open surgery, laparoscopy, or robot-assisted laparoscopy. The training period was, for all study subjects, followed by performing a robot-assisted bowel anastomosis in a pig model. As surrogate markers of surgical quality, the anastomoses were tested for resistance to pressure, and video recordings of the procedure were evaluated by two blinded expert robotic surgeons, using a global rating scale of robotic operative performance (Global Evaluative Assessment of Robotic Skills (GEARS)).ResultsThe mean leak pressure of bowel anastomosis was 36.25 (7.62–64.89) mmHg in the laparoscopic training group and 69.01 (28.02–109.99) mmHg in the open surgery group, and the mean leak pressure for the robotic training group was 108.45 (74.96–141.94) mmHg. The same pattern was found with GEARS as surrogate markers of surgical quality. GEARS score was 15.71 (12.37–19.04) in the laparoscopic training group, 18.14 (14.70–21.58) in the open surgery group, and 22.04 (19.29–24.79) in the robotic training group. In comparison with the laparoscopic training group, the robotic training group had a statistically higher leak pressure (p = 0.0015) and GEARS score (p = 0.0023). No significant difference, for neither leak pressure nor GEARS, between the open and the robotic training group.ConclusionIn our study, training in open surgery was superior to training in laparoscopy when transitioning to robotic surgery in a simulation setting performed by surgically naive study subjects.

Redrawing vitreoretinal surgical training program in the COVID-19 era: Experiences of a tertiary care institute in North India.

Purpose:The COVID-19 pandemic has brought medical and surgical training to a standstill across the medical sub-specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This “loss” has adversely impacted trainees’ morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training.Methods:We introduced a three-pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands-on transfer of surgical skills in the operating room in our institute.Results:Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three-pronged approach in developing surgical skills and building their confidence.Conclusion:The disruption caused by the COVID-19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.

MP67-15 INTERNATIONAL OUTREACH SURGERY WORKSHOPS CAN DOUBLE AS A FOCUSED SUB-SPECIALTY HANDS-ON TRAINING OPPORTUNITY FOR UROLOGISTS FROM OTHER COUNTRIES SEEKING TO IMPROVE THEIR SKILLS AND OUTCOMES

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-15 INTERNATIONAL OUTREACH SURGERY WORKSHOPS CAN DOUBLE AS A FOCUSED SUB-SPECIALTY HANDS-ON TRAINING OPPORTUNITY FOR UROLOGISTS FROM OTHER COUNTRIES SEEKING TO IMPROVE THEIR SKILLS AND OUTCOMES Catherine Nguyen, Hung Do, and Joel Gelman Catherine NguyenCatherine Nguyen More articles by this author , Hung DoHung Do More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Currently, the overwhelming majority of Reconstructive Urology Fellowships are located in the United States, whereas most countries in the world lack a single training center. In these countries, Urologists interested in becoming experts in urethroplasty often develop skills through informal training or on their own. Our United States - HCMC Vietnam outreach relationship was established in 2014 to improve urethral stricture treatment success in Vietnam by training a single Urologist through annual 2-week outreach trips. Recently, we expanded these workshops to include the participation of practicing Urologists from other countries seeking supplemental training. We report our early experience and the perceived value of a hands-on approach in comparison to "live" and "semi-live surgical broadcasts. METHODS: Urologists from Indonesia, Australia, Hong-Kong and Malaysia who perform urethroplasty without formal Fellowship training were invited to join the annual workshop. Every day included urethroplasty where participants observed and/or assisted in the cases. All participants completed a survey of their experiences anonymously to minimize bias. RESULTS: All 5 participants completed the survey. All previously attended semi-live and live broadcast meetings. All felt that being in the OR was the most useful educational tool, and live broadcast of surgery was the second most useful. All participants felt that the workshop helped them learn the pitfalls of reconstructive surgery. Most agreed that the workshop provided them with skills that will or has improved their surgical success rate. All participants agree this model should be continued and expanded. CONCLUSIONS: Data from our small initial study indicates that this post-graduate educational model is valuable for honing urethroplasty skills. Given the scarcity of training opportunities in male reconstructive urology outside of the United States, sub-specialty specific outreach workshops can and should be expanded to include the participation of Urologists from other countries seeking to serve as leaders in urethral reconstruction in their countries. With this model, which can be applied to other sub-specialties, global outreach trips will not only deliver care and provide training to the Urologists of the visited country, but also allow for the transfer of surgical skills to Urologists from other parts of the world where a formal Fellowship is not available. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e515-e515 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Nguyen More articles by this author Hung Do More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

V05-03 AUGMENTED REALITY TECHNOLOGY IN GLOBAL UROLOGIC SURGERY

INTRODUCTION AND OBJECTIVE:Surgical medical missions allow for the global transfer of surgical skills, knowledge, and resources between high and low to middle-income countries to the benefit of bot...

Should Robotic Surgery Simulation Be Introduced in the Core Surgical Training Curriculum?

Introduction: The focus of this research is to qualitatively analyse the literature and address the knowledge gap between robotic surgery simulation (RoSS) and core surgical training curriculum. It will compare the effectiveness and the benefits of using robotic simulators in training as compared to the current standard training methods.Materials and Methods: A qualitative research of literature was carried out with the use of critical analysis formatting to expand the search. The inclusion criteria entailed selecting academic resources that focused on Robotic Surgery Simulation (RoSS) and core surgical curriculum. The Online databases used in the search took into account information retrieval from stakeholders.Evidence Synthesis: In this article, we compiled and scrutinized the available relevant literature comparing performance assessments, surgical skills transfer and assessment tools between robotic surgery simulation (RoSS) and current training platforms in open and minimal access surgery. Data that has been published underpins the authenticity of robotic Surgery Simulation (RoSS), based on a combination of observational evaluation and simulation scores.Conclusion: The introduction of robotic surgery simulation (RoSS) has the potential to bring major improvements in the surgical training curriculum. RoSS platforms are more robust in terms of ensuring rapid surgical skills transfer/ acquisition, assessment is standardized, unbiased and the training covers non-technical skills aspects.

Virtual reality simulation in robot-assisted surgery: meta-analysis of skill transfer and predictability of skill.

BackgroundThe value of virtual reality (VR) simulators for robot-assisted surgery (RAS) for skill assessment and training of surgeons has not been established. This systematic review and meta-analysis aimed to identify evidence on transferability of surgical skills acquired on robotic VR simulators to the operating room and the predictive value of robotic VR simulator performance for intraoperative performance.MethodsMEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science were searched systematically. Risk of bias was assessed using the Medical Education Research Study Quality Instrument and the Newcastle–Ottawa Scale for Education. Correlation coefficients were chosen as effect measure and pooled using the inverse-variance weighting approach. A random-effects model was applied to estimate the summary effect.ResultsA total of 14 131 potential articles were identified; there were eight studies eligible for qualitative and three for quantitative analysis. Three of four studies demonstrated transfer of surgical skills from robotic VR simulators to the operating room measured by time and technical surgical performance. Two of three studies found significant positive correlations between robotic VR simulator performance and intraoperative technical surgical performance; quantitative analysis revealed a positive combined correlation (r = 0.67, 95 per cent c.i. 0.22 to 0.88).ConclusionTechnical surgical skills acquired through robotic VR simulator training can be transferred to the operating room, and operating room performance seems to be predictable by robotic VR simulator performance. VR training can therefore be justified before operating on patients.

Deep Learning-Based Haptic Guidance for Surgical Skills Transfer.

Having a trusted and useful system that helps to diminish the risk of medical errors and facilitate the improvement of quality in the medical education is indispensable. Thousands of surgical errors are occurred annually with high adverse event rate, despite inordinate number of devised patients safety initiatives. Inadvertently or otherwise, surgeons play a critical role in the aforementioned errors. Training surgeons is one of the most crucial and delicate parts of medical education and needs more attention due to its practical intrinsic. In contrast to engineering, dealing with mortal alive creatures provides a minuscule chance of trial and error for trainees. Training in operative rooms, on the other hand, is extremely expensive in terms of not only equipment but also hiring professional trainers. In addition, the COVID-19 pandemic has caused to establish initiatives such as social distancing in order to mitigate the rate of outbreak. This leads surgeons to postpone some non-urgent surgeries or operate with restrictions in terms of safety. Subsequently, educational systems are affected by the limitations due to the pandemic. Skill transfer systems in cooperation with a virtual training environment is thought as a solution to address aforesaid issues. This enables not only novice surgeons to enrich their proficiency but also helps expert surgeons to be supervised during the operation. This paper focuses on devising a solution based on deep leaning algorithms to model the behavior of experts during the operation. In other words, the proposed solution is a skill transfer method that learns professional demonstrations using different effective factors from the body of experts. The trained model then provides a real-time haptic guidance signal for either instructing trainees or supervising expert surgeons. A simulation is utilized to emulate an operating room for femur drilling surgery, which is a common invasive treatment for osteoporosis. This helps us with both collecting the essential data and assessing the obtained models. Experimental results show that the proposed method is capable of emitting guidance force haptic signal with an acceptable error rate.

Adoption of newer teaching methods to overcome challenges of training in ophthalmology residency during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted training programs across all specialties. Surgical specialties, such as ophthalmology, that need continued microsurgical training are affected the most. The pandemic has resulted in ophthalmology residents being taken off their regular duties in ophthalmology and inducted into COVID duties. The focus on COVID care has de-emphasized training in ophthalmology. We highlight the challenges that teachers face in continuing the training programs of theory, clinical skill, and surgical skill transfer. Embracing technology is the need of the hour. We discuss the multiple options available to enable continued training programs and emphasize the need for all training institutes to include technology as an additional component of their training curricula.

Flash Box - A pragmatic tool to hone surgical skills of residents during postgraduate curriculum in ophthalmology

Purpose: To introduce a novel pragmatic tool (FLASH BOX) to help students learn, practice, and improve surgical skills during postgraduate curriculum in ophthalmology, especially small incision cataract surgery (SICS). Materials and Methods: Surgical training and transfer of surgical skills to the ophthalmology residents who will be our future lineage is the need of a good residency program. Animal eyes, postmortem human eyes, simulators, devices, teaching tools such as Kitaro dry lab and wet lab system kit are currently available to learn and practice surgical steps. Their availability in teaching institutes is really grueling. Flash box is a simple intraocular lens box freely available in each operation theater in all set ups and can be used freely to learn and master various steps of SICS. Results: Practicing on Flash box allows residents to get familiar with various surgical steps, operating microscope, and ophthalmic microsurgical instruments in a stress-free environment and helps to nurture surgical skills in residents. Conclusion: Flash box will help in the transformation of the surgical mindset of residents and can be a very helpful option for learning surgical steps of various ophthalmic surgeries.

Developing international inter hospital cooperation to reach the SDGs

Abstract Background The current epidemiological transition creates news issues to address (NCD as oncology, cardiovascular, diabetes, road accidents...) and causes an important increase of skills transfer needs in resource-poor/intermediate countries. Hospital cooperation is an efficient way to help the partner country/city adapt and increase their quality of care. Objectives The aims were multiple: set up transfer skills programs, but also understand both obstacles and success factors of such projects over the long term. AP-HP’s (Greater Paris University Hospitals) Department of International Relations, has developed 3 year-long projects (financed in majority by public funders) which link one or more hospitals of our group to a southern hospital, on a precise topic. Our multidisciplinary teams then support the local professionals either by training them or assessing their current situation and proposing an action plan. Results Over those last 4 years, we built more than 50 cooperations, most of them being successful and still active today. 20 of our hospitals have been involved in at least one project. In 2018, we were working with more than 30 different countries. We noticed a growing interest both from our teams and new partners, over the years. In 2018, around 150 healthcare professionals from AP-HP took part in at least one mission abroad and more than 3 000 foreign professionals have been trained in various ways (from conferences to technical surgical skill transfer), including about 50 trained on site in Paris. These trainings are intended not only to physicians but also for midwives, nurses and managers. Conclusions Those projects have a good efficiency in a short term. Therefore, the risk of unsustainability is quite important. For the programs to be effective in the long run, there needs to be a collective involvement both from institutions and healthcare teams in the project on both sides. Key messages European hospitals should develop a strong international cooperation policy. AP-HP intends to intensify its work, being an efficient way of contributing to reach both SDG 3 and 9.

African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries.

There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa-based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care. An observational study was conducted by emailing questionnaires to past fellows. All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care. Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion.

Objective assessment of surgical skill transfer using non-invasive brain imaging.

Physical and virtual surgical simulators are increasingly being used in training technical surgical skills. However, metrics such as completion time or subjective performance checklists often show poor correlation to transfer of skills into clinical settings. We hypothesize that non-invasive brain imaging can objectively differentiate and classify surgical skill transfer, with higher accuracy than established metrics, for subjects based on motor skill levels. 18 medical students at University at Buffalo were randomly assigned into control, physical surgical trainer, or virtual trainer groups. Training groups practiced a surgical technical task on respective simulators for 12 consecutive days. To measure skill transfer post-training, all subjects performed the technical task in an ex-vivo environment. Cortical activation was measured using functional near-infrared spectroscopy (fNIRS) in the prefrontal cortex, primary motor cortex, and supplementary motor area, due to their direct impact on motor skill learning. Classification between simulator trained and untrained subjects based on traditional metrics is poor, where misclassification errors range from 20 to 41%. Conversely, fNIRS metrics can successfully classify physical or virtual trained subjects from untrained subjects with misclassification errors of 2.2% and 8.9%, respectively. More importantly, untrained subjects are successfully classified from physical or virtual simulator trained subjects with misclassification errors of 2.7% and 9.1%, respectively. fNIRS metrics are significantly more accurate than current established metrics in classifying different levels of surgical motor skill transfer. Our approach brings robustness, objectivity, and accuracy in validating the effectiveness of future surgical trainers in translating surgical skills to clinically relevant environments.

Development of a saphenous vein harvest model for simulation-based assessment

ObjectiveThere is a need to develop a realistic model of open saphenous vein harvesting for simulation training and assessment. The purpose of this study was to develop a novel simulated model of this procedure and to examine its viability by examining participants’ performance and feedback on this model. MethodsA total of 14 participants (cardiac surgeons, residents, students) conducted open saphenous vein harvesting on a portable, noncommercial, simulated vein model (complete with artificial vein, subcutaneous tissue, and skin) within an operating room. Surgical assistance was provided by a cardiac resident. Participants provided feedback through questionnaires and interviews. Technical performance was rated by 2 blinded raters using a global rating scale for operative technical skills. ResultsQuantitative analyses demonstrated that participants considered the model to be realistic and useful. Analyses of performance ratings indicated that the model could be used as a reliable indicator of skill level, given that raters were able to use performance scores to discriminate participants according to their level of experience at a high level of accuracy. Participants with a higher level of experience performed significantly better than those with a lower level of experience. Qualitative analyses revealed the model was considered to be most beneficial to learn procedural steps of vein harvesting and basic surgical skills. ConclusionsResults provide support for the technical fidelity of this model and its ability to identify skill level for assessment of vein harvesting. Future work should examine transfer of surgical skills from simulator to clinical practice to assess its viability for training.