Touch Surgery Research Articles

Evaluation of the utility of surgical simulation software in medical postgraduate education

BackgroundThe use of medical simulation software in medical institutions is growing to address teaching challenges. The study aims to assess the effectiveness of the Touch Surgery app, a free medical simulation software, as a supplement to the teaching methodology of unified surgery for medical students. MethodsTwenty-three postgraduate students, divided into three groups based on residency training years, and five senior orthopedic surgeons took part in the study. Each participant completed three modules within the Large External Fixators module using the Touch Surgery app. The results achieved by orthopedic specialists and postgraduates in the test module were recorded separately. The orthopedic specialists' first test module scores were used as a baseline. A Likert survey assessed the usefulness and content accuracy of the app. Statistical analysis included analysis of variance and 2-tailed t-test. ResultsThe first and second scores achieved by the postgraduates in the three groups were significantly different from the baseline of the orthopedic specialists, but the mean scores of all postgraduate's groups increased with simulator usage for learning and by the third attempt they were at the same level as the orthopedic specialists. However, no significant performance differences were observed between postgraduates with different training years. Postgraduates expressed a positive opinion of the usefulness and content of Touch Surgery in the questionnaire and their intention to continue using it in their future studies. ConclusionsThis study shows that the use of Touch Surgery improves postgraduates' performance and ultimately enables them to reach the level of orthopedic specialists in simulated surgery, and received positive ratings for the software's experience and content. Touch Surgery can be a valuable complement to traditional surgical teaching methods, bridging the gap between theoretical learning from textbooks and guided rehearsals of surgical steps and skills.

Impact of the COVID-19 Pandemic on Surgical Residency Training: Time to Digitalization

Background: The COVID-19 pandemic has had a profound impact on medical education, particularly in surgical specialties. Surgical training, traditionally reliant on hands-on experience, has faced unprecedented challenges due to reduced clinical activities and elective surgeries. Aim: The primary aim of this study was to evaluate the effects of the COVID-19 pandemic on the clinical and surgical training of Tunisian surgical residents, along with their psychological well-being. Additionally, the study aimed to propose feasible and cost-effective measures for enhancing surgical training in low-income countries, like Tunisia, during and after the pandemic. Methods: A cross-sectional survey was conducted at a teaching hospital in Tunisia between December 1st and 30th, 2020. The survey, distributed to 36 surgical residents, included questions on demographic characteristics, training activities, and psychological impact using the GAD-7 and PHQ-9 questionnaires. Data on respondents' suggestions for training improvements were also collected. Results: Of the invited residents, 72% (26 participants) responded. The respondents reported a significant reduction in clinical and surgical training opportunities, with 85% believing the pandemic negatively impacted their training. Psychological assessment revealed increased stress and anxiety among all participants, with 77% showing signs of depression. The residents suggested increasing the frequency of teleconference-based college courses and clinical case discussion sessions. Additionally, the adoption of low-cost simulation-based training, free access to online surgical video libraries, and use of the Touch Surgery application were highlighted as valuable tools. Conclusion: The COVID-19 pandemic has significantly disrupted surgical residency training in Tunisia, impacting both the training quality and psychological well-being of residents. The findings emphasize the need for innovative training methodologies in low-resource settings. Proposed measures, including simulation-based training using low-cost models and enhanced digital resources, offer practical solutions to sustain surgical education during such global crises. The study underscores the importance of adapting and expanding surgical training methodologies to ensure continued learning and skill development in challenging times.

Assessment of Surgical Training Modality Efficacy in Medical Students – A Comparison of Surgical Simulation, Video Demonstration, and Live Instruction

Objectives Surgical simulation is a growing form of education in medical training, but it remains unclear how simulation compares to traditional lecture or apprenticeship models of teaching when translating procedural knowledge to surgical performance. This study aimed to assess the effectiveness of translating procedural knowledge to surgical skill when trained by the surgical simulation app “Touch Surgery (TS),” recorded video lecture, or in-person teaching of the trigger finger release (TFR) surgery. The study also aimed to identify the learners’ preferred teaching modality. Methods Twenty-seven first- and second-year medical students were recruited to participate. They were randomly assigned to one of three cohorts (n=9) as designated by a different TFR surgery learning modality: surgical simulation through TS (cohort “SS”), video demonstration (cohort “VIDEO”), or live teaching by a board-certified orthopaedic hand surgeon (cohort “LIVE”). Each participant completed their modality three times. They then completed an assessment of the procedural steps before performing the TFR surgery on a cadaver. Outcome measures included procedural test scores and cadaveric performance, evaluated using a surgery-specific detailed checklist, a global rating scale (GRS) of soft surgical skills, and a pass/fail assessment. Participants graded their modality’s usefulness using a 5-point Likert scale. Results There was no statistically significant difference in TFR procedural assessment scores (P=0.123) or cadaveric surgical performance between groups when evaluated by the surgery-specific step checklist (P=0.549), GRS (P=0.567), and pass/fail assessment (P=0.874). Students in the LIVE cohort rated their modality as their first-choice training tool (P=0.009); however, those in the SS cohort rated their modality as easiest to use, follow, and understand (P=0.010). Conclusion All educational modalities should be considered in surgical training. This study demonstrates that students can perform cognitively and technically similar learning from virtual or live formats; however, they preferred live teaching. Level of Evidence III

Current trends and barriers to video management and analytics as a tool for surgeon skilling.

The benefits of intraoperative recording are well published in the literature; however, few studies have identified current practices, barriers, and subsequent solutions. The objective of this study was to better understand surgeon's current practices and perceptions of video management and gather blinded feedback on a new surgical video recording product with the potential to address these barriers effectively. A structured questionnaire was used to survey 230 surgeons (general, gynecologic, and urologic) and hospital administrators across the US and Europe regarding their current video recording practices. The same questionnaire was used to evaluate a blinded concept describing a new intraoperative recording solution. 54% of respondents reported recording eligible cases, with the majority recording less than 35% of their total eligible caseload. Reasons for not recording included finding no value in recording simple procedures, forgetting to record, lack of access to equipment, legal concerns, labor intensity, and difficulty accessing videos. Among non-recording surgeons, 65% reported considering recording cases to assess surgical techniques, document practice, submit to conferences, share with colleagues, and aid in training. 35% of surgeons rejected recording due to medico-legal concerns, lack of perceived benefit, concerns about secure storage, and price. Regarding the concept of a recording solution, 74% of all respondents were very likely or quite likely to recommend the product for adoption at their facility. Appealing features to current recorders included the product's ease of use, use of AI to maintain patient and staff privacy, lack of manual downloads, availability of full-length procedural videos, and ease of access and storage. Non-recorders found the immediate access to videos and maintenance of patient/staff privacy appealing. Tools that address barriers to recording, accessing, and managing surgical case videos are critical for improving surgical skills. Touch Surgery Enterprise is a valuable tool that can help overcome these barriers.

Touch surgery to improve surgical performance with a robotic system in a public hospital in Central America

Since 2012 robotic surgery has been available in Panama. In 2022, the Hugo robot became available in a public hospital. The adoption of a new robotic platform can be difficult. We reviewed our experience in implementing this robotic system for urologic surgery in a public hospital in Central America using Touch surgery, a cloud-based video storage and analytics system, available on smartphones. We use the Touch surgery reports to compare time in minutes between the 5 first and the last 5 radical prostatectomy surgeries.

Surgical Phase Duration in Robot-Assisted Partial Nephrectomy: A Surgical Data Science Exploration for Clinical Relevance.

(1) Background: Surgical phases form the basic building blocks for surgical skill assessment, feedback, and teaching. The phase duration itself and its correlation with clinical parameters at diagnosis have not yet been investigated. Novel commercial platforms provide phase indications but have not been assessed for accuracy yet. (2) Methods: We assessed 100 robot-assisted partial nephrectomy videos for phase durations based on previously defined proficiency metrics. We developed an annotation framework and subsequently compared our annotations to an existing commercial solution (Touch Surgery, Medtronic™). We subsequently explored clinical correlations between phase durations and parameters derived from diagnosis and treatment. (3) Results: An objective and uniform phase assessment requires precise definitions derived from an iterative revision process. A comparison to a commercial solution shows large differences in definitions across phases. BMI and the duration of renal tumor identification are positively correlated, as are tumor complexity and both tumor excision and renorrhaphy duration. (4) Conclusions: The surgical phase duration can be correlated with certain clinical outcomes. Further research should investigate whether the retrieved correlations are also clinically meaningful. This requires an increase in dataset sizes and facilitation through intelligent computer vision algorithms. Commercial platforms can facilitate this dataset expansion and help unlock the full potential, provided that the phase annotation details are disclosed.

Assessing the training effect of knee arthroscopy cognitive-task surgical simulations on the theoretical and technical knowledge acquisition in novices

Background The COVID-19 pandemic had drastic consequences on medical education, especially in surgical exposure and procedural learning. Cognitive task analysis (CTA) simulators, including Touch Surgery, are gaining prominence as a learning tool for surgical training in a low-risk environment virtually. The study objective was to investigate the training effect of Touch Surgery’s knee arthroscopy module in both theoretical and technical knowledge acquisition for novices, and qualitative feedback on CTA simulators for surgical education. Methods Thirteen medical students were recruited in an Institutional Review Board-approved study to complete the knee arthroscopy simulation module on Touch Surgery, a clinically validated, cognitive task mobile-app based surgical simulator. Participants were given an expert-validated questionnaire evaluating surgical theory and technique on knee arthroscopy before and after at least three consecutive attempts on the module, along with qualitative questions assessing attitudes towards using the platform. A 2-tailed paired Student t-test was used to assess for statistically significant changes between pre- and post-study scores, with p-value < 0.05 considered significant. Results Mean scores for pre- and post-simulator use demonstrated statistically significant improvements for technical and overall knowledge acquisition (p < 0.05). Improvement in theoretical knowledge acquisition was also observed, but the difference was not statistically significant (p = 0.052). Participants generally found the app “easy to use”, “fun to use” and “more interactive compared to other study material”. Conclusion CTA simulators provide an effective means of technical knowledge acquisition for novices such as medical students, and serve as an engaging and useful training adjunct for surgical education.

Automated operative workflow analysis of endoscopic pituitary surgery using machine learning: development and preclinical evaluation (IDEAL stage 0).

Surgical workflow analysis involves systematically breaking down operations into key phases and steps. Automatic analysis of this workflow has potential uses for surgical training, preoperative planning, and outcome prediction. Recent advances in machine learning (ML) and computer vision have allowed accurate automated workflow analysis of operative videos. In this Idea, Development, Exploration, Assessment, Long-term study (IDEAL) stage 0 study, the authors sought to use Touch Surgery for the development and validation of an ML-powered analysis of phases and steps in the endoscopic transsphenoidal approach (eTSA) for pituitary adenoma resection, a first for neurosurgery. The surgical phases and steps of 50 anonymized eTSA operative videos were labeled by expert surgeons. Forty videos were used to train a combined convolutional and recurrent neural network model by Touch Surgery. Ten videos were used for model evaluation (accuracy, F1 score), comparing the phase and step recognition of surgeons to the automatic detection of the ML model. The longest phase was the sellar phase (median 28 minutes), followed by the nasal phase (median 22 minutes) and the closure phase (median 14 minutes). The longest steps were step 5 (tumor identification and excision, median 17 minutes); step 3 (posterior septectomy and removal of sphenoid septations, median 14 minutes); and step 4 (anterior sellar wall removal, median 10 minutes). There were substantial variations within the recorded procedures in terms of video appearances, step duration, and step order, with only 50% of videos containing all 7 steps performed sequentially in numerical order. Despite this, the model was able to output accurate recognition of surgical phases (91% accuracy, 90% F1 score) and steps (76% accuracy, 75% F1 score). In this IDEAL stage 0 study, ML techniques have been developed to automatically analyze operative videos of eTSA pituitary surgery. This technology has previously been shown to be acceptable to neurosurgical teams and patients. ML-based surgical workflow analysis has numerous potential uses-such as education (e.g., automatic indexing of contemporary operative videos for teaching), improved operative efficiency (e.g., orchestrating the entire surgical team to a common workflow), and improved patient outcomes (e.g., comparison of surgical techniques or early detection of adverse events). Future directions include the real-time integration of Touch Surgery into the live operative environment as an IDEAL stage 1 (first-in-human) study, and further development of underpinning ML models using larger data sets.

Using an application to measure trainees' procedural knowledge before chest tube insertion.

To collect validity evidence for the chest tube insertion (CTI) test mode on the medical simulation application Touch Surgery. This was done by using Messick's contemporary framework. Novice, intermediate and experienced participants provided informed consent and demographic information. After familiarisation with the application, they completed the CTI test mode. Validity evidence was collected from four sources: content, response process, relation to other variables and consequences. A post-study questionnaire with 5-point Likert scales assessed the perceived realism, relevance and utility of the assessment. Mean scores of the three groups were compared. A total of 25 novices, 11 intermediates and 19 experienced participants were recruited. Content evidence was collected by an expert in CTI and was based on published literature and guidelines. All users were familiarised with the application, and received standardised instructions throughout the test. Most users rated the simulation as realistic and suitable to assess cognitive skills. Novices received significantly lower (55.9±7.5) test mode scores than intermediates (80.6±4.4) (p<0.001) and experienced participants (82.3±5.3) (p<0.001). There was no significant difference in score between intermediate and experienced participants (p=0.75). Consequences evidence was provided by establishing a pass/fail score of 71% using the contrasting groups method, which resulted in one observed false positive and no false negatives. A robust validity argument was constructed for the CTI test mode, which can be implemented in surgical curricula to assess learners' cognitive skills prior to hands-on simulation practice.

Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study

BackgroundSerious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games.ObjectiveThis study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning.MethodsJabareen’s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit “diagnostic criteria” as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games—Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery—and the results were compared to the published test validity for each game.ResultsDiagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module.ConclusionsThe diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes.

Not Just a Medical Student: Delivering Medical Education Through a Short Video Series on Social Media.

“Not Just a Medical Student” is an innovative bite-size medical education video series founded and hosted on social media. Its primary aim is to inspire tomorrow’s doctors to be creative while engaging and informing them with the latest innovations, technology, and conferences within various specialties. To our knowledge, these themes are scarcely covered in the structured medical curriculum. Created and launched in August 2017, “Not Just a Medical Student” quickly gained traction; with over 1000 followers on Facebook and a rapidly increasing number of views, it reached the medical community across the globe. The video series features a trailblazer in virtual reality surgery and its potential impact on the evolution of medical education, reviewing future medical technology apps, such as Touch Surgery, and reporting on the latest medical education and health apps. The series engaged in topical medico-politics at the British Medical Association House and reported on global health issues and innovations at the Royal Society of Medicine Conference. The video series has further received several national awards including the Association and Study of Medical Education (ASME) Educator Innovator 2017 award, runner up to the Zeshan Qureshi Outstanding Contribution to Medical Education Award, and the Alternative Docs National Social Media Influencer award. The concept has been presented at international conferences (eg, the Healthcare Leadership Academy conference) and gained international recognition upon personal invitation at the Norwegian Annual Junior Doctors Conference. With the rise of the social media generation, innovative methods to inspire, engage, and inform students contributing to the continuous evolution of medical education should be encouraged and further explored.

A Randomized Controlled Trial of Skills Transfer: From Touch Surgery to Laparoscopic Cholecystectomy

BackgroundSurgical training has traditionally involved teaching trainees in the operating room. However, intraoperative training is time-intensive and exposes patients to greater risks. Touch Surgery (TS) is an application that uses animation to provide simulation training via cognitive task analysis as an adjunct to intraoperative training. MethodsForty students were recruited and randomly allocated to either a control or intervention group. Each group received the same preparation before intervention, including a 10-min introduction to laparoscopic equipment and a 15-min educational tutorial on laparoscopic cholecystectomies. The participants then received training via either TS (intervention) or written information (control). Their performance was compared using a validated scoring tool on a porcine laparoscopic cholecystectomy model. Significance was defined as P < 0.050. ResultsIn total, n = 22 and n = 18 participants were randomly assigned to intervention and control groups, respectively. There was no significant difference between age (P = 0.320), year of medical school (P = 0.322), handedness (P = 1.000), or gender (P = 0.360) of the groups. The overall mean performance score was higher for intervention (mean ± SD = 41.9 ± 22.5) than control (mean ± SD = 24.7 ± 19.6; P = 0.016). There was no significant difference between scores for each intraoperative segment between the intervention and control group (P > 0.050). ConclusionsThis study demonstrates that TS is effective for providing cognitive training in laparoscopic cholecystectomies to medical students. It is likely that this effect will be seen across modules and other platforms that use cognitive task analysis alongside high-fidelity animation. Further work is necessary to extend this to other surgical procedures for evaluating its longitudinal effectiveness.

Neurosurgical digital teaching in low-middle income countries: beyond the frontiers of traditional education.

Neurosurgical training is usually based on traditional sources of education, such as papers, books, direct surgical experience, and cadaveric hands-on courses. In low-middle income countries, standard education programs are often unavailable, mainly owing to the lack of human and economic resources. Introducing digital platforms in these settings could be an alternative solution for bridging the gap between Western and poor countries in neurosurgical knowledge. The authors identified from the Internet the main digital platforms that could easily be adopted in low-middle income countries. They selected free/low-cost mobile content with high educational impact. The platforms that were identified as fulfilling the characteristics described above are WFNS Young Neurosurgeons Forum Stream, Brainbook, NeuroMind, UpSurgeOn, The Neurosurgical Atlas, Touch surgery, The 100 UCLA Subjects in Neurosurgery, Neurosurgery Survival Guide, EANS (European Association of Neurosurgical Societies) Academy, Neurosurgical.TV, 3D Neuroanatomy, The Rhoton Collection, and Hinari. These platforms consist of webinars, 3D interactive neuroanatomy and neurosurgery content, videos, and e-learning programs supported by neurosurgical associations or journals. Digital education is an emerging tool for contributing to the spread of information in the neurosurgical community. The continuous improvement in the quality of content will rapidly increase the scientific validity of digital programs. In conclusion, the fast and easy access to digital resources could contribute to promote neurosurgical education in countries with limited facilities.

Touch Surgery: a Twenty-First Century Platform for Surgical Training.

This manuscript reviews Touch Surgery, a novel online platform geared towards innovating professional training for surgical procedures. In other industries, such as aviation, simulation has already been shown to reduce costs and improve outcomes in crisis (JETS 3(4):348-352, 2010). Studies involving simulation-based learning in healthcare similarly indicate the potential for reducing errors through skill acquisition and cognitive retention (Int J Oral Maxillofac Surg 46:211, 2017). Cohort studies have shown improved performance among simulator-trained medical students in comparison to those with traditional ward training (Med Teach 9:53-57, 1987). With this front in mind, Touch Surgery is paving its way for implementation within the surgical realm. The simulations in this application are numerous and come from over 14 different specialties. This review details the purpose and features of the application-to include its two distinct modules-while providing reviews based on its user functionality and application in medical training. Given the revolutionary shift to simulation-based learning, platforms like Touch Surgery must now meet the demands of surgical training in the twenty-first century.

Pre-course cognitive training using a smartphone application in orthopaedic intern surgical skills “boot camps”

BackgroundWe evaluated a cognitive task analysis–based application, Touch Surgery. MethodsOrthopaedic surgery interns completed a simulated ankle open reduction and internal fixation and a lag screw fixation before starting the boot camp. Surveys were administered before the simulation and after the boot camp. ResultsFourteen of 19 interns completed the study. Ten interns thought the application improved their baseline understanding. Nine thought the application accelerated the learning process. Eight thought the application made the procedures easier to learn. ConclusionsTouch Surgery enhanced the surgical skills curriculum, was well-received, and has the potential to supplement training of interns.

Touch Surgery: Analysis and Assessment of Validity of a Hand Surgery Simulation "App".

Surgical educators are increasingly exploring surgical simulation and other nonclinical teaching adjuncts in the education of trainees. The simulators range from purpose-built machines to inexpensive smartphone or tablet-based applications (apps). This study evaluates a free surgery module from one such app, Touch Surgery, in an effort to evaluate its validity and usefulness in training for hand surgery procedures across varied levels of surgical experience. Participants were divided into 3 cohorts: fellowship-trained hand surgeons, orthopedic surgery residents, and medical students. Participants were trained in the use of the Touch Surgery app. Each participant completed the Carpal Tunnel Release module 3 times, and participants' score was recorded for each trial. Participants also completed a customized Likert survey regarding their opinions on the usefulness and accuracy of the app. Statistical analysis using a 2-tailed t test and analysis of variance was performed to evaluate for performance within and between cohorts. All cohorts performed better on average with each subsequent simulation attempt. For all attempts, the experts outperformed the novice and intermediate participants, while the intermediate cohort outperformed the novice cohort. Novice users consistently gave the app better scores for usefulness as a training tool, and demonstrated more willingness to use the product. The study confirms app validity and usefulness by demonstrating that every cohort's simulator performance improved with consecutive use, and participants with higher levels of training performed better. Also, user confidence in this app's veracity and utility increased with lower levels of training experience.

A pilot study to assess the utility of a freely downloadable mobile application simulator for undergraduate clinical skills training: a single-blinded, randomised controlled trial

BackgroundMedical simulators offer an invaluable educational resource for medical trainees. However, owing to cost and portability restrictions, they have traditionally been limited to simulation centres. With the advent of sophisticated mobile technology, simulators have become cheaper and more accessible. Touch Surgery is one such freely downloadable mobile application simulator (MAS) used by over one million healthcare professionals worldwide. Nevertheless, to date, it has never been formally validated as an adjunct in undergraduate medical education.MethodsMedical students in the final 3 years of their programme were recruited and randomised to one of three revision interventions: 1) no formal revision resources, 2) traditional revision resources, or 3) MAS. Students completed pre-test questionnaires and were then assessed on their ability to complete an undisclosed male urinary catheterisation scenario. Following a one-hour quarantined revision period, all students repeated the scenario. Both attempts were scored by allocation-blinded examiners against an objective 46-point mark scheme.ResultsA total of 27 medical students were randomised (n = 9 per group). Mean scores improved between baseline and post-revision attempts by 8.7% (p = 0.003), 19.8% (p = 0.0001), and 15.9% (p = 0.001) for no resources, traditional resources, and MAS, respectively. However, when comparing mean score improvements between groups there were no significant differences.ConclusionsMobile simulators offer an unconventional, yet potentially useful adjunct to enhance undergraduate clinical skills education. Our results indicate that MAS’s perform comparably to current gold-standard revision resources; however, they may confer significant advantages in terms of cost-effectiveness and practice flexibility.Trial registrationNot applicable.

Using Touch Surgery to Improve Surgical Education in Low- and Middle-Income Settings: A Randomized Control Trial

There is a severe surgical workforce shortage in Rwanda. Innovative educational tools must be introduced to train more residents and increase surgical capacity. Touch Surgery (TS) is a smartphone application that offers trainees the opportunity to practice operations; however, its effect is unknown in low- and middle-income countries. Our objectives were to determine the training effect of TS and its feasibility for use in surgery education in a low-resource setting. We performed a randomized control trial of University of Rwanda surgical residents. Participants were blocked by postgraduate year and randomized to textbook or TS for learning tendon repair surgical technique. After the learning period, participants performed a tendon repair simulation, evaluated by blinded expert raters. Presimulation and postsimulation questionnaires tested their knowledge of tendon repair. The study was conducted at the simulation center of the University Teaching Hospital of Kigali, a tertiary referral and teaching hospital. The study included University of Rwanda surgery residents. A total 27 of 51 surgery residents (52.94%) were enrolled. Participating residents represented the following specialties: general surgery (51.85%), orthopedics (40.74%), and urology (7.41%). TS users scored 89.7% on tendon repair simulation, compared to textbook users who scored 63.4% (p < 0.001). Postsimulation questionnaires showed a significant improvement in cognitive scores for TS users (38.6%, p < 0.001), as compared to nonsignificant improvement for textbook users (15.9%, p = 0.304). About 92.3% of TS users reported that TS represents a useful training tool, and 61.5% reported that it would be a good or very good required part of the curriculum. TS is a useful tool to improve both technical skills and knowledge of tendon repair procedure steps; however, its role may be limited to a supplemental tool as it does not improve the theoretical knowledge. TS has the potential to be implemented in a surgical academic curriculum in low- and middle-income countries.

Touch surgery: an inventive adjunct to surgical training

Touch surgery: an inventive adjunct to surgical training

App-based serious gaming for training of chest tube insertion: study protocol for a randomized controlled trial

BackgroundChest tube insertion is a standard intervention for management of various injuries of the thorax. Quick and accurate execution facilitates efficient therapy without further complications. Here, we propose a new training concept comprised of e-learning elements as well as continuous rating using an objective structured assessment of technical skills (OSATS) tool. The study protocol is presented for a randomized trial to evaluate e-learning with app-based serious gaming for chest drain insertion.MethodsThe proposed randomized trial will be carried out at the Department of Orthopedics and Traumatology at Heidelberg University in the context of regular curricular teaching for medical students (n = 90, 3rd to 6th year). The intervention group will use e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion, whereas the control group uses serious gaming for an unrelated procedure. Primary endpoint is operative performance of chest drain insertion in a porcine cadaveric model according to OSATS.DiscussionThe randomized trial will help determine the value of e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion by using the OSATS score. The study will improve surgical training for trauma situations.Trial registrationTrial Registration Number, DRKS00009994. Registered on 27 May 2016.