Trainees Group Research Articles

A comparative assessment of time-consuming and laborious diatom analysis：Brief experimentation with suggestion of automatic identification

Diatom testing is considered a useful method for providing supportive evidence for the diagnosis of drowning in forensic pathology. However, various factors remain controversial for recognizing diatoms, such as being time-consuming and laborious and influencing the consistency of the results. Given the absence of precise and well-defined studies on this subject, this study aimed to determine the relationship between the ability to identify diatoms and researchers with different technical backgrounds. A total of 55 samples from 18 cases, including water, lungs, liver, and kidneys, were treated using the microwave digestion-vacuum filtration-automated scanning electron microscopy (MD-VF-Auto SEM), which was used to compare diatom analyses among three groups of well-trained forensic pathologists (FPs), trained junior employees (JEs), and new trainees (TEs). In addition to achieving similar accuracy of positive findings from drowning cases, counting efficiency was evaluated based on taxonomy records and counting time after viewing more than 5500 diatom images. In contrast to the higher counting efficiency of the JE group than that of the TE group, we observed a statistically significant difference (p < 0.05) in the diatom classification between these two groups. Based on our experiments, an efficient analysis for automatically identifying and classifying diatoms is urgently required.

Teaching suturing skill to emergency physicians: the experience of a hands-on practical training in a laboratory simulation-based setting

Both specialists and trainees in emergency medicine are often unaware of the principles of good suturing. Hands-on training course was proposed to both members of the staff (group A) and trainees (group B) of the emergency department of our hospital. Familiarity with all aspects of the operation, pre-course 0%, postcourse 79% (group A) and 85.71% (group B) - p&lt;0.000); clear economy of movement and maximum efficiency, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p&lt;0.000; fluid moves with instruments and no awkwardness, pre-course 0%, post-course 73.8% (group A) and 89.80% (group B) - p&lt;0.000; obviously planned course of operation with effortless flow from one move to the next, pre-course 0%, post-course 79% (group A) and 89,80% (group B) - p&lt;0.000; strategically used assistants to the best advantage of all time, pre-course 0%, post-course 73,8% (group A) and 89,80% (group B) - p&lt;0.000; improvement in dexterity, 79.5% of students post-course). The course was judged very useful by 94.8% of students. Attending suturing skill courses could be very useful for both trainees and specialists in emergency medicine.

Augmented Reality Improves Learning Curve of Endovascular Navigation

Intra-Operative Positioning System (IOPS) (Centerline Biomedical, Cleveland, OH) is a 3D electromagnetic (EM) endovascular navigation system approved by the US Food and Drug Administration and developed as an adjunct to fluoroscopy. It provides real-time 3D display of sensorized material on an anatomical map on a flat screen. An investigational prototype based on IOPS incorporates the ability to map implanted stent grafts and visualize the stents and anatomy using augmented reality headset. The aim of this study was to compare the completion of bifurcated stent graft gate cannulation performed by participants of varying experience using fluoroscopy or different variations of IOPS. The task was cannulation of the gate of a bifurcated aortic endograft deployed into a 3D printed abdominal aortic aneurysm model connected to flow pump reproducing physiological conditions, performed in a hybrid operating room (GE Allia IGS 7). Each participant performed the tasks with fluoroscopy, EM guidance with flat screen display (EM-FS), and EM guidance with augmented reality headset (EM-AR) (Fig 1), in randomized order. All participants used the same sensorized guidewire and steerable sensorized 6F catheter for the three runs. Participants were classified in three groups of experience. Primary end points included cannulation time and technical success, defined as the advancement of the catheter over the guidewire within the graft main body. Fifteen minutes was the cutoff time for each trial. There were 26 participants including 13 endovascular naïve trainees (group 1), 12 in training surgeons (group 2) and one advanced level vascular surgeon. In group 1, mean cannulation time was lower using EM-AR versus fluoroscopy (4.3 ± 4.4 vs 7.1 ± 4.9 minutes; P = .04), with no difference between EM-FS and fluoroscopy (6.3 ± 4.5 vs 7.1 ± 4.9 minutes; P = .63). In group 1, technical success was 77% with fluoroscopy and 92% with both EM modalities (P = .59). In group 2, there was a trend toward shorter times with EM-FS or EM-AR as compared to fluoroscopy (mean of 2.5 ± 0.9, 4.4 ± 4.0 and 5.2 ± 4.5 minutes, respectively). In group 2, technical success was 92% with fluoroscopy and 100% with IOPS (P > .99). The advanced level vascular surgeon repeated the cannulation task four times for each endovascular approach, with 100% technical success and no difference in mean time (P = .89) (Fig 2). Augmented reality allows for reducing the gate cannulation time as compared to fluoroscopy in participants with no previous experience in endovascular navigation. This auspicious finding suggests that augmented reality can be beneficial for individuals early in their career and can mitigate the learning curve.Fig 2Mean cannulation times of bifurcated stent graft gate cannulation using electromagnetic (EM) guidance with flat screen display or augmented reality compared to fluoroscopy, performed by operators of varying experience.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Laparoscopic appendectomy as an index procedure for surgical trainees: clinical outcomes and learning curve

Surgical training is essential to maintain safety standards in healthcare. The aim of this study is to evaluate learning curves and short-term postoperative outcomes of laparoscopic appendectomy (LA) performed by trainees(TRN) and attendings(ATT). The present study included the medical records of patients with acute appendicitis who underwent a fully LA in our department between January 2013 and December 2018. Cases were divided into trainees (TRN and ATT groups based on the experience of the operating surgeon. The primary outcome measures were30-day morbidityand mortality. Preoperative patients' clinical characteristics, intraoperative findings, operative times, and postoperative hospitalization were compared. Operative times were used to extrapolate learning curves and evaluate the effects of changes in faculty using CUSUM charts. A propensity score matching analysis was performed to reduce differences between cohorts regarding both preoperative characteristics and intraoperative findings. A total of 1173 patients undergoing LA for acute appendicitis were included, of whom 521 (45%) in the TRN group and 652 (55%) in the ATT group. No significant differences were found between the two groups in terms of complication rates, operative times and length of hospital stay. However, CUSUM chart analysis showed decreased operating times in the TRN group. Operative times improved more quickly for advanced cases. The results of this study indicate that LA can be performed by trainees without detrimental effects on clinical outcomes, procedural safety, and operative times. However, the learning curve is longer than previously acknowledged.

The Practice of Classroom Code-Switching, Translanguaging or Simply Alternating Languages in FL Teacher Talk

Alternating between languages in an FL classroom is first of all observed in teacher talk which is an important dimension of FL teachers’ discourse. (Tsui 2008). The empirical study presented here focuses on the language choices made between the L1 and FL(s) by both in-service teachers (group 1) and pre-service trainees (group 2) during English lessons—but it is not meant to be an in-depth debate on L1/FL use in a language classroom. It is a small-scale diagnostic study of a FL classroom and TT behaviour of the subjects. The text starts with a brief presentation of the concepts of code-switching and translanguaging, as applied in educational contexts and here operationalized for the purposes of a pilot study on language choices in teacher talk. The observations of EFL lessons focus on the purpose(s) language alterations are made by the teachers and seek to reflect on the extent to which these purposes refer to clearly-defined instructional functions—cognitive but also affective ones. These language choices made also constitute an important pedagogical dimension beyond language instruction itself. The results of the study show that both experienced and trainee teachers switch languages consciously during the lesson at similar stages and for similar purposes, however some differences are also observed and discussed in the text. The major focus of discussion is on the pre-service teachers, as the study is part of awareness raising, and thus reflectivity enhancement of trainees participating in their teacher training at the undergraduate level (BA) but who are already active teachers in the period of their school placement.

Proximalized Total Arch Replacement Can Be Safely Performed by Trainee.

Background The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education. Methods Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A). Results Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups. Conclusions The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.

Assessment of well-being and coping abilities among medical and paramedical trainees, in a Government Medical College, West Uttar Pradesh, India

Background: High levels of stress and psychological morbidity occur in health-care professional students. Objective: The objective of this study was to estimate psychological well-being, perceived stress level, and coping abilities among medical and paramedical students. Materials and Methods: A cross-sectional analytical study carried out in a tertiary care hospital, West Uttar Pradesh, India. The total study period was from September 2019 to November 2019 with a sample of 145 medical students aged 17–25 years and 81 paramedical students aged 19–33 years. Ethical clearance was obtained from the College Ethical Committee. We used self-administered, three different types of validated tools for data collection. Data were analyzed using SPSS Version 20. Results: The median age of paramedical and medical trainees was 22 and 21 years, respectively. Family history of mental illness was 21% and 5.5%, respectively. On general health questionnaire-12 scale, 9% of paramedical trainees reported evidence of distress and 91% of severe problem and psychological distress while 19% of medical trainees having evidence of distress and 81% of severe problem and psychological distress. On perceived stress scale-10 (PSS-10) scale, 15% of paramedical trainees reported average level, 27% moderate level, and 55% high level of perceived stress while 2% of medical trainees having average, 19% moderate level, and 79% high level of perceived stress, respectively. The difference in mean score on PSS-10 and Brief COPE scale between paramedics and medical trainees group was found statistically significant (P < 0.05). Conclusion: We concluded the higher level of severe problem and psychological distress in the paramedical and high level of perceived stress in medical trainees. Paramedical trainees practice a better coping mechanism than medical trainees.

Laparoscopic pyloromyotomy can be performed safely by senior pediatric surgery trainees without supervision at high volume centers

Aim of the StudyPediatric surgery trainees at our institution perform 15 to 20 supervised laparoscopic pyloromyotomies during their junior year, and are allowed to perform the operation independently without supervision during their senior year. We reviewed the outcomes of laparoscopic pyloromyotomies performed by senior trainees operating without supervision and compared them to experienced pediatric surgeons. MethodWe did a retrospective reviewed of all unsupervised laparoscopic pyloromyotomies (n = 90) performed by the last 12 pediatric surgery fellows (2012–2018) during their senior year, and the most recent 90 consecutive laparoscopic pyloromyotomies performed by 9 experienced pediatric surgeons. Statistical significance was determined by T-test and Fisher's exact test. Data is expressed as mean (SD) or median (range). A p value of ≤0.05 was considered significant. ResultsMean age at surgery was 4.7 (SD: 1.6) and 5 (SD: 2.3) weeks in the trainees and surgeons group, respectively (p = 0.38). Mean operative time was 28 (SD: 13) minutes in the trainees group vs. 25 (SD: 10) minutes in the surgeons group (p = 0.09). Intraoperative complications occurred in 3 of 90 (2.7%) cases in the trainees group (three mucosal perforations, all detected during the operation, one repaired laparoscopically, two repaired open), and none in the surgeons group (p = 0.11). One postoperative complication requiring reoperation occurred in the trainees group (omentum eviscerated through an incision site), while none occurred in the surgeons group (p = 0.36). No incomplete pyloromyotomies occurred in either group. The median length of postoperative hospital stay was 1 (1 to 10) and 1 (1 to 6) days in the trainees and surgeons group, respectively (p = 0.63). ConclusionSenior trainees at high-volume training programs can perform unsupervised laparoscopic pyloromyotomies safely as a mean to promote surgical autonomy without compromising patient outcomes. Level of EvidenceIII

Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) conference 2018: overview of the conference and analysis of delegates’ feedback

The Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the JTG Annual Conference aim to support pre-registrar trainees interested in OMFS. The theme of the 2018 conference, "Research and Innovation" was disseminated through a diversity of expert speakers and interactive workshops. This paper provides an overview of the conference and analysis of the delegates' feedback to show how it represented their interests and influenced their decisions to pursue OMFS. Online questionnaires assessed demographics and the impact of the conference on numerous aspects of the decisions made about careers by delegates at different levels of training. A Kruskal Wallis test with post-hoc pairwise comparisons was done to assess the significance of differences between groups. A total of 135 delegates completed the questionnaires (13% dual-qualified; 13% second-degree medics; 18% second-degree dentists; 6% singly-qualified medics; 41% singly-qualified dentists; 5% first-degree medics; and 4% first-degree dentists), and 141 submitted abstracts of which 32 poster and 12 oral presentations were accepted. A total of 79/135 (59%) were members of the BAOMS. Word-of-mouth was the commonest way by which delegates became aware of the conference. As the stage of training advanced, they agreed more that it represented their training level and influenced them to pursue research and attend the BAOMS 2018 conference. The JTG conference is the only national meeting for pre-registrar trainees, and this year there were record numbers of delegates and abstracts. As the JTG grows, we continue to assist juniors to pursue their involvement in OMFS units and to participate in research and collaborative projects. Our goals are to expand as a national platform to represent junior trainees who are interested in OMFS, and to support them as they progress towards registrar training.

Feasibility and safety of laparoscopy-assisted distal gastrectomy performed by trainees supervised by an experienced qualified surgeon.

Laparoscopic gastrectomy is becoming more commonly performed, but acquisition of its technique remains challenging. We investigated whether laparoscopy-assisted distal gastrectomy (LDG) performed by trainees (TR) supervised by a technically qualified experienced surgeon (QS) is feasible and safe. The short-term outcomes of LDG were assessed in patients with gastric cancer between 2008 and 2018. We compared patients who underwent LDG performed by qualified experienced surgeons (QS group) with patients who underwent LDG performed by the trainees (TR group). The operation time was longer in the TR group than in the QS group (median time: 270min vs. 239min, p < 0.001). The median duration of the postoperative hospital stay was 9days in the QS group and 8days in the TR group (p = 0.003). The incidence of postoperative complications did not differ significantly between the two groups. Grade 2 or higher postoperative complications occurred in 18 patients (12.9%) in the QS group and 47 patients (11.7%) in the TR group (p = 0.763). Grade 3 or higher postoperative complications occurred in 9 patients (6.4%) in the QS group and 17 patients (4.2%) in the TR group (p = 0.357). Multivariate analysis showed that the American Society of Anesthesiologist Physical Status was an independent predictor of grade 2 or higher postoperative complications and that gender was an independent predictor of grade 3 or higher postoperative complications. The main operator (TR/QS) was not an independent predictor of complications. Laparoscopy-assisted distal gastrectomy performed by trainees supervised by an experienced surgeon is a feasible and safe procedure similar to that performed by experienced surgeons.

The Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) Conference 2018: A Conference Overview

Introduction: The Junior Trainees Group (JTG) of BAOMS and JTG annual conference aim to support pre-registrar trainees interested in OMFS. Our 2018 conference theme of “Research and Innovation,” was disseminated through diverse expert speakers and interactive workshops. We aim to provide a conference overview and analyse delegate feedback to demonstrate whether the conference represented delegates’ interests and influenced their decision to pursue OMFS.

The Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) Conference 2018: A Conference Overview

Introduction: The Junior Trainees Group (JTG) of BAOMS and JTG annual conference aim to support pre-registrar trainees interested in OMFS. Our 2018 conference theme of “Research and Innovation,” was disseminated through diverse expert speakers and interactive workshops. We aim to provide a conference overview and analyse delegate feedback to demonstrate whether the conference represented delegates’ interests and influenced their decision to pursue OMFS.

Laparoscopic appendectomy — Outcomes of senior trainees operating without supervision versus experienced pediatric surgeons

Aim of the studyPediatric surgery trainees at our program are allowed to perform unsupervised laparoscopic appendectomies during their last year of training to promote independent operative decision-making skills. We reviewed the outcomes of laparoscopic appendectomies done by senior trainees without supervision and compared them to experienced pediatric surgeons. MethodsWe reviewed 500 laparoscopic appendectomies performed without supervision by the last 10 pediatric surgery trainees during their last year of training (first 50 cases of each trainee). We compared the outcomes of those 500 cases to the outcomes of 200 laparoscopic appendectomies performed by eight experienced pediatric surgeons (last 25 cases of each surgeon). Data are expressed as mean (SD), unless otherwise indicated. A P value of ≤0.05 was regarded as significant. Main resultsMedian age in the “trainees” and “surgeons” groups was 11 (range 2–22) and 12 (2–20) years, respectively (P = 0.35). The proportion of perforated appendicitis was similar: 98/500 (19.6%) in the trainees group and 42/200 (21%) in the surgeons group, respectively (P = 0.75). Mean operative time was 41 (SD 14.5) min in the trainees group vs. 39 (SD 16.1) min in the surgeons group (P = 0.05). Minor intraoperative complications occurred in 3/500 (0.6%) cases in the trainees group vs. 1/200 (0.5%) in the surgeons group (P = 0.69). No major complications occurred in either group. Mean hospital stay was 2 (range 0.5–26) and 2.3 (range 0.5–18) days in the trainees and surgeons groups, respectively (P = 0.25). There were 13/500 vs. 5/200 readmissions (P = 0.92), and 1/500 vs. 1/200 reoperations in the trainees and surgeons groups, respectively (P = 0.91). ConclusionAllowing senior pediatric surgery trainees to perform laparoscopic appendectomies without supervision to stimulate surgical autonomy is safe and does not compromise patient outcomes. Level of evidenceIII.

Propensity-matched analysis of outcomes after mitral valve surgery between trainees and consultants (institutional report).

We aimed to determine whether early outcomes and long-term survival after mitral valve surgery performed by trainee residents are equivalent in terms of safety and efficacy when compared with consultant surgeons. Between January 2000 and December 2015, a total of 1742 patients who underwent mitral valve surgery were identified. Of these, 1622 operations were performed by consultants (Group I) and 120 operations were performed by trainees (Group II). A propensity score-matched analysis has been used to minimize selection bias. Early postoperative outcomes were defined as in-hospital mortality, cerebrovascular accident, postoperative requirement of renal replacement therapy, reoperation for bleeding and postoperative length of hospital stay. Long-term outcomes were evaluated using late survival data after discharge. Before matching, the 2 groups differed significantly in terms of gender and reduced left ventricular ejection fraction, but these differences were solved after matching. Also, Group I included significantly more patients with mitral regurgitation (83% vs 62%; P < 0.01), but after matching, this difference was corrected (62% vs 59%; P = 0.71). Consultant group was associated with a higher in-hospital mortality (6% vs 2%; P = 0.04) in the unmatched population. Moreover, in the unmatched cohort, this group had longer cross-clamp time compared with the trainees group (91 ± 38 vs 89 ± 26 min; P = 0.47) and longer cardiopulmonary bypass time (132 ± 58 vs 121 ± 33 min; P = 0.27); these differences were not statistically significant. There were no significant differences in postoperative dialysis, cerebrovascular accident, reoperation for bleeding and length of hospital stay. Even after matching, no significant differences were found in terms of perioperative complications. The Kaplan-Meier survival curves at 1, 5 and 10 years were similar between the 2 groups. Mitral valve surgery can be safely performed by trainees and provides similar short- and long-term results compared with consultant surgeons.

Management of cervicofacial infections: a survey of current practice in maxillofacial units in the UK

Cervicofacial infections are common emergency presentations to maxillofacial departments in the UK, there is no consensus about their management and, in particular, the role of corticosteroids is not clear. Our aim was to find out the current practice of UK maxillofacial surgeons in managing these infections using a multicentre questionnaire study. The questionnaire was designed, piloted, and revised before distribution, and questions were asked to assess preoperative, operative, and postoperative management. It was distributed to maxillofacial surgeons throughout the UK through the Maxillofacial Research Trainee Collaborative (MTReC) network, and at the 2016 British Association of Oral and Maxillofacial Surgeons (BAOMS) Junior Trainees Group conference. A total of 350 questionnaires were distributed to 17 maxillofacial units. Eighty-six questionnaires were distributed at the BAOMS Junior Trainee conference. An overall response rate of 92% (n=324) was achieved. The results showed that there were important differences in reported practice between and within maxillofacial units in the UK in managing these infections. The antibiotic regimens and use of steroids varied widely. Twenty-three per cent of respondents had to wait over 24hours for access to emergency theatres. However, these results provide no hard evidence for or against the use of corticosteroids in cervicofacial infections.

A Multi-Site Quality Improvement Initiative to Increase Knowledge of Cardiogastroenterology

Introduction: The American Society of Gastrointestinal Endoscopy recommends continuing aspirin prior to routine endoscopy. Discontinuing anti-platelet agents increases the risk of thrombosis and associated adverse events. Studies have shown that continuing aspirin/NSAIDs periprocedurally does not increase risk of post-polypectomy bleeding. A survey of 317 endoscopy units found less than 50% continued aspirin prior to routine endoscopy due to concern about bleeding and perceived minimal downside to stopping aspirin. Utilizing the Kern model, we implemented a quality improvement initiative aimed at antithrombotic management pre and post routine endoscopy and during acute gastrointestinal (GI) bleeding. This intervention was mainly targeted at our internal medicine colleagues who refer patients to our endoscopy suite via direct access and the nursing staff who perform pre-procedure teaching. Methods: Primary care and specialty nurses (group 1) at one site along with medical trainees (group 2) across three sites were included. Both groups received a tailored pre and post-test questionnaire evaluating their knowledge of cardiogastroenterology. All groups were educated on current recommendations for antithrombotic therapy. The educational module for the medical trainees also included antithrombotic management in the setting of an acute GI bleed. Results: Data from 18 nurses and 75 medical trainees was evaluated. There was a significant improvement noted in both groups (figures 1 & 2). The greatest change was seen in knowledge of aspirin/NSAID management (30.5% vs. 95% for group 1; 44% vs. 92% for group 2, p=<.0001). Pre-test, 50.7% of medical trainees knew how to manage anti-platelets post aspirin-induced GI bleed. Post-intervention, this number increased to 93.3%. Chi-squared analysis showed a statistically significant difference in knowledge across all areas among medical trainees pre and post-test, p < .001.Figure 1Figure 2Conclusion: Incorrect management of antithrombotics in the setting of both elective and emergent GI procedures can lead to significant morbidity and mortality. National data shows that many practitioners do not follow current guidelines. With the use of an educational intervention aimed at quality improvement, both nurses and medical trainees showed a significant improvement in knowledge. Educational programs based on current guidelines may be an effective way to improve quality and patient safety.

Impact of laparoscopic sacrocolpopexy learning curve on operative time, perioperative complications and short term results

ObjectiveLaparoscopic sacrocolpopexy (LSCP) learning is a challenge for unexperienced surgeons, since complications occurrence and anatomical results could depend from surgeon's experience. The aim of this study was to describe LSCP characteristics, perioperative complications and short term anatomical results when LSCP was performed by LSCP-experienced surgeons or trainees. Study designPatients who underwent LSCP in our surgical unit in the last ten years were included. Patients were excluded if laparotomy was performed without any laparoscopic time. Interventions were divided into LSCP experienced surgeons (who had performed at least 30 procedures) and trainees (residents, fellows, and surgeons with less than 30 procedures). Main outcomes were operative time, peroperative complications (included conversions to open or vaginal surgery, bladder and vaginal perforation, epigastric vessels injury and hemorrhage) early postoperative complications, mesh complications and anatomical results at three months. Results492 patients were included, 108 in the trainee group and 384 in the LSCP-experienced group. Groups were comparable for demographics, preoperative clinical examination and surgery characteristics. Average operative time was significantly higher in trainees group than in LSCP-experienced group (251 versus 178min (p<0.0001)). There was no difference in open surgery conversion rate (5.6% versus 3.9%, p=0.42) or peroperative complication occurrence (4.7% versus 4.6%, p=0.98). Bladder perforations were more frequent in trainee group but difference was not statistically significant (3.7% versus 1.3%, p=0.11). 98% patients were assessed at three months. Overall anatomical success rate was 94.9%. There was no difference in anatomical failure rate between trainee group and LSCP experienced surgeons group (respectively 4.7% versus 5.2%, p=0.82), neither in mesh complication rate (3.9% versus 2.8%, p=0.77). ConclusionLSCP learning in an experimented surgical team induces high operative time, but remains safe for patient.

Training Surgeons in Minimally Invasive Mitral Valve Repair: A Single Institution Experience

We aimed to study the results of minimally invasive mitral valve repair performed by 5 young surgeons who were trained in mitral valve repair directly through a minimally invasive approach, and a senior surgeon who introduced the technique at our institution and was responsible for the training program. This was a retrospective, observational cohort study of prospectively collected data from 595 consecutive patients who underwent minimally invasive mitral repair performed by 5 trainees (n = 240, 40.3%) and by our lead consultant (n = 355, 59.7%) between 2007 and 2013. Treatment selection bias was controlled by constructing a propensity score from core patient characteristics and it was included along with the comparison variable in the multivariable analyses of outcome. Patients operated on by trainees were more likely to be female (p = 0.04), older (p = 0.001), and with history of atrial fibrillation (p = 0.001). Trainees required a significant longer cardiopulmonary bypass (137 ± 56 vs 123 ± 52 minutes; p = 0.003) and aortic clamp time (97 ± 41 vs 83 ± 40 minutes; p = 0.001). I-hospital mortalities were 1.3% in the trainees group and 0.8% in the senior surgeon group (p = 0.6). The incidence of stroke (1.7% vs 2.5%; p = 0.5), conversion to sternotomy (2.6% vs 3.5%; p = 0.5), and conversion to mitral valve replacement (12.5% vs 10.9%; p = 0.6) were similar between groups. No differences were found regarding other complications. Five-year survival (88.9% vs 89.5%; p = 0.4) and freedom from reoperation (94.5% vs 95.1; p = 0.6) were similar between groups. Minimally invasive mitral valve repair is a safe and reproducible surgical technique that can be taught successfully to cardiac trainees.

Curriculum development for basic gynaecological laparoscopy with comparison of expert trainee opinions; prospective cross-sectional observational study

ObjectiveTo develop content for a basic laparoscopic curriculum in gynaecology. Study designProspective cross-sectional observational study. Modified Delphi method with three iterations undertaken by an invited group of national experts across the United Kingdom (UK). Two anonymous online surveys and a final physical group meeting were undertaken. Junior trainees in gynaecology undertook a parallel iteration of the Delphi process for external validation. Population included: expert panel – certified specialists in minimal-access gynaecological surgery, RCOG national senior trainee representatives, and medical educationalists, junior trainees group – regional trainees in gynaecology in first and second year of speciality training. ResultsExperts (n=37) reached fair to almost complete significant agreement (κ=0.100–0.8159; p<0.05) on eight out of nine questions by the second iteration. Trainees (n=19) agreed with the experts on 89% (51/57) of categories to be included in the curriculum.Findings indicated that 39 categories should be included in the curriculum. Port placement, laparoscopic equipment and patient selection were ranked the most important theoretical categories. Hand-eye co-ordination, camera navigation and entry techniques were deemed the most valuable skills. Diagnostic laparoscopy, laparoscopic sterilisation, and laparoscopic salpingectomy were the operations agreed to be most important for inclusion. Simulation training was agreed as the method of skill development. The expert panel favoured box trainers, whereas the junior trainee group preferred virtual reality simulators. A basic simulation laparoscopic hand-eye co-ordination test was proposed as a final assessment of competence in the curriculum. ConclusionConsensus was achieved on the content of a basic laparoscopic curriculum in gynaecology, in a cost- and time-effective, scientific process. The Delphi method provided a simple, structured consumer approach to curriculum development that combined views of trainers and trainees that could be used to develop curricula in other areas of post-graduate education.

Board 243 - Program Innovations Abstract Acute Blood Loss - Hemorrhagic Shock

Introduction/Background Despite the fact that the modern 3D simulators have basic scenarios of acute blood loss, adaptation of the scenarios to specialization of trainees and increase of realism are necessary. Methods “Acute blood loss- hemorrhagic shock” is developed and used by trainees at MSC of Siberian State Medical University. The scenario consists of sections such as: 1) Skills - collection of information (documents, personnel of ambulance and hospital department, other information source); patient assessment; monitoring (heart rate, pulse, blood pressure, auscultation of the lungs etc.) diagnosis; sequence of actions, efficiency assessment of therapy; 2) Information for an assistant: a) preparation of manikins (Susie S2000, Hal S3000 or Noelle S575, choice of manikin depends on specialization of trainees). The assistant has to fill the venue system and bladder, to lubricate the manikin’s airway and urethra; b) preparation of medical equipment and instruments for the scenario (stethoscope, blood pressure cuff, sets for airway management, ventilators, oxygen and ways of delivery, patient monitors, perfusors, vacuum suction, etc.); c) preparation of special materials (bandages, gloves, antiseptic, systems for intravenous infusion, nasogastric probe, Blackmor’s probe, urinary catheters, syringes, infusion solutions, containers with blood, albumin, epinephrine and other drugs). Vials of distilled water are used instead of real drugs. To achieve maximum realism during simulations colorants are added into the vials (if necessary) and labels are stuck; 3) Guide for operator (description of simulation process): a) stages of the scenario (the physiological parameters of a patient-simulator: respiratory pattern and rate, rhythm, heart rate, temperature, blood pressure, cyanosis and other); b) duration of stages; c) the variety of transition to next stage. Clinical parameters of the simulator, described by qualified doctors (expert), are based on guidelines. Scenario consists of several clinical stages: 1 = Normal state, 2 = Acute blood loss (Hypovolemya), 3 = Shock Compensation, 4 = Shock Decompensation, 5 = Agony, 6 = Asistolia, 7 = Stabilization of the state (level 1), 8 = Stabilization of the state (level 2), 9 = Persistently stabilized patients state or patient’s death. Correct conducting of diagnosis and therapy leads to stabilization on any stages of the scenario. Number of required actions to help depends on the patient state (scenario stage). Incorrect conducting of diagnosis and therapy leads to death of the patient (robot simulator). Variants of scenario development: a) preoperative preparation and examination; b) postoperative intensive care; c) conservative therapy, if there is no indication for surgery. Transition to the next stage is implemented automatically or by operator (according to manipulations of trainees). Therefore, an operator has to know the clinical pattern of diseases and to be able to evaluate trainees manipulations; 4) Information for trainees (briefing). To motivate trainees, three variants of the scenarios are developed (for surgeons, internists and obstetricians); 5) Additional information (analysis Results, X-ray and ultrasound investigations, etc.) is given to trainees on request. During simulation audio video control is conducted. Moreove,r there is a checklist for every trainees group wherethe trainer notes duration of decision making, performing of manipulations, drugs and its doses (in obedience to National Standards). The checklist is used for debriefing, then trainees have opportunities of retraining. Results: Conclusion Basic scenarios require adaptation to trainee’s specialization. It is necessary to describe participant’s duties in details for preparation of simulation. Use of real medical equipment of ICU and drug imitation are provided to add realism of simulation training. Special clinical training of simulation operator (engineer) is necessary. Scenarios should be created by qualified doctors (expert). Audio-video control and checklist make debriefing more reasonable. Ninety two percent of trainees that studied at MSC of Siberian State Medical University in 2012 (n=458), gave a positive assessment of scenarios. Disclosures None.