Operating Room Training Research Articles

Current status of laparoscopy teaching in gynecology and obstetrics medical residency in Brazil.

To characterize laparoscopy teaching in Medical Residency Programs in Gynecology and Obstetrics in Brazil, and to evaluate preceptors' characteristics in laparoscopy programs and map laparoscopic training practice scenarios. This descriptive cross-sectional study evaluated questionnaire responses from coordinators of the Medical Residency Programs in Gynecology and Obstetrics from 2019 to 2021. The questionnaire was sent to 175 programs, and 90 responses were received (51.4%). From the 85 valid responses, it was noted that 67 programs had laparoscopic training. Of the 64 responses received regarding location, 32 replies (50%) indicated the Southeast of Brazil, particularly some country's capitals. In 37.3% (n=25) of the cases, the program coordinator performed laparoscopy. The chief of the laparoscopy sector has advanced experience in most 52.5% (n=10) medical residency services; the preceptors also had advanced experience in 89.4% (n=59) of the services. Residents received laboratory training in 39.4% (n=26) of the services. In most cases, training was performed using a physical simulator. Of the 26 medical residency services with laparoscopy training outside the operating room, 80.8% (n=21) performed them as part of the curriculum, 61.5% (n=16) had a schedule for the same, and only 3.9% (n=1) were objectively evaluated. Laparoscopy teaching in Brazil is heterogeneous, with only a few programs offering any training in laparoscopy. The preceptors had advanced experience and participated in laboratory and operating room training. Only a few programs have their own laboratories or training centers, and most teaching programs do not plan to set up training centers.

Shadows and Lights: Perspectives of Training and Education in Neurosurgery for Undergraduate Students.

IntroductionNeurosurgical education should start during medical school to involve more students, favoring the recruitment of the most prepared and motivated ones and spreading this subject to the future medical generations. Despite multiple investigations, a dedicated educational plan does not exist. This study aims to assess the undergraduates' interests, needs, and perceptions of this subject.Materials and MethodsThe survey was structured to collect demographic data of the participants, and to explore their interest in neurosurgery, their consideration of its importance in medical school, their opinions about the role of this subject in medical education, their needs in this training, and, the usefulness of this subject for their future career.ResultsA total of 156 students participated in the survey. Interest in neurosurgery was shown by 76 (48.7%) participants, however, this subject was also perceived as intimidating by 86 (55.1%). Attending the first 2 years of medical school (p < 0.02), previous interest in neuroscience (p < 0.01), and in a surgical subject (p < 0.01) were the factors associated with a greater interest in this subject. Neurosurgery should be included in all students' education, according to 117 (75.0%) participants and practical operating room training should involve all students, according to 96 (61.5%). The most effective learning methods were considered internship (134, 85.9%), followed by participation in meetings or seminars (113, 72.4%). Online seminars were considered useful by 119 participants (76.3%). Neurosurgery was assessed as a potentially interesting career by 99 students (63.5%), who also considered that it can increase their preparation for other subjects (116, 74.4%).ConclusionsNeurosurgery was positively considered by medicals students, who, however, also perceived it as intimidating and hardly approachable. Demonstration that knowledge of neurosurgical concepts can improve their preparation also in general medical settings and, not only in the field of neuroscience, can be useful to promote their interest toward this subject. A combination of lectures and practical internships is considered an effective learning method, which can be fruitfully associated with new technologies.

Experimental swine models for perforator flap dissection in reconstructive microsurgery.

BackgroundPerforator flaps account for a fraction of reconstructive procedures despite their growing popularity. Specific microsurgical skills are required for successful harvesting of perforator flaps, which are difficult to attain through direct operating room training. Cadaver and small animal dissection cannot simulate human perforator dissection, lacking either bleeding and vessel feedback or providing too small calibers. Thus, we have developed and refined over the last ten years five perforator flaps models in living pig, described their harvesting technique and provided evidence for their effectiveness as perforator flap training models.MethodCT angiography data from ten living pigs was used for detailed examination of the integument’s vascular anatomy. Microsurgical techniques were used to standardize and harvest the perforator flaps in acute models. The same operator-assistant team, with no prior perforator flap harvesting experience, raised all flaps in a sequential manner, one animal per day, during a 7 weeks timespan. Porcine flaps were compared to human counterparts in terms of vessel caliber, dissection times. Immediate flap survival was measured as duration of perforator pulsation after completion of flap harvesting, measured every 10 minutes for up to two hours.ResultsFive perforator flaps were standardized, based on the deep cranial epigastric, thoracodorsal, lateral intercostal, cranial gluteal and dorsal cervical arteries and the operative technique was described in detail. Mean pig perforator size was 1.24±0.36 mm and mean pedicle diameter was 2.78±0.8 mm, which matched closely the human calibers for each flap. Total harvesting time increased 22.4% between the first two experiments due to a more cautious approach following the lack of perforator pulsation in all flaps in the first experimental animal. A total decrease of 44.4% harvesting time between second and last experiment was observed, as expected with all repetitive surgical procedures. Post-operative perforator pulsation time revealed a steep learning curve, with no or short-term pulsatile perforators in the first five pigs, followed by a 275% increase in total perforator pulsation time between 5th and 6th experimental animal. Based on these findings we provide a description of the most common mistakes, their consequences and gestures which can be trained using the pig perforator flaps, in order to overcome these mistakes.ConclusionThese five pig perforator flap models provide a fast and efficient learning tool to develop perforator flap harvesting skills safely. Surgical training using these five experimental models offers a similar hands-on perforator flap dissection experience as with human tissue, based on the similar sized calibers of both perforators and pedicles with their human counterparts.

Effect of Simulation-based Training on Surgical Proficiency and Patient Outcomes: A Randomised Controlled Clinical and Educational Trial

BackgroundIt is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. ObjectiveTo evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Design, setting, and participantsThis international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. InterventionParticipants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. Outcome measurements and statistical analysisThe number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. Results and limitationsA total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72–2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39–2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91–1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. ConclusionsAlthough the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. Patient summaryThis study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.

Current Status of Simulation Use in Canadian Cardiac Surgery Training Programs

The apprenticeship model of surgical education, relying solely on operating room training, may be insufficient to meet current needs of cardiac surgery trainees. Challenges such as resident duty hour restrictions, increasing case complexity, and novel techniques limit direct intraoperative experience. Simulation is a widely accepted educational tool in surgery. The purpose of this study was to establish an understanding of the current use of simulation in Canadian cardiac surgery and to examine the attitudes of Canadian educators and residents toward simulation training. Canadian cardiac surgery residents and faculty surgeons were surveyed at each of the 12 Canadian academic institutions. Simulation was used in all 12 academic programs, with the average use being 3 to 4 times a year. The most common simulators used were anastomotic task trainers and porcine heart models. Simulation sessions were deemed incomplete, lacking clearly stated learning objectives and evaluations. There was an overall desire from both residents and faculty surgeons to have more simulation use at their centres. This study identified that although simulation is used and valued within Canada, it is not yet employed to maximum potential. Simulation cannot replace operative experience, but current demands on surgeons and residents mandates a broader, more effective application of simulation as an educational adjunct.

Current Challenges for Education and Training in Transanal Surgery.

Transanal endoscopic microsurgery (TEM) is a technique that was introduced in the 1980s for improved exposure to upper rectal polyps. This technique, though initially difficult to master due to new skill acquisition for surgeons, has spared many patients proctectomy. There are many benign indications for transanal endoscopic surgery which has led to in vivo operating room training with fewer undesirable effects to the patient. With the explosion of laparoscopic technology this transanal technique is no longer limited to intraluminal pathology, but is now being used to remove the entire rectum. In transanal total mesorectal excision (taTME), benign indications are less common, translating to potentially more severe oncologic patient consequences during the early phase of adoption. For this reason, strict training criteria consensus guidelines have been developed by the experts in taTME. The current consensus statements agree that training surgeons should have performed a minimum of 10 laparoscopic TME procedures and should have some experience with transanal surgery. Surgeons need to attend a formal training course and should start clinically on benign or early malignant pathology without threated circumferential resection margins. Surgeons also need to have their first cases proctored until deemed proficient by the proctor and monitor their morbidity, oncologic, and functional outcomes prospectively.

Toward interprofessional team training for surgeons and anesthesiologists using virtual reality

PurposeIn this work, a virtual environment for interprofessional team training in laparoscopic surgery is proposed. Our objective is to provide a tool to train and improve intraoperative communication between anesthesiologists and surgeons during laparoscopic procedures.MethodsAn anesthesia simulation software and laparoscopic simulation software are combined within a multi-user virtual reality (VR) environment. Furthermore, two medical training scenarios for communication training between anesthesiologists and surgeons are proposed and evaluated. Testing was conducted and social presence was measured. In addition, clinical feedback from experts was collected by following a think-aloud protocol and through structured interviews.ResultsOur prototype is assessed as a reasonable basis for training and extensive clinical evaluation. Furthermore, the results of testing revealed a high degree of exhilaration and social presence of the involved physicians. Valuable insights were gained from the interviews and the think-aloud protocol with the experts of anesthesia and surgery that showed the feasibility of team training in VR, the usefulness of the system for medical training, and current limitations.ConclusionThe proposed VR prototype provides a new basis for interprofessional team training in surgery. It engages the training of problem-based communication during surgery and might open new directions for operating room training.

Development and content validation of the percutaneous nephrolithotomy assessment score.

To develop and content validate a percutaneous nephrolithotomy assessment score, taking into consideration the procedure-specific risks. This prospective international study utilized the Healthcare Failure Mode and Effect Analysis to systematically outline percutaneous nephrolithotomy and failure modes for each step. A total of 25h was spent observing percutaneous nephrolithotomy carried out by six expert surgeons. Hazard analysis scoring was carried out by 11 experts. It was determined if the steps were single point weaknesses. Single point weaknesses and those assigned a hazard score ≥4 were included in the percutaneous nephrolithotomy assessment score. The tool was then content validated by 16 experts from 10 countries. Application of the Healthcare Failure Mode and Effect Analysis identified 64 failure modes; 37 failure modes had a hazard score ≥4. After adaptations based on expert feedback the final percutaneous nephrolithotomy assessment score was developed containing 10 phases, 21 processes and 47 subprocesses. All participants agreed that the tool contained pertinent procedural steps. This study has developed and shown the international content validity of a novel percutaneous nephrolithotomy assessment score. The tool can be utilized in modular operating room training to quantify operator progress, and can be used in conjunction with other modules as part of a complete percutaneous nephrolithotomy curriculum for trainees.

Learner-Centered Operating Room Training Using Augmented Reality in 2030.

Learner-Centered Operating Room Training Using Augmented Reality in 2030.

The Construction of Case-Specific Resident Learning Goals

Developing resident autonomy in the operating room is a complex process and resident established case specific learning goals may increase resident operating room training efficiency. However, little is understood about residents' experience identifying learning goals for a given case. The aim of this study was to explore the essential components contributing to surgery residents' identification of specific learning goals for surgical cases. We conducted focus group interviews with general surgery residents across all post-graduate years (PGY) through convenience sampling. Audio recordings of each interview were transcribed and iteratively analyzed. Emerging themes were identified using a framework method. The study was conducted within the Department of General Surgery at the Ohio State University Medical Center, a tertiary academic medical center. Eight junior (PGY 1-2) and 10 senior (PGY 3-5) residents participated, of whom 10 were female and 8 were male. On average, each focus group interview lasted 57.00 (SD ± 12.99) minutes. Three essential components of residents' creation of case-specific learning goals emerged from the focus group interviews: medical knowledge, surgical experience and entrustment. Residents require baseline knowledge and surgical experience with an operation to identify the learning goal they would aim to execute. They also require entrustment of themselves and support of the attending to accomplish the case specific learning goal. Differences in the possession of these three components would likely influence differences in the ability to create learning goals between junior and senior residents. Medical knowledge, surgical experience and entrustment are 3 factors that are imperative to the creation of a resident's case specific learning goal. The complex combination of these three components contributes to the building of the learning goal prior to the start of the operation. Elucidating these aspects provides additional information for targeted interventions in the future.

Clinical Teaching of Residents in Operating Room: A Review of Methods and Strategies for Strengthening Teaching and Learning

Background The operating room is considered a learning platform for technical and non-technical skill training. Training in operating rooms helps learners from different groups, especially surgery residents, acquire the necessary clinical competence. Nevertheless, operating room training is only effective if it is accompanied by efficient and applicable teaching methods. Objectives The current study aimed at reviewing the strategies and methods to enhance teaching and learning of residents in operating room settings. Methods The current review study was conducted based on library studies and review of the literature. PubMed, SID, and MagIran databases, as well as Google Scholar search engine, were searched using relevant phrases and keywords. A total of 60 articles were retrieved, out of which 22 articles were identified as consistent with the study objectives. Results The data obtained from the literature review were categorized into three sections: “General structure of training in the operating room”, “strategies and methods to strengthen teaching and learning in the operating room”, and “structured training models in the operating room”. Finally, application of these strategies in clinical teaching was summarized in three stages: Before operation, during operation, and after operation. Conclusions The operating room is a clinical facility with specific characteristics, which can challenge teaching in this setting. However, application of effective strategies and methods, as well as efficiently structured training based on the proposed models can facilitate teaching and learning enhancement in operating rooms.

Out-of-hospital endotracheal intubation experience, confidence and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study

ObjectiveClinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among...

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

The Role of the WFSA in Reaching the Goals of the Lancet Commission on Global Surgery.

Team training and assessment in mixed reality-based simulated operating room : Current state of research in the field of simulation in spine surgery exemplified by the ATMEOS project

Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions. Using amixed reality approach, asynthetic patient model, real surgical instruments and radiation-free virtual X‑ray imaging are combined into asimulation of spinal surgery. In previous research studies, the concept was evaluated in terms of realism, plausibility and immersiveness. In the current research, assessment measurements for technical and non-technical skills are developed and evaluated. The aim is to observe multidisciplinary surgical teams in the simulated operating room during minimally invasive spinal surgery and objectively assess the performance of the individual team members and the entire team. Moreover, the effectiveness of training methods and surgical techniques or success critical factors, e. g. management of crisis situations, can be captured and objectively assessed in the controlled environment.

Simulation-based training and assessment in urological surgery.

Simulation has become widely accepted as a supplementary method of training. Within urology, the greatest number of procedure-specific models and subsequent validation studies have been carried out in the field of endourology. Many generic-skills simulators have been created for laparoscopic and robot-assisted surgery, but only a limited number of procedure-specific models are available. By contrast, open urological simulation has only seen a handful of validated models. Of the available modalities, virtual reality (VR) simulators are most commonly used for endourology and robotic surgery training, the former also employing many high-fidelity bench models. Smaller dry-lab and ex vivo animal models have been used for laparoscopic and robotic training, whereas live animals and human cadavers are widely used for full procedural training. Newer concepts such as augmented-reality (AR) models and patient-specific simulators have also been introduced. Several curricula, including one recommended within, have been produced, incorporating various different training modalities and nontechnical skills training techniques. Such curricula and validated models should be used in a structured fashion to supplement operating room training.

Effects of WeChat group in teaching of standardized training among Operating Room nurses

Objective To explore the effects of WeChat group in teaching of standardized training among Operating Room nurses. Methods A total of 28 nurses accepting standardized training in Operating Room were selected as control group (standardized training) from July 2011 to December 2012. A total of 28 nurses accepting standardized training in Operating Room were selected as intervention group (standardized training & WeChat group teaching ) from January 2013 to July 2014. What was compared after intervention among nurses between two groups included theoretical knowledge, the score of operation skill, nurses′ satisfaction with training, the satisfaction degree of patients and family members and surgeons′ satisfaction with nurses. Results After the intervention with WeChat group teaching, scores of theoretical knowledge and technical knowledge were (96.3±3.6) and (94.5±4.6) in intervention group which were higher than those in control group with significant differences (t=-8.652, -7.254; P 0.05). Scores of suture needle, aseptic technique, transferring equipment in operation, arranging surgical position, surgery cooperation were (92.1±6.2), (91.6±5.2), (95.6±3.3), (96.2±3.6), (97.1±2.6) in intervention group which were higher than those in control group with significant differences (t=-4.125, -4.526, -3.856, -5.846, -9.032; P<0.01). Satisfaction degrees of nurses with training, surgeons with nurses, patients′ family members with treatment in intervention group were obviously better than those in control group with significant differences (P<0.01). Conclusions Training with WeChat group in nurses can visibly improve nurses′ study enthusiasm, theoretical knowledge, operation skill, satisfaction degrees of nurses with training, surgeons with nurses, patients and their family members with treatment and improve the quality of care in operating room at the same time. Key words: Operating Room; Standardized training; WeChat group

Full immersion simulation: validation of a distributed simulation environment for technical and non-technical skills training in Urology.

To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non-technical skills training in endourology. To evaluate the educational impact of DS for urology training. DS offers a portable, low-cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real-time and 'blinded' video analysis and validated performance metrics. Non-parametric statistical methods were used to compare differences between groups. The DS environment demonstrated face, content and construct validity for both non-technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance. This study has shown the validity of the DS environment for non-technical, as well as technical skills training. DS-based simulation appears to be a valuable addition to traditional classroom-based simulation training.

Ophthalmology residency training in Jordan: an evaluation of quality and comparison with international standards.

To evaluate Jordanian ophthalmology residency programs in achieving competencies outlined by the International Council of Ophthalmology (ICO) and residents' satisfaction with available training programs in Jordan, and to highlight weakness points that may be improved and strengthened. A closed-ended questionnaire was circulated to all ophthalmologists who completed their training in Jordanian institutions between 2006 and 2011, to measure the quality of residency training and satisfaction level with regards to clinical conferences, journal clubs, scientific lectures, wet lab sessions, simulations, outpatient clinics and operating room training. Barriers to a successful board exam were cited. All ophthalmologists had official residency training in Jordanian Hospitals; this includes military, university, governmental and private sector hospitals. Sixty-one questionnaires completed out of 69 circulated. Males (75.4%) were more than females. Mean age was 32.5±3.27y. A total 21 (34.4%) responders expressed an overall satisfaction, 38 (62.3%) were dissatisfied and 2 (3.3%) were equivocal. Respondents reported insufficient exposure to low-vision rehabilitation 57 (93.4%), or refraction and glasses prescription 34 (55.7%). Regarding operative experiences, the mean cataract extraction per-resident was 43 cataracts; the number of phacoemulsification surgery was 2.96 per-resident, 46 (75.4%) of responders never did a single phacoemulsification during residency. Nine (14.8%) had training in refractive surgery, and 15 (24.6%) assisted orbital surgery. Forty-four (72.1%) never assisted in vitreoretinal surgery. Among The graduates surveyed, 14 (23.0%) passed Jordanian licensing board exam at the first attempt, and felt that their residency programs adequately prepared them for the examinations. Around two thirds (62.3%) of ophthalmologists expressed dissatisfaction with residency training at Jordanian programs, further study is required to assess each program separately and evaluate the system of accreditation in Jordanian residency programs.

Faculty Led Senior Medical Student Skills Course Effectively Prepares Students for Surgery Residency

With the advent of residency work hour restrictions along with increasing monetary and time restraints to operating room training, we have made efforts to use the fourth year of medical school to teach surgical skills. For the past seven years we have provided a (spring semester) senior medical school course called Advanced Surgical Skills to students entering surgical specialties. This is a one month class with forty hours a week of instruction and simulation taught by surgical faculty. Students have concentrated experience in surgical anatomy including cadaver dissection, laparoscopic simulation and tasks central to the FLS skills, basic surgical skill modules (including instruments, knot tying, suturing, anastamosis, etc) ultrasound simulation, and practical instruction in basic clinical management problems .

Assessment of medical simulators as a training programme for current surgical education

Aim-Background The rapid evolution of minimally invasive surgery has demonstrated the need for training surgical skills outside the operating room using animal model simulators. There is increasing evidence that educating trainee surgeons by simulation is preferable to traditional operating-room training methods with actual patients.