Manual Skills Training Research Articles

Skills on wheels: caregiver perspectives on the design and long-term impact of a pediatric wheelchair Skills training program.

Manual wheelchair skills training programs are novel developments, particularly in the United States. As perceived by the caregivers of participants, this study aimed to examine the long-term impact of the Skills on Wheels program on participants' occupational engagement and quality of life at home, at school, and in the community. Secondly, this study investigated the caregivers' perspectives of the program design of Skills on Wheels. This was a qualitative inquiry based upon thematic analyses of semi-structured interviews after participation in a pediatric wheelchair skills training program. The study participants were 9 caregivers whose children participated in this program over the 2021 and 2022 implementation years. Caregivers were given a 10-question semi-structured interview. The five overarching topics included program impact: (i) occupational engagement, (ii) program impact: quality of life factors, (iii) program resources/design, (iv) novelty/importance of program/wheelchair skills training, and (v) desired continued wheelchair skills practice in the future. Results provided tangible feedback to integrate into program design and supported the Skills on Wheels program's positive value as it relates to impact on quality of life and occupational engagement for participants.

Application of virtual reality and haptics system Simodont in Chinese dental education: A scoping review.

Virtual reality (VR) and haptic simulation technology have been increasingly implemented in dental training. Since the first haptic VR dental simulator (Simodont) was introduced 10 years ago, it has been applied in more than 40 universities in mainland China. This scoping review aimed to review literature, showcasing the teaching reform of dental virtual simulation in mainland China to global dental education peers. This scoping review was conducted using the PRISMA extension for scoping review guidelines. Seven electronic databases were searched, and two reviewers independently performed the selection and characterization of the studies. The final scoping review included 12 studies. Four studies focused on the G. V. Black class II cavity, three on manual dexterity skills training, two on full metal crown preparation, one on pulpal access and coronal cavity preparation, one on flipped classroom teaching, and one on 'doctor-patient communication' skills. The most critical scenarios, self-assessment, working posture, curriculum setting, training and cost are analysed and discussed. Haptic simulation technology is a valuable complementary tool to the phantom head in dental education. The combined utilization of these two training devices has been superior to either in isolation. However, there is a lack of research on the sequencing of the two systems, as well as the appropriate distribution of curriculum between them. It is necessary for educators to organize or engage in experience sharing, collaboration and knowledge dissemination. These actions are essential for promoting effective teaching within dental educational institutions.

The combination of listening to background music and deep breathing as a stress reduction strategy during dental preclinical study.

According to our earlier study, background music can help foster dental preclinical manual dexterity training and learning and has the potential to increase student satisfaction and productivity. Deep diaphragmatic breathing helps produce a relaxed mental state and is considered a behavioral coping strategy to reduce anxiety. Experimental data on whether background music combined with deep belly breathing reduces the stress and anxiety of preclinical dental students during practice is lacking. Thus, we focused on evaluating the effects of the combined use of these two techniques on dental students during preclinical manual skills training. Thirty-one voluntary 3rd-year dental students' anxiety levels and their behavioral changes were monitored via anonymous, voluntary surveys including the Patient Health Questionnaire-4, General Health Questionnaire-12 (GHQ-12), and Visual Analogue Scale for Anxiety (VAS-A). Overall, stress measured by GHQ-12 decreased significantly in female students (p=0.025), but not in males. Both background music and deep belly breathing significantly reduced all students' fear and stress based on their VAS-A scores in practice. However, a clear difference from the nonuse of coping strategies could not be conclusively shown. The students regarded the course positively based on survey replies. The combined use of the two coping strategies delivered beneficial effects to the preclinical dental students: they reduced the amount of stress in the supervised preclinical students and considerably cut down the students' anxiety. Further investigation of this new dental training scenario may help professionals provide better student education and care management during the dental preclinical phase.

Influence of background music on stress reduction and impact on performances during students' simulation exercises.

The acquisition of manual skills is essential in preclinical dental training. Background music improves the learning of many manual skills, though we found no data on the consequences of background music on preclinical manual skills training of dental students. The first aim of this project was to explore whether listening to slow background music could reduce the stress of students when learning how to perform cavity preparations and restorations in a simulation laboratory. The second aim of this study was to determine the impact of slow background music on the quality and time used during cavity preparation. We invited all of the 40 third-year dental students to participate in the study, of whom 88% chose to anonymously fill in questionnaires on their subjective evaluations of the effects of slow background music on the stress or anxiety levels experienced during the course. Twenty-four students further volunteered to participate in a cross-over study on the impact of slow background music on the quality of and time used during cavity preparation. The overall satisfaction with the slow background music was high. In particular, the music reduced stress but also increased motivation to learn and practice. Communication in the classroom went well despite the music. Time use and quality of cavity preparation were enhanced. This study lends support to the use of slow background music in preclinical cariology training, as it appeared to have helpful effects on dental skills education and practice.

Cadaveric Sheep Head Model for Anterior Clinoidectomy in Neurosurgical Training

Anterior clinoidectomy is an important procedure used in the treatment of a range of diseases of the frontotemporal region, both vascular and tumoral. Mastering this technique requires a high level of manual skills training. The objective of the study was to describe an easily accessible and economical alternative model of anterior clinoidectomy, with a principal focus on the significance of mastering technical skills and training tactile feedback. Five cadaveric sheep heads (10 sides) fixed in formalin and alcohol were injected with silicone and used to simulate extradural (5 sides) and intradural (5 sides) routes and 1 head was used to prepare an anatomic specimen for better demonstration of the anatomy of the paraclinoid region. A comparative anatomic analysis between the ovine and human anterior clinoid process was performed. Using cadaveric sheep models, all principal steps of the procedure for both the extradural and the intradural routes were imitated. A cadaveric sheep head model serves as a good model of anterior clinoidectomy regarding manual skills training and can serve as a good alternative to human cadaveric training.

Training residents in minimally invasive surgery; confirming competence or hoping for the best?

BackgroundVeterinary minimally invasive surgery (MIS) is rapidly developing, and most surgeons are performing MIS in their clinical practice. The technical skills of presented surgical techniques are increasingly complex. Required training of American College of Veterinary Surgeons (ACVS) surgical residents in soft tissue MIS (laparoscopy/thoracoscopy) are limited to traditional apprentice training. Unfortunately, such training has been found insufficient to create competent MIS surgeons.Aim of the reviewThis review discusses development of MIS training for Doctor of Medicine (M.D.) residents in context of veterinary applicability and investigates comparative evidence for how to best train veterinary residents in soft tissue MIS.ConclusionsA structured curriculum, with validated tasks and clear training goals have been found imperative for training success. Such a curriculum includes both didactic sessions and manual skills training, with video tutorials and reading material to inform and motivate the residents.Implications of key findingsACVS residents and diplomates may benefit if a MIS curriculum was developed and made available to all training programs.

Usability of a virtual reality manual wheelchair simulator

Purpose: Individuals with impaired mobility often require assistance for getting around. The skilled use of a manual wheelchair (MW) is required in order to gain independence while preventing injuries. Training in a virtual reality (VR) setting allows for safe practice of MW skills in a wide range of environments. We developed a low-cost MW simulator which includes visual and haptic feedback. Our objectives were to assess the usability and fidelity of the VR simulator, by clinicians and expert MW users, and to determine whether the addition of haptic feedback would positively improve the user’s experience. Materials and Methods: This mixed method study investigated the sense of presence, overall experience and ease of use of the experience in six MW users, as well as five clinicians (wheeled mobility experts) who practiced in the simulator. Results: Participants reported a positive perception of usefulness, sense of presence, and immersion during the MiWe simulator experience. The addition of haptic feedback to the simulator significantly enhanced fidelity of the overall experience, compared to the no-feedback condition. Conclusion: Our low-cost simulator was well perceived by clinicians and MW users and was considered as a potentially useful tool to complement MW skill training. IMPLICATIONS FOR REHABILITATION We developed a low-cost, virtual reality simulator with visual and haptic feedback, for the practice of manual wheelchair skills. Expert clinicians and wheelchair users reported a positive experience after practicing in the wheelchair simulator, in terms of presence, realism and usability. Participants highlighted the potential usefulness of our low-cost simulator in the training of manual wheelchair skills.

Influence of Roulez avec confiance, a peer-led community-based wheelchair skills training program, on manual wheelchair users

Purpose Few studies have demonstrated that peer-led manual wheelchair (MWC) skills training can increase MWC skills, MWC use self-efficacy and satisfaction with participation of MWC users. Limited information is available on MWC skills training in the community. The primary objective was to measure the influence of Roulez avec confiance (RAC, which translated to “Wheeling with confidence”), a peer-led community-based wheelchair skills training program, on satisfaction with participation. The secondary objectives were to explore the: (1) influence of RAC on MWC use self-efficacy, MWC skills, and quality of life; (2) experiences of the participants who completed RAC and (3) three-month retention of outcomes. Methods A parallel mixed design was used with validated questionnaires on satisfaction with participation (WhOM), MWC use self-efficacy (WheelCon-M), MWC skills (WST-Q), quality of life (SWLS) and a semi-structured interview on participants’ experiences. Non-parametric longitudinal analyses of the questionnaires and thematic content analysis of the interviews were completed. Results Nineteen community-dwelling MWC users participated. There was a statistically significant increase (p < 0.0001) in all outcomes except quality of life (p = 0.16). Improvements were retained after three months. Participants mentioned their background influenced their experiences in RAC. Positive elements about RAC and areas for improvement were discussed. Participants reported overall positive social experiences and stated that the physical environment influenced RAC. Finally, participants spoke about what they learned and emotions they felt during RAC. Conclusions Peer-led community-based MWC training influenced satisfaction with participation, MWC skills, and MWC use self-efficacy. This study was a first step in demonstrating the efficiency of RAC. IMPLICATIONS FOR REHABILITATION Limited information is available on manual wheelchair skills training in the community. Peer-led community-based manual wheelchair training influenced satisfaction with participation, manual wheelchair skills and use self-efficacy. This study was a first step in demonstrating the efficiency of Roulez Avec Confiance.

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study.

IntroductionThe manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators.MethodThis pilot study used a two‐phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45‐min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one‐to‐one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire‐Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups.ResultsPost intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.”ConclusionsThe pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.

Virtual Reality Simulator for Pediatric Laparoscopic Inguinal Hernia Repair.

Purpose: Due to the small space environment, the learning curve of pediatric laparoscopic procedures is steep and requires excellent procedural skills. These are mainly gained through an apprenticeship on real patients. Computer-based virtual reality (VR) simulators offer a safe, cost-effective, and configurable training environment free from ethical and patient safety issues. Materials and Methods: We have developed a prototype VR simulator for core manual skills training for pediatric laparoscopic hernia repair. The simulator currently consists of a hernia suturing task on a virtual nonanatomic trainer at a real pediatric scale. Results: A simulation realism validation study was carried out by obtaining subjective feedback (face and content validity) through a questionnaire from 36 pediatric surgeons. The overall simulation realism was on average marked 3.08 on a 5-point Likert scale (1: "very unrealistic" and 5: "very realistic"). The participants were most satisfied with the visual realism (3.33) and most critical about the behavior of virtual tissue. The simulator showed good content validity; its usefulness as a training tool for hernia repair, suturing in general, and in learning fundamental laparoscopic skills was marked 3.61, 3.64, and 3.89, respectively. Conclusions: VR simulation of pediatric laparoscopic procedures can contribute to surgical training and improve the educational experience without putting our youngest patients at risk. This simulator is a first prototype, and the initial results indicate that it provides promising foundations for further development. More formal and larger studies such as construct validity and transfer of skills are envisaged as the prototype is developed further.

Physical Education for Manual Wheelchair Users in Quebec: A Description of Teacher Training and Child Integration in Elementary and High Schools

Pediatric manual wheelchair users (PMWUs) do not meet the Canadian 24-hour movement guidelines. Consequences are significant in terms of physical, emotional and cognitive health. Physical education (PE) classes are an important facilitator to increased physical activity among children and youth with disability. However, many teachers do not feel adequately prepared to provide education to children with special needs. Indeed, many Quebec (Canada) schools do not meet the recommended minutes of PE per week and the provincially mandated education program targets typically developing children only. Study objectives were to describe (1) the PE teachers’ training in adapted physical activity and (2) the integration of PMWUs in PE classes within Quebec elementary and high schools. An online survey asked 47 questions about: (1) demographic and descriptive information, (2) integration of PMWUs in PE classes, (3) teaching strategies (4) evaluation methods, (5) use of reference tools and (6) interests and opinions. Complete responses were received from 136 PE teachers. Forty-nine percent of PE teachers received adapted physical activity training through their university curriculum and 14.9% took additional training after university. Eighty-six percent of PE teachers were interested in receiving education about manual wheelchair skills training. While 97% of PMWUs participate with or without assistance in PE classes, some PE teachers were not satisfied with how they adapted their PE courses for PMWUs, reporting that adaptations to classes and evaluations are primarily based on professional judgment. Most PE teachers who did not currently teach PMWUs would not feel equipped to adapt their classes to do so. More work is needed to develop programs to facilitate PE teacher training. Improved PE courses may in turn increase physical activity among PMWUs.

Development and evaluation of simulation methods for manual skills training in 'Removable dentures' module

The material 1 phase of the study were 82 people, students of 3 courses, divided into a control group where the training was conducted with the use of standard phantoms and group study which used a dental simulator CDS 100 of V generation. Material 2 stages presented 48 people who participated in phase 1 and divided into groups similar to the 1 stage, young professionals in 2016. An objective assessment of the quality of preparation for 2 stages made with a scanner Zirkozahn arti s600. In the control group, the main reason for the need for additional correction of the abutment teeth as 1 and 2 is the inadequacy of stage periodontal ledge factor ANOVA with the indicator 1.1 for one phase of the study and 1.15 for 2 stages, indicating that the statistical predictors in this group identity. The group studies found no statistically significant difference in the quality of the executed periodontal ledges 1 and 2 stages of the study, 0.9-way ANOVA factor, which indicates the statistical significance of the predictor as pre-acquisition movements automatism acquired while working with the simulator. The use of an interactive computer simulation CDS 100 provides a higher level of acquisition, and the main 'survival' of practical skills, confirmed by subsequent clinical practice, compared with the classical form of education.

A Workshop for Training of Basic Neurosurgical Skills "From Microsurgery to Endoscopy": A Stepping Stone for Young Neurosurgeons.

BackgroundThe aim of the project was to show the peculiarities of manipulations in two-dimensional (2D) visualization and to enlighten young neurosurgical residents for further independent training of their manual skills in the anatomic lab. The course followed a step-by-step training program starting with artificial models in a static 2D exoscopic view field with subsequent transition to cadaveric animal models and the use of dynamic four-hand techniques and endoscopy.Materials and methodsSince 2015, two 2-day workshops and four 1-day workshops have been organized. All courses consisted of short theoretical and prevailing hands-on practical part and were designed mainly for manual skills training. For optimal practical training, each pair of trainees were engaged with a separate working place equipped with a video system, exoscope, drill, suction, and a set of microsurgical and endoscopic instruments. A total of 48 trainees, including residents of the Nikolay Nilovich (NN) Burdenko National Medical Research Center of Neurosurgery (NMRCN), the Russian Medical Academy of Continuous Postgraduate Education, and other institutions from different regions of Russia, completed the program. Analysis of evaluation sheets revealed that over 90% of trainees were under the age of 30.ResultsThe key idea – accommodation to endoscopy through a series of microsurgical exercises in 2D visualization – has been successfully actualized and met with interest. After analyzing the questionnaires, we found that an overall satisfaction rate was high. The vast majority of trainees intended to gain further experience and apply new techniques in their clinical neurosurgical and microsurgical practice. The number of practiced techniques and the quality of the provided equipment were considered by the participants as good or very good. The highly individualized training course with a participant/tutor ratio of 4:1 and the use of tissue models (no sacrifice of living animals) was well appreciated.ConclusionThe demand for a workshop indicates a lack of such training activities for young professionals, such as the one we presented herein. Evaluation of the courses by the trainees showed that the contents of workshops corresponded to their tasks and expectations, regardless of their previous experience. The workshop was not only the 'stepping stone' from which the path of practical self-development should begin but also initiated the development of a whole series of specially focused training workshops on microsurgery and endoscopy for neurosurgeons.

СИМУЛЯЦІЙНЕ НАВЧАННЯ СТУДЕНТІВ ЯК ОДИН ІЗ ПЕРСПЕКТИВНИХ МЕТОДІВ ФОРМУВАННЯ ТА ВДОСКОНАЛЕННЯ ПРОФЕСІЙНИХ ХІРУРГІЧНИХ НАВИЧОК У МАЙБУТНІХ ЛІКАРІВ

Мета роботи – дослідити взаємозв’язок між симуляційними методами навчання та формуванням професійних навичок у студентів.Основна частина. У роботі проаналізовано ефективність використання Міжкафедрального навчально-тренінгового центру симуляційного навчання ДВНЗ “Тернопільський державний медичний університет імені І. Я. Горбачевського МОЗ України” у відпрацюванні практичних навичок студентів з дисципліни “Загальна хірургія”. Засвоєння матеріалу і відпрацювання навичок студентами на фантомах дозволяють залучати їх до виконання певних маніпуляцій на пацієнтах під ретельним контролем з боку викладачів (промивання шлунка, катетеризація сечового міхура, перев’язки та ін.). Опанування на симуляторах таких навичок, як внутрішньовенна та внутрішньом’язова ін’єкції, навичок серцево-легеневої реанімації необхідне для навчання студентів на будь-якій клінічній кафедрі.Симуляційний центр, створений у ТДМУ, забезпечує теоретичну частину, вивчення практичних випадків, відеосесію, тренінг мануальних навичок та вмінь, роботу на анімальних моделях, спеціалізовані тренінги, участь у конференціях. Для адекватного засвоєння навичок виділено понад 10 % від загального навчального навантаження.Висновок. Використання симуляційних методів значно покращує якість презентації навчального матеріалу й ефективність його засвоєння студентами, збагачує зміст навчального процесу, підвищує мотивацію до навчання та дозволяє об’єктивно оцінити досягнутий рівень професійної підготовки кожного студента.

Quantifying performance metrics of cervical spine mobilization for improved education and clinical outcomes: Early experience with a novel wearable device.

IntroductionEvaluation of manual skills training for spinal rehabilitation has been stagnant for 40 years. Observation and mimicry are coupled with feedback from “expert” observers to train and evaluate learners, relying on rater experience to discern speed and force. Spinal manipulation is a controlled act under the Regulated Health Professions Act (1991) as it is not without risk. The discordance between current methods for evaluating proficiency and the potential risks of inadequate application is a critical gap.MethodsThis work reports a novel wearable device that measures finger forces via microstrain bending of the physiotherapist’s nail. The device leaves the tactile finger pad unobstructed and does not interfere with treatment application. Five expert-level physiotherapists performed a standard postero-anteriorly directed spinal segmental mobilization treatment for 1 min at 1–1.5 Hz rhythm.ResultsThe device successfully measured all treatment forces (0.2–27.3 N). Physiotherapists applied a maximum force rate of 0.03 ± 0.01 N/s with a rhythm of 1.76 ± 0.38 Hz. In 15 trials, there were no device failures. The device was easily applied and removed, and physiotherapists were able to walk about and interact normally with patients.ConclusionsThese results indicate that this technology can be integrated into a skills training program to provide quantitative feedback for objective assessments.

Effectiveness and safety of wheelchair skills training program in improving the wheelchair skills capacity: a systematic review

Objective: To comprehensively assess the effectiveness and safety of wheelchair skills training program in improving wheelchair skills capacity. Data sources: PubMed, OVID, EBSCO, ScienceDirect, Web of Science, CINAHL, Cochrane Library, Google Scholar, and China Knowledge Resource Integrated Database were searched up to March 2017. Methods: Controlled clinical trials that compared a wheelchair skills training program with a control group that received other interventions and used the wheelchair skills test scores to evaluate wheelchair skills capacity were included. Two authors independently screened articles, extracted data, and assessed the methodological quality using the Cochrane risk-of-bias tool in randomized controlled trial (RCT) and methodological index for non-randomized studies. The data results of wheelchair skills test scores were extracted. Results: Data from 455 individuals in 10 RCTs and from 140 participants in seven non-randomized studies were included for meta-analysis using Stata version 12.0 (Stata Corporation, College Station, TX, USA). In the short term (immediately to one week) post-intervention, relative to a control group, manual wheelchair skills training could increase the total wheelchair skills test scores by 13.26% in RCTs (95% confidence interval (CI), 6.19%–20.34%; P < 0.001) and by 23.44% in non-randomized studies (95% CI, 13.98%–32.90%; P < 0.001). Few adverse events occurred during training; however, compared with a control group, evidence was insufficient to support the effectiveness of powered wheelchair skills training and the long-term (3–12 months) advantage of manual wheelchair skills training (P = 0.755). Conclusion: The limited evidence suggests that wheelchair skills training program is beneficial in the short term, but its long-term effects remain unclear.

仮想の鏡「ハイパーミラー」を用いた内視鏡下鼻内手術の遠隔手技指導実験( 臨床現場のVR)

仮想の鏡「ハイパーミラー」を用いた内視鏡下鼻内手術の遠隔手技指導実験( 臨床現場のVR)

Manual Wheelchair Skills Training for Community-Dwelling Veterans with Spinal Cord Injury: A Randomized Controlled Trial.

ObjectivesTo test the hypotheses that community-dwelling veterans with spinal cord injury (SCI) who receive the Wheelchair Skills Training Program (WSTP) in their own environments significantly improve their manual wheelchair-skills capacity, retain those improvements at one year and improve participation in comparison with an Educational Control (EC) group.MethodsWe carried out a randomized controlled trial, studying 106 veterans with SCI from three Veterans Affairs rehabilitation centers. Each participant received either five one-on-one WSTP or EC sessions 30–45 minutes in duration. The main outcome measures were the total and subtotal percentage capacity scores from the Wheelchair Skills Test 4.1 (WST) and Craig Handicap Assessment and Reporting Technique (CHART) scores.ResultsParticipants in the WSTP group improved their total and Advanced-level WST scores by 7.1% and 30.1% relative to baseline (p < 0.001) and retained their scores at one year follow-up. The success rates for individual skills were consistent with the total and subtotal WST scores. The CHART Mobility sub-score improved by 3.2% over baseline (p = 0.021).ConclusionsIndividualized wheelchair skills training in the home environment substantially improves the advanced and total wheelchair skills capacity of experienced community-dwelling veterans with SCI but has only a small impact on participation.

Wearable Sensors for eLearning of Manual Tasks: Using Forearm EMG in Hand Hygiene Training.

In this paper, we propose a novel approach to eLearning that makes use of smart wearable sensors. Traditional eLearning supports the remote and mobile learning of mostly theoretical knowledge. Here we discuss the possibilities of eLearning to support the training of manual skills. We employ forearm armbands with inertial measurement units and surface electromyography sensors to detect and analyse the user’s hand motions and evaluate their performance. Hand hygiene is chosen as the example activity, as it is a highly standardized manual task that is often not properly executed. The World Health Organization guidelines on hand hygiene are taken as a model of the optimal hygiene procedure, due to their algorithmic structure. Gesture recognition procedures based on artificial neural networks and hidden Markov modeling were developed, achieving recognition rates of () for individual gestures. Our approach is shown to be promising for further research and application in the mobile eLearning of manual skills.

Ermittlung der operationsbezogenen Ausbildungskosten zum Facharzt für Orthopädie und Unfallchirurgie

Trauma surgery is a discipline in which the training phase for specialization requires atechnical and time-intensive learning curve, including the repetitive training of manual skills. This results in prolonged operation times and thus elevated costs. The present study retrospectively examines operations in trauma surgery and orthopaedics at aMunich university hospital according to the required curriculum for further specialist training. The duration of procedures at the various training levels and the resulting costs were compared. Based on digital surgical records, more than 2,000 surgical interventions were analysed and checked that they fulfilled the practical requirements. Patients with multiple injuries and polytrauma, in addition to irregularly complex cases, were removed from the calculation to ensure high comparability of the individual cases. This yielded more than 1,000+ cases for evaluation. The per-minute cost was calculated to allow for the translation of operating time into costs. The study shows aprolonged duration of operating time of 19.75 % when the procedure was conducted by residents. This prolongation can be split into 37subgroups according to body region and type of procedure. The prolongation of operation time could be quantified as a specific prolongation per cluster, in addition to cumulative prolongation. By including the operating costs, the operation-dependent training costs are shown as an exact sum of Euros. Surgical training of residents costs hospitals the appropriate amounts of time and money and reduces the overall number of procedures performed, justifying special consideration of the financing of training hospitals.