An enhanced fresh cadaveric model for reconstructive microsurgery training

Open access via Springer Compact Acknowledgements The generosity of the people of the North East of Scotland who donated their bodies to the University of Aberdeen for anatomical study is recognised. Their contribution is appreciated and valued. Funding The authors received no financial support for the research, authorship, and/or publication of this article.Peer reviewedPublisher PD

Research priorities in light of current trends in microsurgical training: revalidation, simulation, cross-training, and standardisation.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly citedPlastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

Is it all about the money? : The effects of low and high cost simulator training scenarios in surgical training

Background: The learning process is complex and dependent on several factors such as for instance, the environment to learn, prior knowledge and distinct abilities, motivation, goal-orientation as well as the effects of instructor feedback. Medical education, in particular within surgical domains is imperative due to its influence on patient safety. The demand for training surgeons has shifted from the “master-apprentice/practice on patients”, towards a safer modality, involving simulators. The positive effects laparoscopic simulator training has on laparoscopic performance is extensive, as well as its impact on operating room performance. Nonetheless, the difference in learning effect using either low-cost or high-fidelity laparoscopic simulators were not totally clear prior to study start. Aims 1. To examine whether laparoscopic surgical training may be offered at a lower cost, with maintained equivalent level of training and effect in knowledge/learning using a low-cost laparoscopic Blackbox (Paper I). 2. To study the impact of PC-gaming experience, visuospatial ability and gender on the various parameters of the MIST-VR simulator and its effect on the score (Paper II). 3. To further investigate the Blackbox, and if different adjuncts (video analysis) could provide more information regarding the effects of training (Paper III). 4. To study the effects on time to learn laparoscopic knot- and suturing skills in novices using two different laparoscopic needle holders in a more advanced Blackbox, evaluate outcomes regarding performance, ergonomic discomfort and time to perform laparoscopic knot- and suturing skills, as well as to evaluate an objective video evaluation scoring table (OVEST) (Paper IV). Materials and Methods: The participants were medical students from the surgical semester at Karolinska Institutet, Stockholm (Studies I-III) and medical students at Athens University Medical School in Athens, Athens, Greece (Study IV). The studies were conducted at CAMST (Center for Advanced Medical Simulation and Training), Karolinska University Hospital, Stockholm (Studies I-III), and at MPLSC (Medical Physics-Lab Simulation Center), Athens University Medical School, Athens, Greece (Study IV). In conjunction with inclusion, the students (Studies I-II) performed a test (MRT-A; Mental Rotation Test – A) for the assessment of their visuospatial ability, and questionnaires including baseline questions (Studies I-IV). The simulator training/tests were done using different laparoscopic simulators; Blackbox (Studies I and III); LapMentor (Study I); MIST-VR (Studies I-III); Simball box (Study IV). The participants’ simulator performance analyzed; time to completion and economy of movement (Studies I-IV); optical flow metrics (path-length and total number of particles) as displayed by the automated video analysis software (Study III); knot- and suturing skills (Study IV). Results: Studies I and II showed, as previous studies, that the visuospatial ability correlated with the initial simulator training sessions. Study I showed no significant difference in performance between laparoscopic basic skills training regardless of simulator used; low-cost or high-fidelity laparoscopy simulator. Studies I, II and III showed discrepancies between prior PC-gaming experience and the simulator performance, as well as some gender-specific differences. Study III also showed that the use of a low-cost automated video analysis software may be feasibly comparable to the build-in software of the MIST-VR simulator. Study IV presented a shortened time to learn for novices performing laparoscopic knot- and suturing tasks in a simulated environment when using the newly designed laparoscopic needle holder compared to a conventional market needle holder. Conclusions: Laparoscopic simulator training clearly facilitates laparoscopic skills performance. Improved prerequisites of training opportunities for surgeons could potentiate patient safety, especially since enhanced surgical performance improves patient safety. Subsequently, as depicted in this thesis, there is not one single truth or solution, rather different angles and several factors that affect learning in general and surgical performance in particular. Therefore, considerations of for instance individual differences, gender, and motivation, should all be included when producing laparoscopic skills training curriculum for future surgical trainees

Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?

BACKGROUND: Essentials Skills in the Management of Surgical Cases - ESMSC is an International Combined Applied Surgical Science and Wet Lab course addressed at the Undergraduate level. Laparoscopic Skills is a fundamental element of Surgical Education and various Simulation-Based Learning (SBL) models have been endorsed. This study aims to explore if there is any significant difference in delegates' performance depending on whether they completed In Vivo module prior to the equivalent in the laparoscopic simulator. MATERIALS AND METHODS: 37 Medical Students from various EU countries were divided in 2 groups, and both completed the "Fundamentals in Laparoscopic Surgery" module in the Dry-lab Laparoscopic Simulator as well as the same module "In Vivo" on a swine model. Group A (18 students, 48.6%) completed the "Fundamentals in Laparoscopic Surgery - FLS" module prior to the "In Vivo", whereas group B completed the "In Vivo" module first. Direct Observation of Procedural Skills (DOPS) were used to assess delegates' performance. RESULTS: The mean DOPS scores for the "FLS" and "In Vivo" models were 2.27 ± 0.902 and 2.03 ± 0.833, respectively, and the delegates' performance was not statistically significantly different between them (p = 0.128). There was no statistically significant difference in the scores among different gender, year of study, school and handedness groups. The alteration in the sequence between Dry-lab "FLS" and "In Vivo" modules did not affect the performance in neither the "FLS" nor the "In Vivo" models. CONCLUSIONS: The inexpensive, but low-fidelity "FLS" model could serve an equal alternative Simulation-Based Learning model for the early undergraduate training. Our study demonstrated that high fidelity In Vivo simulation for laparoscopic skills does not affect significantly the improvement in the delegates' performance at the undergraduate level. Further studies should be conducted to identify at which stage of training should high fidelity simulation be introduced

Training the gynecologic oncologists of the future: challenges and opportunities

Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.</p

Laparoscopic simulation training in gynaecology:Current provision and staff attitudes - a cross-sectional survey

<p>The objectives of this study were to explore current provision of laparoscopic simulation training, and to determine attitudes of trainers and trainees to the role of simulators in surgical training across the UK. An anonymous cross-sectional survey with cluster sampling was developed and circulated. All Royal College of Obstetricians and Gynaecologists (RCOG) Training Programme Directors (TPD), College Tutors (RCT) and Trainee representatives (TR) across the UK were invited to participate. One hundred and ninety-six obstetricians and gynaecologists participated. Sixty-three percent of hospitals had at least one box trainer, and 14.6% had least one virtual-reality simulator. Only 9.3% and 3.6% stated that trainees used a structured curriculum on box and virtual-reality simulators, respectively. Respondents working in a Large/Teaching hospital (<i>p</i> = 0.008) were more likely to agree that simulators enhance surgical training. Eighty-nine percent agreed that simulators improve the quality of training, and should be mandatory or desirable for junior trainees. Consultants (<i>p</i> = 0.003) and respondents over 40 years (<i>p</i> = 0.011) were more likely to hold that a simulation test should be undertaken before live operation. Our data demonstrated, therefore, that availability of laparoscopic simulators is inconsistent, with limited use of mandatory structured curricula. In contrast, both trainers and trainees recognise a need for greater use of laparoscopic simulation for surgical training.</p

Apprenticeship to simulation - The metamorphosis of surgical training

Surgery is a dynamic specialty and surgical competencies are a combination of both technical and non-technical skills. After the inception of the art of surgery, surgical education and training has undergone incredible evolution. The first model of surgical training was introduced in the 19th century and is known as the \u27apprenticeship model\u27, followed by the famous \u27Halstedian\u27 model. However, a report by the Institute of Medicine challenged the teaching institutions to formulate alternative methods of surgical education to ensure patients\u27 safety and to reduce the fear among patients of them being practised on. Teaching surgical skills outside the operating room to ensure patient safety has laid the foundation of simulation-based training in surgical education. More recently, the focus of surgical training and residency has shifted to competency and outcome-based models. The current review article was planned to describe the evolution and transformation of surgical training over time

Virtual and Augmented Reality in Medical Education

Virtual reality (VR) and augmented reality (AR) are two contemporary simulation models that are currently upgrading medical education. VR provides a 3D and dynamic view of structures and the ability of the user to interact with them. The recent technological advances in haptics, display systems, and motion detection allow the user to have a realistic and interactive experience, enabling VR to be ideal for training in hands-on procedures. Consequently, surgical and other interventional procedures are the main fields of application of VR. AR provides the ability of projecting virtual information and structures over physical objects, thus enhancing or altering the real environment. The integration of AR applications in the understanding of anatomical structures and physiological mechanisms seems to be beneficial. Studies have tried to demonstrate the validity and educational effect of many VR and AR applications, in many different areas, employed via various hardware platforms. Some of them even propose a curriculum that integrates these methods. This chapter provides a brief history of VR and AR in medicine, as well as the principles and standards of their function. Finally, the studies that show the effect of the implementation of these methods in different fields of medical training are summarized and presented