Identifying Opportunities for Virtual Reality Simulation in Surgical Education: A Review of the Proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR Surgery

To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation

National Patterns of Immediate Breast Reconstruction for Neoplastic Disease

Background:In the United States, one in eight women will suffer from breast cancer in her lifetime and 40,000 will die from the disease each year. The overall US mortality from breast cancer is approximately 20%. The current modified radical mastectomy approach, with various adjuvant options provides 35-40% twenty-year survival. Following mastectomy, women have the option of no reconstruction, immediate reconstruction or delayed reconstruction. There is no significant difference in mortality with reconstruction. Objectives:This study was performed to evaluate patterns of immediate breast reconstruction at the national level, to determine what factors influence immediate breast reconstruction in women. Methods: In order to evaluate trends in immediate breast reconstruction for neoplastic disease at the national level we used the Nationwide Inpatient Sample (NIS) for the years 1998-2003, a national all-payer database. The primary measured outcome for this study was immediate breast reconstruction vs. no immediate breast reconstruction for patients undergoing resection of breast neoplasm. In reference to the primary measured outcome of immediate breast reconstruction, we performed chi square analyses of our variables of interest. To identify which factors independently conferred statistical significance in predicting likelihood of immediate breast reconstruction a multivariate logistic regression was performed. Adjustments were made for certain patient characteristics including, age (70), race (white vs. non-white), socioeconomic status (median income for patient zip code), co-morbid conditions, diagnosis type, payer status, and year of resection. In addition, adjustments were made for certain hospital level variables, which included, teaching status, geographic region, and hospital surgical volume. The patient cohort was limited to female patients between 18 and 100 years of age. Results: In the United States from 1998-2003 an estimated 682,511 patient-discharges occurred with the principal diagnosis of neoplastic disease of the breast. Of the initial cohort, 598,698 (88%) underwent either breast conservative therapy or some degree of mastectomy. Of these women, 116,420 (20%) underwent one of the reconstructive breast procedures. Median age for the reconstructed group was 50, compared to 66 for the non-reconstructed group. On univariate analysis, younger women, white women, and women with a higher annual income were significantly more likely to undergo immediate reconstruction. Overall, 40.5% of women less than 50 years old underwent reconstruction compared to women ages 50-70 (20.7%) and women greater than 70 years of age (2.6%) (p$45,000 (p Conclusion:Well- proven disparities in health care extend into the practice of breast reconstruction after mastectomy. Even when evaluated as independent variables, age, race, income bracket, hospital volume, and teaching status were all significant predictors of higher rates of immediate reconstruction nationally. As specialty centers, such as academic interdisciplinary breast cancer centers, become even more prevalent, the disparity will only worsen for those that do not have access to such resources. Efforts need to be made to bring these practices into smaller hospitals and into non-teaching institutions. In addition, at all centers, physicians must be creative in their communication strategies and encouraging toward patients of lower income and racial minorities

Effects of Sleep Hours and Fatigue on Performance in Laparoscopic Surgery Simulators

International audienceBackground Studies on a virtual reality simulator have demonstrated that sleep-deprived residents make more errors. Work-hour restrictions were implemented, among other reasons, to ensure enough sleep time for residents. The objective of this study was to assess the effects of sleep time, perceived fatigue, and experience on surgical performance. We hypothesized that performance would decrease with less sleep and fatigue, and that experienced surgeons would perform better than less experienced surgeons despite sleep deprivation and fatigue. Methods Twenty-two surgical residents and attendings performed a peg transfer task on two simulators: the Fundamentals of Laparoscopic Skills (FLS) trainer and the Virtual Basic Laparoscopic Surgical Trainer (VBLaST©), a virtual version of the FLS. Participants also completed questionnaires to assess their fatigue level and recent sleep hours. Each subject performed 10 trials on each simulator in a counterbalanced order. Performance was measured using the FLS normalized scores, and analyzed using a multiple regression model. Results The multiple regression analysis showed that sleep hours and perceived fatigue were not covariates. No correlation was found between experience level and sleep hours or fatigue. Sleep hours and fatigue did not appear to affect performance. Expertise level was the only significant determinant of performance in both FLS and VBLaST©. Conclusions Restricting resident work-hours was expected to result in less fatigue and better clinical performance. In our study, peg transfer task performance was not affected by sleep hours. Experience level was a significant indicator of performance. Further examination of the complex relationship between sleep hour, fatigue, and clinical performance is needed to support the practice of work-hour restriction for surgical residents

Needs assessment for a focused radiology curriculum in surgical residency: a multicenter study

Patient instability and limited radiology staffing may compel surgeons to make clinical decisions based on their independent interpretations of imaging studies. Despite potential implications for patients, no research to date has assessed the need for a diagnostic radiology curriculum in general surgery residency. We performed a cross-sectional study of surgery faculty and residents at 13 teaching hospitals across the United States. Survey responses were summarized using frequency and percentage, and analyzed by chi-square, Mantel-Haenszel chi-square, and McNemar tests. Surveys were distributed to 465 faculty and 520 residents, with response rates of 26% and 30%, respectively. Most respondents reported making decisions based on their independent imaging interpretation at least sometimes, with higher frequency in acute scenarios. The majority voiced a need for a dedicated radiology curriculum, with teaching in chest x-rays, abdominal x-rays, abdominal computed tomography, chest computed tomography, and focused assessment with sonography in trauma examinations. Surgeons and surgical residents enact treatment plans based on their independent interpretation of imaging studies, especially during acute patient scenarios. Further curricular development efforts are warranted to ensure trainee accuracy in radiologic interpretation. •No study to date has evaluated independent imaging interpretation among surgeons.•This study evaluated patterns in radiologic interpretation among surgeons and residents.•Both cohorts enact care plans based on their interpretations of imaging studies.•Participants denied formal training in radiology. Residents cited their colleagues as teachers.•Our data support a curriculum in diagnostic radiology for general surgery residents

Effects of sleep hours and fatigue on performance in laparoscopic surgery simulators

International audienceBackground Studies on a virtual reality simulator have demonstrated that sleep-deprived residents make more errors. Work-hour restrictions were implemented, among other reasons, to ensure enough sleep time for residents. The objective of this study was to assess the effects of sleep time, perceived fatigue, and experience on surgical performance. We hypothesized that performance would decrease with less sleep and fatigue, and that experienced surgeons would perform better than less experienced surgeons despite sleep deprivation and fatigue. Methods Twenty-two surgical residents and attendings performed a peg transfer task on two simulators: the Fundamentals of Laparoscopic Skills (FLS) trainer and the Virtual Basic Laparoscopic Surgical Trainer (VBLaST©), a virtual version of the FLS. Participants also completed questionnaires to assess their fatigue level and recent sleep hours. Each subject performed 10 trials on each simulator in a counterbalanced order. Performance was measured using the FLS normalized scores, and analyzed using a multiple regression model. Results The multiple regression analysis showed that sleep hours and perceived fatigue were not covariates. No correlation was found between experience level and sleep hours or fatigue. Sleep hours and fatigue did not appear to affect performance. Expertise level was the only significant determinant of performance in both FLS and VBLaST©. Conclusions Restricting resident work-hours was expected to result in less fatigue and better clinical performance. In our study, peg transfer task performance was not affected by sleep hours. Experience level was a significant indicator of performance. Further examination of the complex relationship between sleep hour, fatigue, and clinical performance is needed to support the practice of work-hour restriction for surgical residents