Development of a Comprehensive Ex-vivo Technical Skills Curriculum for an Advanced Minimally Invasive Surgical Procedure

It is well recognized that a certain component of surgical residency training has transitioned from the operating room to the surgical skills lab. Although a significant amount of important work has validated simulators as viable systems for teaching technical skills outside the operating room, the next step is integrating simulators into a comprehensive curriculum. Several frameworks for curricular design have been described in the literature; however, few curricula have been described or validated for minimally invasive surgical procedures. This study describes the design and validation of a comprehensive technical skills curriculum for laparoscopic colorectal surgery, an advanced laparoscopic procedure. The initial step in this project utilized the Delphi consensus methodology to develop a procedure-specific evaluation tool for laparoscopic colorectal surgery. This evaluation tool demonstrated reliability and validity in the context of expert and novice performance in the operating room. The next phase of the project also used the Delphi method to develop international consensus on a proficiency-based virtual reality program designed to teach the technical skills necessary to perform laparoscopic colorectal surgery. This virtual reality training program was then integrated into a comprehensive curriculum consisting of psychomotor training on the virtual reality simulator, as well as cognitive training and a cadaver lab. The final component of this project was a randomized single-blinded controlled trial that demonstrated that surgical residents who participated in the comprehensive curriculum exhibited superior technical skills in the operating room, and superior cognitive knowledge relating to laparoscopic colorectal surgery, compared to residents who received only conventional residency training.Ph

Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: A Delphi approach

Background. Although task training on virtual reality (VR) simulators has been shown to transfer to the operating room, to date no VR curricula have been described for advanced laparoscopic procedures. The purpose of this study was to develop a proficiency-based VR technical skills curriculum for laparoscopic colorectal surgery. Methods. The Delphi method was used to determine expert consensus on which VR tasks (on the LapSim simulator) are relevant to teaching laparoscopic colorectal surgery. To accomplish this task, 19 international experts rated all the LapSim tasks on, a Likert scale (1-5) with respect to the degree to which they thought that a particular task should be included in a final technical skills curriculum. Results of the survey were sent back to participants until consensus (Cronbach's alpha > 0.8) was reached. A crass-sectional design was utilized to define the benchmark scores for the identified tasks. Nine expert surgeons completed all identified tasks on the "easy," "medium," and "hard" settings of the simulator Results. In the first round of the survey, Cronbach's alpha was 0.715; after the second round, consensus was reached at 0.865. Consensus was reached for T basic tasks and I advanced suturing task. Median expert time and economy of movement scores were defined as benchmarks for all curricular tasks. Conclusion. This study used Delphi consensus methodology to create a curriculum for an advanced laparoscopic procedure that is reflective of current clinical practice on an international level and conforms to current educational standards of proficiency-based training. (Surgery 2012;151:391-7.

Step, error, and event frameworks in endovascular aortic repair

Objective: Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). Methods: This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach alpha>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. Results: Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach alpha=0.82-0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%-100%). Conclusion: A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery

Evaluating performance of peripheral endovascular interventions : a Delphi consensus

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