Video-Based Surgical Learning: Improving Trainee Education and Preparation for Surgery

Since the end of the XIX century, teaching of surgery has remained practically unaltered until now. With the dawn of video-assisted laparoscopy, surgery has faced new technical and learning challenges. Due to technological advances, from Internet access to portable electronic devices, the use of online resources is part of the educational armamentarium. In this respect, videos have already proven to be effective and useful, however the best way to benefit from these tools is still not clearly defined.Surgical Sciences Research Domain, Life and Health Sciences Research Institute, ICVS/3B’s—PT Government Associate Laboratory, School of Medicineinfo:eu-repo/semantics/publishedVersio

Training or non-surgical factors-what determines a good surgical performance? A randomised controlled trial

Background Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. Methods This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 x 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre-to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. Results In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. Conclusion The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training

Incidence of Chronic Postsurgical Pain (CPSP) after General Surgery

Objective. This study investigated the incidence and determinants of chronic postsurgical pain (CPSP) in a general surgical patient population. Design. This is a prospective cross-sectional study at a university-affiliated clinic/level 1 trauma center. Patients were followed at least 1 year postoperatively. By surgical discipline, procedures were 50% orthopedic/trauma, 33% general (abdominal/visceral), and 17% vascular. Setting. All patients admitted during one year (N = 3020) were eligible. Exclusion criteria were cognitive impairment, communication/language barrier, nonoperative treatment, and refusal to participate. A CPSP questionnaire was completed. Step-by-step analysis followed with a 2nd questionnaire to detect CPSP with numeric rating scale (NRS) pain intensity >= 3. Finally, individual follow-up examinations were performed. Results. 911 patients responded (30.2%). 522 complained of pain intensity >= 3 on NRS (scale 0-10). The second step identified 214 patients with chronic pain (NRS >= 3, mean 29 months postoperatively). On final examination, 83 CPSP patients (14.8%) were identified. By surgical discipline, 28% were general, 15% vascular, and 57% trauma/orthopedic surgery. Most oftenly cited pain sites were joint (49.4%), incisional/scar (37.7%), and nerve pain (33.7%). By procedure, patients underwent pelvic surgery, colon surgery, laparoscopies, inguinal herniorrhaphies, arthroscopies, and hardware extractions. All patients in the laborer and unemployed categories reported chronic pain. Conclusion. Bias due to study design and/or heterogeneity of patients is possible, but there was a high CPSP rate after 2 years both generally and particularly in orthopedic/trauma (57%) patients. Both major and minor surgical procedures led to CPSP

Principled teaching for deep progress: improving mathematical learning beyond methods and materials

This paper contributes to knowledge about principled action which makes a difference to learners attainment. We report on the Improving Attainment in Mathematics Project, a project focusing on low-attaining secondary students. The purpose of the project was to introduce innovations in practice through action research with 10 teachers over 2 years, and evaluate the effect on students learning using national test scores, teachers reports, non-routine tasks and other performance indicators. However, this is not a study which shows how certain methods lead to better results. While it was found that learning improved, the methods and strategies the teachers used were not always generalisable across the project, indeed some were contradictory. Continued searching led to the identification of common underlying principles of teaching which different teachers manifested in different ways. Overt methods were less important than the collection of beliefs and commitments which underpinned teachers choices. There was, however, a convergence of practice around a focus on long-term development, the process of becoming a learner of mathematics, rather than short-term gains. In addition, we had to deal with some of the realities of authentic collaborative research with practitioners