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Virtual reality for training procedural skills in minimally invasive surgery and proficiency-based training method are encouraging to change the training paradigm in all of procedural-based medicine. The company, which is manufacturing the carotid stend system, is planning to work with physician trainers to educate physician trainees using a tiered training approach including online, multimedia components.

Objective: To examine the effect of previous-day excessive alcohol consumption on laparoscopic surgical performance. Design: Study 1 was a randomized controlled trial. Study 2 was a cohort study. Setting: Surgical skills laboratory. Participants: Sixteen science students (laparoscopic novices) participated in study 1. Eight laparoscopic experts participated in study 2. Interventions: All participants were trained on the Minimally Invasive Surgical Trainer Virtual Reality (MIST-VR). The participants in study 1 were randomized to either abstain from alcohol or consume alcohol until intoxicated. All study 2 subjects freely consumed alcohol until intoxicated. Subjects were assessed the following day at 9 AM, 1 PM, and 4 PM on MIST-VR tasks. Main Outcome Measures: Assessment measures included time, economy of diathermy use, and error scores. Results: In study 1, both groups performed similarly at baseline, but the alcohol group show eddeterioration on all performance measures after alcohol consumption. Overall, although the timescore differences between the 2 groups were not statistically significant (P=.29), there was a significant difference between the 2 groups' diathermy (P<.03) and error (P<.003)scores. There was also a significant effect for time of testing (P<.003), diathermy (P<.001), and errors (P<.001). In study 2, experts demonstrated a similar postalcohol performance decrement for time (P<.02), diathermy (P<.001), and error scores (P<.001). Conclusion: Excessive consumption of alcohol appeared to degrade surgical performance the following day even at 4 PM, suggesting the need to define recommendations regarding alcohol consumption the night before assuming clinical surgical responsibilities. [ABSTRACT FROM AUTHOR]

Presents a response to a letter to the editor of "The Journal of the American Medical Association" regarding virtual reality training for carotid stenting. Discussion of the article "Approval of Virtual Reality Training for Carotid Stenting: What This Means for Procedural-Based Medicine," by Anthony Gallagher and Christopher Cates.