Search

Objective: To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods: A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results: Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0-4.0) to 7 (IQR, 5.0-8.0) [bootstrap p<0.0001] for each of the randomly chosen pairings. The majority of candidates showed significantly improved cognitive skills after the HMR course despite their poor cognitive skills before the course. According to further analysis, there were significant enhancements in grades for all topics, especially regarding the basic principles of the procedure and management of complications (bootstrap p<0.0001). The odds ratio for the pre- versus post-course mean test results was 5.23. Due to the confidentiality stipulation, the pre- and post-course scores were not matched. Conclusion: A two-day continuing medical educational course could be efficient in improving the nontechnical (cognitive) skills for HMR. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a hysteroscopic myoma resection (HMR) two-day training course on non-technical (cognitive) surgical skills among gynecologists. Materials and methods: A 2-day educational course was held in which 95 consultant gynecologic surgeons and beginner infertility fellowship residents took part. Among all 80 participants (84.2%) had ever performed diagnostic hysteroscopy and 30 (31.3%) had performed non-resectoscopic operative hysteroscopy. The training program included instructive speeches, simulated surgical presentations, and a live hands-on myomectomy workshop. Non-technical skills were assessed two times, once before and the other after the course through two written tests with 10 multiple-choice questions for each. Results: Concerning the 95 participants, 43 (47.3%) took the pre-course test and all of them (100%) took the post-course one. The mean score improved significantly from 3 (interquartile range [IQR], 0–4.0) to 7 (IQR, 5.0– 8.0) [bootstrap p

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. Methods: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. Results: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. Conclusions: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component. [ABSTRACT FROM AUTHOR]

Background: The SAGES University Colorectal Masters Program is a structured educational curriculum that is designed to aid practicing surgeons develop and maintain knowledge and technical skills for laparoscopic colorectal surgery. The Colorectal Pathway is based on three anchoring procedures (laparoscopic right colectomy, laparoscopic left and sigmoid colectomy for uncomplicated and complex disease, and intracorporeal anastomosis for minimally invasive right colectomy) corresponding to three levels of performance (competency, proficiency and mastery). This manuscript presents focused summaries of the top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease. Methods: A systematic literature search of Web of Science for the most cited articles on the topic of laparoscopic complex left/sigmoid colectomy yielded 30 citations. These articles were reviewed and ranked by the SAGES Colorectal Task Force and invited subject experts according to their citation index. The top 10 ranked articles were then reviewed and summarized, with emphasis on relevance and impact in the field, study findings, strength and limitations and conclusions. Results: The top 10 seminal articles selected for the laparoscopic left/sigmoid colectomy for complex disease anchoring procedure include advanced procedures such as minimally invasive splenic flexure mobilization techniques, laparoscopic surgery for complicated and/or diverticulitis, splenic flexure tumors, complete mesocolic excision, and other techniques (e.g., Deloyers or colonic transposition in cases with limited colonic reach after extended left-sided resection). Conclusions: The SAGES Colorectal Masters Program top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease anchoring procedure are presented. These procedures were the most essential in the armamentarium of practicing surgeons that perform minimally invasive surgery for complex left and sigmoid colon pathology. [ABSTRACT FROM AUTHOR]

Grant A Justin,1,2 Mohammed Soleimani,3 Sidra Zafar,4 Kasra Cheraqpour,5 Catherine Green,6 Mohammad Moin,7 N Venkatesh Prajna,8 Karl C Golnik,9 Fasika A Woreta4 1Department of Vitreoretinal Surgery, Duke Eye Center, Durham, NC, USA; 2Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 3Department of Ocular Trauma and Emergency, Tehran University of Medical Sciences, Tehran, Iran; 4Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA; 5Department of Eye Research, Tehran University of Medical Sciences, Tehran, Iran; 6Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; 7Department of Ophthalmology, Amee ud Din Medical College, Lahore, Pakistan; 8Department of Cornea and Refractive Eye Services, Aravind Eye Hospital, Madurai, India; 9Department of Ophthalmology, University of Cincinnati, The Cincinnati Eye Institute, Cincinnati, OH, USACorrespondence: Grant A Justin, Department of Vitreoretinal Surgery, Duke Eye Center, Durham, NC, USA, Tel +1 609-468-2468, Email grant.a.justin@gmail.comBackground/Aims: To produce an internationally developed rubric to assess surgical competency in open globe management.Methods: An international expert panel of seven ophthalmologist educators developed a standardized competency-based rubric. The steps to perform an open globe repair were outlined. Based on a modified Dreyfus model, the experts agreed on the steps of surgery and certain global indices. They then assigned descriptors for the competency expected of a novice, beginner, advanced beginner, and competent surgeon. The tool was then vetted by another panel of ten ophthalmologists. The main outcome measure was the final version of the tool as agreed upon by the expert review panel.Results: The steps of open globe repair and key global indices were established. Descriptive wording for each step and global indices for novice, beginner, advanced beginner, and competent surgery were listed. All the expert comments were integrated to establish face and content validity.Conclusion: This standardized rubric to evaluate resident competency should be used globally in training programs to assess open globe repair surgical skills. Using a modified Dreyfus model, four different levels of training competency were defined allowing a non-biased, objective, numerical and simple assessment.Keywords: open globe, resident education, surgical competency

Feedback is a major component of any educational process. Competency assessment and feedback are essential tools for teaching surgical skills. Most current systems of assessment within neurosurgical residency programs use evaluations aggregated over a period of time, which lead to significant bias, rather than case-specific feedback. We describe the use of a mobile device application called SIMPL (System for Improving and Measuring Procedural Learning) to allow for immediate surgical competency assessment and improve the quality of feedback after every operative experience. We retrospectively assessed our use of this program and neurosurgery residents' response to the program. Institutional review board approval was not required, and no patients were involved in the study. This application has already been implemented within general surgery programs with promising results. We document its implementation in a neurosurgery program and the output of the program for residents and program directors. This is the first documentation of such an application within a neurosurgical residency program. In a 6-month period at a single institution, around 300 evaluations were completed by residents and faculty, with a >80% response rate within both groups. Furthermore, these evaluations were companied by a 60% dictation rate from faculty, which contains verbal feedback that is available to residents for playback at any time. The telephone-based SIMPL application allows for assessment of surgical competency and remains quick and easy to use, giving it the potential to improve individual neurosurgical training experiences across the United States. [ABSTRACT FROM AUTHOR]

Background: Attaining competency in placement of core suture with adequate distance from juncture is a key skill for learners of tendon repair. Currently, this is most commonly practiced on animal models in wet laboratory environment. To improve accessibility and availability, we developed a tendon repair trainer that aims to guide learners in obtaining this key competency. Methods: A customized tendon dock was designed and manufactured with additive method that permits insertion of 6mm silicon tendon rods to simulate flexor tendon repair along a digit. Four residents, divided into two groups, were instructed to repair two sets of tendon rods (60 rods per resident) with Kessler suture loop placed at 10 mm from juncture (Group A: rods marked at 10 mm, Group B: unmarked rods). The main criterion for passing was a loop placed within 1 mm of the target distance (10 mm). At a second session, both groups repaired unmarked tendons, and these were marked based on similar criterion. Results: At the first session, 100% of those who repaired marked rods (Group A) passed while 25% of unmarked rods (Group B) attained a pass. At the second session, where both groups repaired unmarked rods, residents from group A achieved a pass rate of 95% while group B achieved 33.3% pass. Conclusions: Learners who had previously repaired marked rods were able to retain their experience when repairing unmarked rods. This suggest that the proposed model may be a helpful adjunct to sharpen learners' skills prior to practicing tendon repairs in more costly animal or cadaveric models. [ABSTRACT FROM AUTHOR]

Objectives The primary goal is the indexation of validated methods used to assess surgical competency in otorhinolaryngology-head and neck surgery (ORL-HNS) residents. Secondary goals include assessment of the reliability and validity of these tools, as well as the documentation of specific procedures in ORL-HNS involved. Data Sources MEDBASE, OVID, Medline, CINAHL, and EBM, as well as the printed references, available through the Université de Montréal library. Review Methods The PRISMA method was used to review digital and printed databases. Publications were reviewed by 2 independent reviewers, and selected articles were fully analyzed to classify evaluation methods and categorize them by procedure and subspecialty of ORL-HNS involved. Reliability and validity were assessed and scored for each assessment tool. Results Through the review of 30 studies, 5 evaluation methods were described and validated to assess the surgical competency of ORL-HNS residents. The evaluation method most often described was the combined Global Rating Scale and Task-Specific Checklist tool. Reliability and validity for this tool were overall high; however, considerable data were unavailable. Eleven distinctive surgical procedures were studied, encompassing many subspecialties of ORL-HNS: facial plastics, general ear-nose-throat, laryngology, otology, pediatrics, and rhinology. Conclusions Although assessment tools have been developed for an array of surgical procedures, involving most ORL-HNS subspecialties, the use of combined checklists has been repeatedly validated in the literature and shown to be easily applicable in practice. It has been applied to many ORL-HNS procedures but not in oncologic surgery to date. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Work-hour restrictions, increased workload, and subjective assessment of competency are major threats to the efficacy of the traditional apprenticeship model of surgical training in modern surgical practice. In response, medical educators are developing time- and resource-efficient competency-based models of surgical training. The purpose of our project was to develop, implement, and measure the outcomes of such objective and structured programs in otolaryngology. We also investigated factors affecting the learning curve, especially deliberate practice, formative feedback, and learners' autonomy.Study Design: Prospective, longitudinal study.Methods: To measure the surgical skills of residents, we first developed and tested objective tools for otolaryngology procedures. Based on these instruments, we identified milestones of the procedures. Training on a virtual-reality simulator was validated to shorten the learning curve. We also studied a learner-centered approach of training, factors affecting the learning curve, and barriers to a competency-based model.Results: The objective tools were found to be a feasible, reliable, and valid opportunity for measuring competency in both the laboratory and operating room. With the formative assessment from these tools, residents had a remediation target to be achieved by deliberate practice. The milestones helped identify the threshold of competency, and deliberate practice on the simulator gave an opportunity for improving skills. The learner-centered approach allowed flexibility and personalized learning by shifting the responsibility of the learning process to the learners.Conclusion: The competency-based model of residency, based on the principles of deliberate practice and a learner-centered approach, is a feasible model of residency training that allows development of competent surgeons and hence improves patient outcomes. Despite these advantages, challenges to this model require a concerted effort to overcome and fully implement these principles of training beyond just technical skills, ultimately creating well-rounded medical professionals and leaders in the surgical field.Level Of Evidence: N/A. Laryngoscope, 125:S1-S14, 2015. [ABSTRACT FROM AUTHOR]

Study Objective To compare differences in trends in reported surgical experience of residents in obstetrics and gynecology in the United States insofar as abdominal, vaginal, and laparoscopic hysterectomy. Design Retrospective analysis of the national case log reports from the Accreditation Council for Graduate Medical Education (ACGME) for obstetrics and gynecology cases logged as “surgeon” from 2002 to 2012 (Canadian Task Force classification III). Setting AGCME-accredited residency programs in obstetrics and gynecology. Participants Eleven thousand five hundred and eight graduating residents in obstetrics and gynecology (n = 11 508). Measurements and Main Results Since 2008, when the ACGME began reporting the 4-year cumulative hysterectomy case load statistics for graduating residents in obstetrics and gynecology, there has been no significant change in the mean (SD) number of hysterectomies performed by residents from 118.1 (38.0) cases in 2008–2009 to 116.1 (31.0) cases in 2011–2012 (p = .16; 95% confidence interval [CI], −0.78 to 4.78). During the past decade, however, the total number of reported abdominal hysterectomies consistently decreased from 89.1 (34.2) cases in 2002–2003 to 59.1 (21.0) cases in 2011–2012 (28% decrease; p <.001; 95% CI, 27.7–32.3). The number of vaginal hysterectomies also trended down from 34.9 (19.2) cases to 19.4 (9.0) cases (40% decrease; p <.001; 95% CI, 14.3–16.7). The ACGME did not report the number of laparoscopic hysterectomies performed by residents until 2008–2009, when residents reported performing 23.4 (17.0) cases. From 2008 to 2012, this number increased to 38.5 (20.0) cases (72% increase; p <.001; 95% CI, 13.6–16.6). The proportion of reported laparoscopic hysterectomies performed with robotic assistance was not separately reported. Conclusions Although the overall number of hysterectomies reported by residents has remained stable since 2008, the predominant modes of hysterectomy during the past decade have changed substantially, with laparoscopic hysterectomy comprising an increasingly large proportion of resident experience. As laparoscopic hysterectomy has become more common, reported cases of abdominal and vaginal hysterectomies have decreased. Additional statistics on the percentage of laparoscopic hysterectomies performed using robotic assistance would be valuable to additionally analyze the effect of this new technology on resident training. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis This study explores the influence of selected factors on achievement of competency in mastoid surgery. Study Design A prospective study of surgical performance and a retrospective survey of learner and training factors. Methods The longitudinal performance of 15 residents was evaluated using the mastoidectomy task-based checklist (TBC). The influence of surgical experience, resident interest, and training factors (course attendance, voluntary use of simulation laboratory) was also examined and compared for the acquisition of distinct levels of technical skill difficulty (cortical mastoidectomy vs. facial recess). Results Ninety-six observations made during the first otology rotation were analyzed. Cortical mastoidectomy tasks showed positive associations with cumulated case numbers (OR 1.13, CI 1.04-1.23, P = .003) and interest in otology (OR 3.86, CI 1.21-12.27, P = .022). Facial recess tasks showed a larger positive association with interest in otology (OR 10.38, CI 2.25-47.94, P = .003), and negative association with extra time spent in laboratory practice (OR .05, CI 0.011-0.23, P = .000). Conclusions Learning trajectory for cortical mastoidectomy and facial recess may be influenced by different factors. Interest in otology, in particular, may have a moderating effect on the acquisition of more complex skills in mastoid surgery. A negative association between self-directed laboratory simulation and performance may reflect the impact of assessment-guided feedback in promoting deliberate practice. Further investigations are suggested to explore the interactions between individual trainee differences, educational models, and learning outcomes. Level of Evidence N/A. Laryngoscope, 123:3162-3167, 2013 [ABSTRACT FROM AUTHOR]

The article discusses a study on the importance of minimum, mean and maximum case numbers for otolaryngology resident surgical procedures and highlights the weaknesses of the U.S. Accreditation Council for Graduate Medical Education (ACGME) case log system. It informs that surgical case numbers are documented for the ACGME resident case log system. To improve accuracy of reporting, examination of the ACGME resident case log system is needed.

Abstract: Outcomes in pediatric cardiac surgery have improved dramatically since its infancy 40years ago. Mortality has been reduced from as high as 90–100% in the initial years to around 4% for high complexity cases and virtually no mortality for simple cardiac defects. While part of this improvement can be attributed to advances in pediatric cardiac anesthesia, pediatric cardiopulmonary bypass and development of highly specialized pediatric cardiac intensive care units, outcomes continue to depend on the technical quality of the surgical repair. In this article we address the importance of the surgical technical performance on the outcomes and discuss the currently available tools for measurement of surgical competency. Our studies showed that the final technical (anatomical) result score had the strongest association with patient outcomes. We offer suggestions for a competency model that continues to evolve as we explore the use of immersive learning, deliberate practice, reflection in action, mentorship by senior surgeons and lifelong learning. [Copyright &y& Elsevier]

Abstract: Introduction: The assessment of surgical competence is a vital component of the surgical training process, the accreditation of specialists, and the maintenance of public confidence in the surgical profession [Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Assessment of technical surgical skills. Eur J Surg 2002;168:139–44.]. The introduction of the Calman system, the European Working Time Directive, the Hospital at Night project, and financial pressures to increase productivity has nearly halved the surgical case load that trainees are exposed to. With less time to acquire surgical proficiency, surgeons may be insufficiently skilled at completion of training [Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327:1032–7.]. We look at the current methods of assessing surgical competency and what new innovative methods are on the horizon. Methods: A Medline search was performed in April 2005 using the keywords ‘surgical training’, ‘surgical competence’, ‘surgical simulation’ and ‘virtual reality’. Only papers published in English have been cited in this review. Articles were reviewed for relevance, impact within the field, and applicability to the UK training system. Results: A large number of articles explore the potential of training techniques – including wet and dry laboratories, computer simulators and virtual reality trainers – to complement traditional ‘apprenticeship’ surgical training. All of the methods demonstrate the ability to distinguish surgeons of varying competence. Discussion: The advantages of the training methods discussed are many and there is great enthusiasm for introducing skills assessment within a nationally standardised and validated surgical curriculum [Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg 2004;91:1549–58.], as well as using it as an adjunct to traditional methods of training. [Copyright &y& Elsevier]

Objectives/Hypothesis The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. Study Design Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. Methods Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. Results These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation-trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy ( P = .06; P <.05) and surgical confidence ( P = .09; P <.05). In addition, the 3 subjects with the highest overall scores on the competency evaluation also had 3 of the 4 highest cumulative simulation times. Conclusions The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents. [ABSTRACT FROM AUTHOR]

Introduction of an increasingly competence-based Royal Australasian College of Surgeons (RACS) Surgical Education and Training ( SET) programme has influenced the nature and conduct of the Fellowship Examination ( FEX). The FEX is the final summative assessment taken near the completion of SET training, and is aligned to the other SET assessment processes. It mainly tests two of the nine RACS surgical competencies, focusing on professional judgement and the clinical application of knowledge. It is used to help determine whether candidates are safe to practise unsupervised at consultant level. There have been refinements to a number of the processes including standard setting, blueprinting, developing marking descriptors and improving the reliability and validity of the examination. An Examiners' Training Course has also been introduced. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to develop and validate a brief, reliable rating scale to measure resident surgical competency. Study Design: For 12 months, the gynecology faculty at Johns Hopkins Bayview Medical Center completed a prototype global rating scale after each surgery. Concurrently, each resident completed the same assessment form as a self-evaluation. Factor analysis, Cronbach''s α, Pearson correlations, and one-way analysis of variance were used to evaluate internal consistency and validity. Results: Using factor analysis, the assessment form was modified to create the Hopkins Assessment of Surgical Competency (HASC). This contained 2 scales, General Surgical Skills and Case Specific Surgical Skills. The Cronbach''s α ranged from 0.86 to 0.89. The item-scale Pearson correlations ranged from 0.74 to 0.87. Senior residents scored significantly higher than junior residents and last rotation scores were significantly higher than the first. Conclusion: The HASC is a concise, valid, and reliable tool for assessing surgical competency in the clinical setting. [Copyright &y& Elsevier]