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For residents or fellows outside anesthesiology and critical care training programs, formal training in managing critically sick patients does not exist in India either at the undergraduate level, or at postgraduate level. Acute critical care course (ACCC) is a simulation-based skills development course that has been developed indigenously to address this lacuna in training of interns and residents in surgical specialties and emergency medicine in India. This study is aimed to find out and to assess the effectiveness of this course. This is a prospective interventional study using low-fidelity simulation-based courses. As many as 1036 candidates (interns and residents) were trained in 40 ACCC provider courses, and 165 instructor candidates in 9 instructor courses in 16 teaching hospitals in India in 2014–2021. However, in this report, the authors have analyzed the feedback (verbal and written) from 487 candidates of 19 ACCC provider courses conducted in 14 teaching hospitals in India between 2014 and 2018. Analysis of data was performed by thematic analysis for qualitative data and descriptive analysis for quantitative data. All the 487 candidates in 19 courses over 5 years replied either as very good (above expectations) or as good (as per expectations). In response to the question of the effectiveness of a lecture or skill station, none of them chose the options fair (below expectations) or poor (unacceptable). Fifteen out of 18 interns replied their emails that were sent 3 weeks after ACCC to find out if there was an improvement in their clinical application on a scale of 1–10. The response to the question in regards to improvement in their own ability 'to assess a sick patient', 'in treating a sick patient', 'communication skills with a colleague', and 'confidence in breaking bad news to patient or relatives', respectively, was 7.5, 7.8, 8.3 and 8.3. Mean scores out of 5 in response to content of ACCC course for clarity, utility, adequacy of content, understandable and interaction during course were 4.59, 4.81, 4,78, 4.86 and 4.97 respectively. Qualitative analysis led to 5 themes described in the manuscript. Low fidelity simulation using role-play appeals to the adult learners, breaks the monotony of classroom teaching, encourages interactive learning, and facilitates active participation in skill development necessary for critical care training of residents in surgical specialties and in emergency medicine. Sharing the vision document of ACCC with the deans of medical colleges is the crucial step in implementing applied physiology in step-wise logical approach in managing a sick patient. [ABSTRACT FROM AUTHOR]

This study reviews the current state of robotic surgery training for surgeons, including the various curricula, training methods, and tools available, as well as the challenges and limitations of these. The authors carried out a literature search across PubMed, MEDLINE, and Google Scholar using keywords related to 'robotic surgery', 'computer-assisted surgery', 'simulation', 'virtual reality', 'surgical training', and 'surgical education'. Full text analysis was performed on 112 articles. The training program for robotic surgery should focus on proficiency, deliberation, and distribution principles. The curricula can be broadly split up into pre-console and console-side training. Pre-Console and Console-Side Training: Simulation training is an important aspect of robotic surgery training to improve technical skill acquisition and reduce mental workload, which helps prepare trainees for live procedures. The study also discusses the various validated assessment tools used for operative performance assessments. Finally, the authors propose potential future directions for robotic surgery training, including the use of emerging technologies such as AI and machine learning for real-time feedback, remote mentoring, and augmented reality platforms like Proximie to reduce costs and overcome geographic limitations. Standardisation in trainee performance assessment is needed. Each of the robotic curricula and platforms has strengths and weaknesses. The ERUS Robotic Curriculum represents an evidence-based example of how to implement training from novice to expert. Remote mentoring and augmented reality platforms can overcome the challenges of high equipment costs and limited access to experts. Emerging technologies offer promising advancements for real-time feedback and immersive training environments, improving patient outcomes. • Progress in robotic surgery is democratising access. • Training programmes need expansion to produce safe, proficient robotic surgeons. • We review the current landscape of Robotic Surgery training. • We summarise future robotic surgery training practices. [ABSTRACT FROM AUTHOR]

Measuring the surgical learning curve (LC) has potential benefits for patient safety and surgical education. Even though it is known that the learning of a practical skill becomes easier with time, the LC remained underutilized in medicine and surgery for decades. The understanding of the LC amongst surgeons needs to be enhanced in terms of its components, measurement, application, and reporting. This prompted us to review the science behind the learning curve and enrich the existing knowledge and its application in surgical learning and research. Application of knowledge of learning curve can help the surgeons to more rapidly achieve/maintain a high expertise level, improvise outcomes for their patients, and facilitate the investigators to scientifically report, audit, or research the surgical learning/innovations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop a novel live Delphi method to obtain a consensus on the skills and competencies that a new ENT registrar (specialty trainee level 3) should possess. Developing a clear outcome set for core surgical trainees is important so that this phase of training can be directed at specific aims. Method: Attendees at the North of England meeting participated in this Delphi exercise. Participants comprised a range of ENT professionals from medical student to consultant surgeons. The main outcome measure of consensus was defined prior to the study as the median response value: strongly agree or more for positive consensus and strongly disagree or less for negative consensus. Results: This study identified multiple areas that reached consensus relating to elective and operative skills and demonstrated agreement in areas relating to ENT specific and allied specialty experience. Conclusion: This study has highlighted a novel method for shaping surgical curricula. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of information about cardiac surgery training and professional practice in Latin American (LATAM) countries. This study is the first comparative analysis of cardiac surgical training and professional practice across LATAM and provides the fundamentals for future academic projects of the Latin American Association of Cardiac and Endovascular Surgery (LACES). Methods: International survey-based comparative analysis of the training and professional practice of cardiac surgeons across LATAM. Trainees (residents/fellows) and staff (graduated) surgeons from LATAM countries were included. Results: A total of 289 respondents (staff surgeons N=221 [76.5%]; residents/fellows N=68 [23.5%]) from 18 different countries participated in the survey. Most surgeons (N=92 [45.3%]) reported being unsatisfied with their salaries. Most respondents (N=181 [62.6%]) stated that it was difficult to obtain a leadership position, and 149 (73.8%) stated that it was difficult to find a job after completing training. Only half of the trainee respondents (N=32 [47.1%]) reported that their program had all resident spots occupied. Only 22.1% (N=15) of residents/fellows were satisfied with their training programs. The majority (N=205 [70.9%]) of respondents would choose cardiac surgery as their specialty again. Most surgeons (N=129 [63.9%]) and residents/fellows (N=52 [76.5%]) indicated that the establishment of a LATAM cardiac surgery board examination would be beneficial. Conclusion: Modernization and standardization of training, as well as greater access to opportunities, may be required in LATAM to increase professional satisfaction of cardiac surgeons and to reduce disparities in the specialty. Such changes may enhance the regional response to the dynamic challenges in the field. [ABSTRACT FROM AUTHOR]

Over the last 20 years, surgical training in the United Kingdom (UK) has changed dramatically. There have been considerable efforts towards creating a programme that delivers the highest standard of training while maintaining patient safety. However, the journey to improve the quality of training has faced several hurdles and challenges. Recruitment processes, junior doctor contracts, flexible working hours and equality and diversity have all been under the spotlight in recent times. These issues, alongside the extended surgical team and the increasingly recognised importance of trainee wellbeing, mean that postgraduate surgical training is extremely topical. Alongside this, as technology has evolved, this has been incorporated into all aspects of training, from recruitment to simulated training opportunities and postgraduate examinations. The coronavirus (COVID-19) pandemic has brought technology and simulation to the forefront in an attempt to compensate for reduced operative exposure and experience, and has transformed the way that we learn and work. In this article, we reflect on the UK surgical trainee experience and discuss areas of success as well as highlighting potential areas for improvement going forward. [ABSTRACT FROM AUTHOR]

With improvement of healthcare in India, it is now possible for specialty surgical units to become a destination for teaching and training. From a humble beginning of 5 beds in 1972, Ganga Hospital, a specialty centre for trauma, orthopaedics and plastic surgery has now become 600 beds performing 26,000 surgeries per year. In the process, the Plastic Surgery Unit has attracted 2165 surgeons from 70 countries. Indian surgical units have the benefit of numbers, but numbers alone can not get international visitors. Consistent quality outcomes, good documentation and availability of data, transparency in processes are appreciated by the visitors. It has also been found that in addition to the founder, the units must have number of reputed surgeons in the team to attract visitors because the international visitors also have a choice of place to choose and look for value for time and effort. [ABSTRACT FROM AUTHOR]

Superspeciality training and subspecialty developments have become vital in the present era. It helps to gain excellence in patient care, academics, research, and widespread recognition among peers and the community. Selecting a subspecialty is challenging but can be accomplished with perseverance and following some principles. One should be an accomplished surgeon in the concerned superspeciality before deciding to choose a subspecialty. It should be unique, interesting, affordable, and possible in the given setup, having good appeal among masses, and the results should be better or comparable to conventional treatment. Publishing and presentations at appropriate forums are critical. This article details the Jabalpur model for developing a superspeciality and a subspecialty branch with neurosurgery and neuroendoscopy as a prototype. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article is to present an overview of the key medical and surgical specialties most likely relevant to chiropractic practice in the United States. Understanding the similarities and differences in the training and typical practices of these medical providers may enhance a chiropractor's likelihood to collaborate and increase participation in team-based care. Methods: This was a descriptive analysis to develop preliminary content on US medical physician specialties. Selection was informed by the authors' clinical experience with medical collaboration, along with results of previously published work on medical specialties most commonly reported to be involved in referral patterns with US chiropractors. Data from the Accreditation Council for Graduate Medical Education and individual specialty boards were synthesized through an iterative process, and supplemented by qualitative input from subject matter experts. Data were entered into tabular format for review and analysis. Results: We propose that the medical and surgical specialties most relevant to typical US chiropractic practice are internal medicine, family medicine, emergency medicine, physical medicine and rehabilitation, neurology, pain medicine, rheumatology, radiology, orthopedic surgery, and neurological surgery. There is overlap in scope of conditions and diagnostic and therapeutic tools utilized by various medical specialties. Conclusion: This work describes 8 medical and 2 surgical specialties proposed to be most relevant to general chiropractic practice in the United States. The results may have relevance to interprofessional education and collaboration. [ABSTRACT FROM AUTHOR]

The Royal College of Physicians and Surgeons of Glasgow is a community of health professionals working together to develop and improve patient care. The College is dedicated to supporting its members through education, training and continuing professional development. Furthermore, the College is committed to good global citizenship and has supported Fellows, Members and staff in their volunteering efforts. [ABSTRACT FROM AUTHOR]

Objective: To develop a simulator of the external auditory canal and tympanic membrane that enables surgical trainees to practise their otomicroscopy skills, which is particularly valuable at a time where there is limited patient contact because of the coronavirus disease 2019 lockdown. Methods: A simulator of the external auditory canal and tympanic membrane was made using a cardboard bowl, a 2 ml syringe and a latex glove. The simulator was used to practise otomicroscopy skills, including microsuction, foreign body removal, myringotomy and grommet insertion. Five doctors in the ENT department participated, ranging from core surgical training year two doctor to specialty doctor. Results: The simulator provides an effective tool on which surgical trainees can practise, develop and maintain a variety of otomicroscopy skills. Conclusion: This inexpensive, easy and quick-to-make simulator enables trainees to practise their otomicroscopy skills on an approximately accurate model during a time when there is minimal clinical opportunity to develop these skills, particularly because of the coronavirus disease 2019 pandemic. [ABSTRACT FROM AUTHOR]

A majority of surgical patients are prescribed opioids for pain management. Many patients have pre-existing chronic pain managed with opioids and/or opioid use disorders (OUDs), which can complicate perioperative management. Patients who use opioids prior to surgery are at increased risk of developing OUD after surgery. To date, no studies have examined the prevalence of opioid screening and electronic medical record (EMR) documentation prior to surgery. A 40-item survey was administered to 268 patients at their first postoperative care visit at a single tertiary academic center from October 2017 to July 2018. A chart review of a random sample of 100 patients was performed to determine provider opioid screening prevalence in the presurgical setting. Log-binomial models were used to calculate prevalence ratios (PRs) to determine the provider role (surgeon, advanced practice clinicians [APC], surgical trainee) association with opioid screening documentation. Exploratory qualitative interviews were conducted with surgical providers to identify barriers to screening and screening documentation. Only 7% of patients were screened preoperatively for opioid use. A total of 38% of patients self-reported that they had used opioids in the past year. Of that group, only 3% had screening by a surgical provider prior to surgery documented in their EMR. Provider role was not associated with likelihood of opioid screening (surgeon versus trainee, PR = 1.2, 95% CI 0.2-8.5) (surgeons versus APCs, PR = 1.05, 95% CI 0.17-8.53). EMRs were discordant with patient survey results for patients with no ICD-10 codes for opioid use. The most common perceived barriers to preoperative screening were insufficient clinic time; logistics of who should screen/not required as part of their clinical workflow; not perceiving screening as a priority; and lack of expertise in the area of chronic opioid use and OUD. Preoperative screening for opioid use is uncommon, and EMRs are often discordant with patient self-reported use. Efforts to increase preoperative screening will need to address barriers screening practices and increasing health system support by incorporating screening into the clinical workflow and adding it to documentation templates. [ABSTRACT FROM AUTHOR]

Introduction: In China, although burn treatment develops rapidly, and ranks in the forefront of the world, there is a relative shortage of burn specialists, which limits the development of burn education. In traditional curriculum of surgery education, burn surgery education accounts for few proportions, which results in the indifference to the burn surgery among medical students. To date, few research reported the application of Clinical pathway- Problem based Learning (CP-PBL) in burn surgery education. The objective of the study is to explore the teaching effect of this novel teaching method in burn surgery education.Methods: A pilot study was performed. One hundred and six students were randomly divided into a Lecture based Learning (LBL) only group (control group) and a LBL combined Clinical pathway- Problem based Learning group (observation group). A set of test was designed as evaluation criteria based on questions of burn surgery in National Medical Licensing Examination (NMLE) from 2011 to 2018.Results: The students with Clinical pathway- Problem based Learning had better academic performances in profession theory. Type A2 and Type A3/A4 scores in the observation group were higher than those in the control group (p < 0.05). The scores of the observation group were higher than those of control group in the domains of understanding and application (p < 0.05). They also have higher favorable impressions of learning experience.Conclusions: More active approaches yield more learning and are viewed more favorable, which provides a vital message for the evolution of curriculum in Chinese medical schools. [ABSTRACT FROM AUTHOR]

Objectives: Standard interviews are used by most residency programs to assess non-cognitive skills, but variability in the interviewer's skills, interviewer bias, and context specificity limit reliability. We sought to investigate the consistency and satisfactoriness of the multiple mini-interview (MMI) model for resident selection into an otorhinolaryngology head and neck surgery residency program. Methods: This pilot study was done in an independent academic residency training center for 15 applicants, in seven eight-minute MMI stations with eight raters for the 2015-2016 academic year. The raters included the chief resident and education committee chairman in one of the stations. Candidates were assessed on two items: medical knowledge (two standardized case scenarios) and behavioral knowledge (personality and attitude, professionalism, communication, enthusiasm to the specialty, and English proficiency). Results: Of 15 candidates, 10 (66.7%) were female and five (33.3%) were male; five were recommended for selection, and five were kept on the waiting list. The reliability, intraclass correlation coefficient (ICC), of the scores obtained from seven items of MMI was 0.36 (95% confidence interval (CI): -0.31-0.75; p = 0.110). However, the ICC of the medical interview was 0.54 (95% CI: 0.45-0.84; p = 0.090). The correlation between behavioral items score and MMI total score was r = 0.135 (p = 0.150). Conclusions: The interview evaluation/survey form given to candidates and interviewers has shown that MMI is a fair and effective tool to evaluate non-cognitive traits. Both candidates and interviewers prefer MMI to standard interviews. The MMI process for residency interviews can generate reliable interview results using only seven stations and is acceptable and preferred over standard interview modalities by residency program applicants and faculty members. [ABSTRACT FROM AUTHOR]

Background: There is a wide chasm in access to essential and emergency surgery between high and low/middle income countries (LMICs). Surgeons worldwide are integral to solutions needed to address this imbalance. Involving surgical trainees, who represent the future of surgery, is vital to this endeavour. The Association of Surgeons in Training (ASiT) is an independent charity that support surgical trainees of all ten surgical specialties in the UK and Ireland. ASiT convened a consensus meeting at the ASiT conference in Liverpool 2016 to discuss trainee engagement with global surgery, including potential barriers and solutions.Methods: A face-to-face consensus meeting reviewed the engagement of, and roles for, surgical trainees in global surgery at the ASiT Conference (Liverpool, England), March 2016. Participants self-identified based on experience and interest in the field, and included trainees (residents and students) and consultants (attending grade). Following expert review, seven pre-determined core areas were presented for review and debate. Extensive discussion was facilitated by a consultant and a senior surgical trainee, with expertise in global surgery. The draft derived from these initial discussions was circulated to all those who had participated, and an iterative process of revision was undertaken until a final consensus and recommendations were reached.Results: There is increasing interest from trainee surgeons to work in LMICs. There are however, ethical considerations, and it is important that trainees working in LMICs undertake work appropriate to their training stage and competencies. Visiting surgeons must consider the requirements of the hosting centres rather than just their own objectives. If appropriately organised, both short and long-term visits, can enable development of transferable clinical, organisational, research and education skills. A central repository of information on global surgery would be useful to trainees, to complement existing resources. Challenges to trainees considering a global surgery placement include approval for placements while on a training program, financial cost and dangers inherent in working in a resource poor setting. Currently global surgery experience is generally as an out of program experience and does not count for certificate of completion of training (CCT). Methods to recognise surgical trainee global surgery experience as an integrated part of training should be explored, similar to that seen in other specialties.Conclusion: There is a role for surgical trainees to become involved in Global Surgery, especially in partnership with local surgeons and with appropriate ethical consideration. Trainees develop translational skills in resource poor settings. Development of appropriate pathways for recognition of global surgery experience for CCT should be considered. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS).Methods: 15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups.Results: Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p = 0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score.Conclusion: Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills. [ABSTRACT FROM AUTHOR]

Introduction The success of modern pediatric surgery (PS) management has led to the recommendation of regional organization and coordination of PS departments. Although small units may obtain excellent results, there is evidence that a concentration to larger units is advantageous. In France, the centralization of PS has been discussed for the past 15 years. A neworganizationwas finally achieved in 2010. The intent was to assure children prompt access to the level of care appropriate to the degree of their pathologies to improve the outcomes and reduce morbidity and mortality. Methods One of the first pertinent governmental measures was an attempt to centralize the PS departments and encourage the development of connection between specialized PS care and routine PS unit. In this review, we report this coordination through the analysis inside two regional French areas. Results Paris is the first example that illustrates the network between four specialized PS departments and eight local hospitals. Theaimof this connectionwas to improve the safety and quality of pediatric surgical management during the night for emergency issues and in the case of neonatology. The second example is the network that coexists in the west part of France through monthly video conferencing sessions and subspecialization (pediatric urology, pediatric oncology, and pediatric liver surgery). Moreover, a national program aimed at improving the management of patients with rare diseases since 2005. For instance, biliary atresia and anorectal malformation centers are located in two academic centers in Paris and the esophageal atresia center is in Lille. These expert centers allowed performing numerous studies along with international publications, thereby offering a better vision of the natural story of diseases to improve care. Finally, this network is emphasized during medical education from PS residency to the fellowship when trainees have to spend at least 1 year in a local hospital. Conclusion The European legislation calls for multidisciplinary centers treating children with rare diseases and proposes clear and demanding quality criteria. The French experience illustrates some interesting and encouraging aspects of the current trends in PS care. Our results strongly suggest that centralization, specialization, and connections between specialized and routine PS departments can greatly improve management of and outcomes in children treated in our units. [ABSTRACT FROM AUTHOR]

Background:The study investigated whether 3D vision and haptic feedback in combination in a virtual reality environment leads to more efficient learning of laparoscopic skills in novices. Material and methods:Twenty novices were allocated to two groups. All completed a training course in the LapSim®virtual reality trainer consisting of four tasks: ‘instrument navigation’, ‘grasping’, ‘fine dissection’ and ‘suturing’. The study group performed with haptic feedback and 3D vision and the control group without. Before and after the LapSim®course, the participants’ metrics were recorded when tying a laparoscopic knot in the 2D video box trainer Simball®Box. Results:The study group completed the training course in 146 (100–291) minutes compared to 215 (175–489) minutes in the control group (p = .002). The number of attempts to reach proficiency was significantly lower. The study group had significantly faster learning of skills in three out of four individual tasks; instrument navigation, grasping and suturing. Using the Simball®Box, no difference in laparoscopic knot tying after the LapSim®course was noted when comparing the groups. Conclusions:Laparoscopic training in virtual reality with 3D vision and haptic feedback made training more time efficient and did not negatively affect later video box-performance in 2D. [ABSTRACT FROM PUBLISHER]

The medical profession continues to learn about the ways in which simulations can help to improve education and training. In addition, simulation is constantly evaluated regarding the many ways it can help to improve the abilities of surgeons throughout their course of training and practice. The goal of this study is to review the importance of reflection on clinical practice in situating surgeons as lifelong learners and explore the role that simulation can play in that process. As surgical trainees work to acquire basic necessary skills, simulations are often used to help new learners with such things as knowledge of procedural steps and development of psychomotor techniques. However, the following is an important question: can simulated procedures still play a role for more advanced learners to continue their professional development beyond the basics? [ABSTRACT FROM AUTHOR]

Tulane graduates have, over the past six years, chosen general surgical residency at a rate above the national average (mean 9.6% vs 6.6%). With much of the recent career choice research focusing on disincentives and declining general surgery applicants, we sought to identify factors that positively influenced our students' decision to pursue general surgery. A 50-question survey was developed and distributed to graduates who matched into a general surgery between the years 2006 and 2014. The survey evaluated demographics, exposure to surgery, and factors affecting interest in a surgical career. We achieved a 54 per cent (61/112) response rate. Only 43 per cent considered a surgical career before medical school matriculation. Fifty-nine per cent had strongly considered a career other than surgery. Sixty-two per cent chose to pursue surgery during or immediately after their surgery clerkship. The most important factors cited for choosing general surgery were perceived career enjoyment of residents and faculty, resident/faculty relationship, and mentorship. Surgery residents and faculty were viewed as role models by 72 and 77 per cent of responders, respectively. This study demonstrated almost half of those choosing a surgical career did so as a direct result of the core rotation experience. We believe that structuring the medical student education experience to optimize the interaction of students, residents, and faculty produces a positive environment encouraging students to choose a general surgery career. [ABSTRACT FROM AUTHOR]

Background: Surgical and anatomical training has been found to be most optimally simulated in a cadaver than any other available methods. Soft embalming methods have made the bodies more 'lifelike' and better suited for training. The widely accepted soft embalming techniques, including Thiel embalming, are designed for temperate climates. Their use in tropical locations has been found to be associated with poor short-term and long-term preservation of the bodies. In fact, adequate reports from tropical countries on effective methods for soft embalming are lacking. Materials and Methods: This article details the modifications made in the Thiel embalming technique over a period of 2 years which has enabled us to preserve the anatomical features of bodies in an optimal way for longer periods in tropical conditions. This study was carried out in a tertiary care referral centre located in a tropical climate zone. A total of 13 frozen and thawed cadavers were used over a period of 2 years for developing such soft embalming technique. The efficacy of the technique was tested using these cadavers for varying types of surgical exercises on multiple occasions. Results: The conventionally described technique of Thiel embalming did not provide desired results. Hence, various modifications to this technique were instituted which helped us to get superior quality of soft-embalmed cadavers. In the final year, these cadavers were used successfully for workshops in flap dissection. Head and neck access surgery, arthroscopic and laparoscopic procedures as well as mock face and hand transplant dissections. Conclusions: The Theil embalming technique for obtaining soft embalmed cadavers, even though found to be best in many centres in the world, has not been found to be suitable to tropical weather. By modifying it, we have succeeded in developing a technique suitable to the tropical weather. This technique yields cadavers suitable for various surgical simulation exercises. This technique also allows the body to be optimally used over several months in multiple occasions. These modifications are very simple and have been described in detail enabling it to be adopted by any surgical skill laboratory in the tropical countries. [ABSTRACT FROM AUTHOR]

Purpose: To confirm the safety and feasibility of single-incision laparoscopic surgery (SILS) and to compare the patient outcomes of single-incision laparoscopic surgery for laparoscopic appendectomy (SILS-LA) performed by resident doctors vs. staff surgeons. Methods: We performed a retrospective analysis of patients who underwent SILS between May, 2009 and May, 2015 at Osaka Police Hospital. Results: We analyzed 2172 patients. The operations performed consisted of cholecystectomy ( n = 598), appendectomy ( n = 202), inguinal hernia repair ( n = 301), colorectal surgery ( n = 673), and gastrectomy ( n = 398). SILS was performed safely for a wide range of procedures with acceptable conversion and perioperative complication rates. The resident doctors in our department operated safely on 77 % (156/202) of patients undergoing SILS-LA. The staff surgeons operated on more elderly patients and patients with complicated appendicitis than did the resident doctors. The operative outcomes of the resident-performed SILS-LAs were better than those of the staff surgeons, although there was a patient selection bias. Conclusions: SILS seems safe and feasible for a wide range of procedures. Based on our findings, we believe that SILS-LA could be a useful teaching procedure for resident doctors to perform on selected patients, under the guidance of an experienced staff surgeon. [ABSTRACT FROM AUTHOR]

Purpose: Comparison of the rates of posterior capsule rupture (PCR) associated with conventional versus a reverse method of teaching phacoemulsification. Methods: Trainees were taught conventional (start to finish) phacoemulsification beginning with an incision (tunnel construction) to capsulorhexis, sculpting, nucleus cracking, segment removal, cortex aspiration, intraocular lens implantation, and viscoelastic removal. In the reverse method, after incision and capsulorhexis, the trainees were progressively taught viscoelastic wash, cortex aspiration, segment removal, nucleus cracking, sculpting, and intraocular lens implantation. Trainees from a Tertiary Eye Care Centre were classified as "beginners," for their first 30 cases and then "trainees" for their next 70 surgeries. Data were collected on posterior capsular rent and vitreous loss during each step of training. Results: Thirty two ophthalmic surgeons learning phacoemulsification surgery on 609 cataracts cases were supervised by 3 trainers. Fifteen beginners performed 287 surgeries using the conventional method, and 17 beginners performed 322 surgeries with the reverse method. The incidence of PCR was 18/287 (6.2%) with the conventional method and 15/322 (4.6%) with the reverse method (P = 0.38). PCR occurred during cortex aspiration (8/287, 2.8%) and segment removal (5/287, 1.7%) in the conventional method. PCR occurred during nucleus cracking, segment removal, and cortex aspiration (4/322 surgeries for each step, 1.2%). In the follow, 70 cases (trainees) there was no difference in PCR with either method (4.7% vs. 4.3%, P = 0.705). Conclusion: Conventional and reverse method for training phacoemulsification were both safe in a supervised setting. [ABSTRACT FROM AUTHOR]

Background Three-dimensional printing (3DP) is gaining increasing recognition as a technique that will transform the landscape of surgical practice. It allows for the rapid conversion of anatomic images into physical objects, which are being used across a variety of surgical specialties. It has been unclear which groups are leading the way in coming up with novel ways of using the technology and what specifically the technology is being used for. The aim of this article was to review the current applications of 3DP in modern surgical practice. Materials and methods An electronic search was carried out in MEDLINE, EMBASE, and PsycINFO for terms related to 3DP. These were then screened for relevance and practical applications of the technology in surgery. Results Four hundred eighty-eight articles were initially found, and these were eventually narrowed down to 93 full-text articles. It was determined that there were three main areas in which the technology is being used to print: (1) anatomic models, (2) surgical instruments, and (3) implants and prostheses. Conclusions Different specialties are at different stages in the use of the technology. The costs involved with implementing the technology and time taken for printing are important factors to consider before widespread use. For the foreseeable future, this is an exciting and interesting technology with the capacity to radically change health care and revolutionize modern surgery. [ABSTRACT FROM AUTHOR]

Venous insufficiency is a common, chronic disease that affects nearly half of the population in highly developed countries. The vast majority of affected patients suffer from varicose veins (VV). Recently, the priority in medicine has been patient satisfaction with treatment and high quality of life. Therefore, disease-specific questionnaires that measure quality of life have been developed. One of these is VEINES-QOL/Sym with two subscales that assess quality of life and disease symptoms. To date, it has been used to examine patients with venous ulcers and thrombosis. No data are available concerning the use of VEINES to assess patients after VV surgery. The aim of the study was to investigate the change in QOL after VV surgery and verify the usefulness of VEINES in daily phlebological practice. Material and methods. The study recruited 69 patients (CEAP class C2-C3) in need of surgery for VV. The patients responded 2 hours before surgery and after 3 months. Patients were differentiated into several categories according to CEAP stage, age, sex, BMI, the use/lack of compression therapy, and education level. Results. The quality of life increased significantly in C3 patients and in patients over the age of 50. Quality of life increased significantly in all patients regardless of education. There were no differences between groups differentiated according to sex, the use or lack of compression therapy, or BMI. Conclusions. The VEINES-QOL/Sym questionnaire can be used in daily phlebological practice to assess patients before and after surgical treatment of VV. VEINES-QOL/Sym is reliable and highly valid. [ABSTRACT FROM AUTHOR]

Background: It has previously been shown that short, pre-operative practice with a simulator, box trainer, or certain video games can temporarily improve one's basic laparoscopic skills; the so-called warm-up effect. In this experiment, we tested the hypothesis that Underground video game made for training basic laparoscopic skills, can also be used for a pre-operative warm-up. Materials and methods: 29 laparoscopic experts were randomized into two different groups, which were tested on two different days. Group 1 ( n = 16) did a laparoscopic skill baseline measurement using the FLS peg transfer test and the Top Gun cobra rope drill on day 1, and did the same tests on day 2 after a 15 min session with the Underground game. Group 2 ( n = 13) did the same, but started with the video game, followed by baseline measurement on day 2. This way, each participant served as its own control. Video recordings of both tasks were later analyzed by two blinded reviewers. Results: On day 1, group 2 was 14.33 % ( P = 0.037) faster in completing the peg transfer test. A trend toward better cobra rope scores is also seen. When comparing the average improvement between both days, group 1-which used the game as a warm-up on day 2-showed a 19.61 % improvement in cobra rope score, compared to a 0.77 % score decrease in group 2 ( P = 0.002). Conclusions: This study shows that the Underground video game can be used as a pre-operative warm-up in an experimental setting. [ABSTRACT FROM AUTHOR]

The article presents a speech by Jan Gielis, former president of the European Association for Cardio-Thoracic Surgery (EACTS)., delivered at the 28th annual meeting of EACTS, held in Milan, Italy on October 11-15, 2014. Topics of the speech included cardio-thoracic surgery, leadership in the surgical practice, and the need for collaboration between cardiothoracic surgeons.

Background Training in basic laparoscopic skills can be undertaken using traditional methods, where trainees are educated by experienced surgeons through a process of graduated responsibility or by simulation-based training. This study aimed to assess whether simulation trained individuals reach the same level of proficiency in basic laparoscopic skills as traditional trained participants when assessed in a simulated environment. Methods A prospective study was undertaken. Participants were allocated to one of two cohorts according to surgical experience. Participants from the inexperienced cohort were randomized to receive training in basic laparoscopic skills on either a box trainer or a virtual reality simulator. They were then assessed on the simulator on which they did not receive training. Participants from the experienced cohort, considered to have received traditional training in basic laparoscopic skills, did not receive simulation training and were randomized to either the box trainer or virtual reality simulator for skills assessment. The assessment scores from different cohorts on either simulator were then compared. Results A total of 138 participants completed the assessment session, 101 in the inexperienced simulation-trained cohort and 37 on the experienced traditionally trained cohort. There was no statistically significant difference between the training outcomes of simulation and traditionally trained participants, irrespective of the simulator type used. Conclusions The results demonstrated that participants trained on either a box trainer or virtual reality simulator achieved a level of basic laparoscopic skills assessed in a simulated environment that was not significantly different from participants who had been traditionally trained in basic laparoscopic skills. [ABSTRACT FROM AUTHOR]

Education in the knowledge, skills, and attitudes necessary for a surgeon to perform at an expert level in the operating room, and beyond, must address all potential cognitive and technical performance gaps, professionalism and personal behaviors, and effective team communication. Educational strategies should also seek to replicate the stressors and distractions that might occur during a high-risk operation or critical care event. Finally, education cannot remain fixed in an apprenticeshipmodel of "See one, do one, teach one," whereby patients are exposed to the risk of harm inherent to any learning curve. The majority of these educational goals can be achieved with the addition of simulation-based education (SBE) as a valuable adjunct to traditional training methods. This article will review relevant principles of SBE, explore currently available simulationbased educational tools for pediatric surgeons, and finally make projections for the future of SBE and performance assessments for pediatric surgeons. [ABSTRACT FROM AUTHOR]

Abstract: Background: The field of global health is rapidly expanding in many medical centers across the US. As a result, medical students have increasing opportunities to incorporate global health experiences (GHEs) into their medical education. Ethics is a critical component of global health curricula, yet little literature exists to direct the further development of didactic training. Therefore, we sought to define ethical encounters experienced by medical students participating in short-term surgical GHEs and create a framework for the design of ethics curriculum specific to global surgery. Materials and methods: Emory University Departments of Surgery, Urology, and Anesthesia, in partnership with the non-profit organization Project Medishare, have taken annual humanitarian surgical trips to Hinche, Haiti. All medical students returning from the trips in 2011 and 2012 received a 35-question survey to assess demographic data, extent of prior ethics education, frequency of exposure and situational confidence to ethical subject matter, as well as ethical conflicts involved in surgical GHEs. The same comparative data were also collected for domestic clinical clerkships. Results: Seventeen out of 21 medical students completed the survey. Nearly all (88.3%) students had previous formal ethics training as an undergraduate or in medical school. Ethical issues were commonly encountered during domestic clinical encounters and volunteerism. However, students reported enhanced exposure to the professional obligation of surgeons (P = 0.025) and truth-telling/surgeon–patient relationships (P = 0.044) during surgical volunteerism. Despite increased exposure, situational confidence did not change. Conclusions: Ethical issues are commonly confronted during GHEs in surgery and differ from domestic clinical encounters. Healthcare ethics curriculum should be designed to meet the needs of medical students involved in global health. [Copyright &y& Elsevier]

Simulation training involves reproducing the management of real patients in a risk-free environment. This study aims to assess the use of simulation training in the management of acutely ill patients for those in second year oral and maxillofacial surgery dental foundation training (DF2s). DF2s attended four full day courses on the recognition and treatment of acutely ill patients. These incorporated an acute life-threatening events: recognition and treatment (ALERT™) course, simulations of medical emergencies and case-based discussions on management of surgical inpatients. Pre- and post-course questionnaires were completed by all candidates. A maximum of 11 DF2s attended the course. The questionnaires comprised 1-10 rating scales and Likert scores. All trainees strongly agreed that they would recommend this course to colleagues and all agreed or strongly agreed that it met their learning requirements. All DF2s perceived an improvement in personal limitations, recognition of critical illness, communication, assessing acutely ill patients and initiating treatment. All participants felt their basic resuscitation skills had improved and that they had learned new skills to improve delivery of safety-critical messages. These techniques could be implemented nationwide to address the more complex educational needs for DF2s in secondary care. A new benchmark for simulation training for DF2 has been established. [ABSTRACT FROM AUTHOR]

Objective: Contributing to medical practice in developing countries has become increasingly prevalent. Primary care and preventative health initiatives have been most visible, although attention has recently shifted to surgical disease, which represents a large burden in resource-poor settings. Typically dominated by individual efforts, there is now a more concerted approach, with surgical care being included in the comprehensive primary health care plan set by the World Health Organization. Although ethical dilemmas in international surgery have been discussed sporadically in the context of specific missions from the visiting surgeon/team perspective, we are missing a comprehensive evaluation of these issues in the literature. Here we have chosen to systematically categorize ethical issues confronted while teaching and operating in a developing country into 2 broad categories: venue (i.e., host) and visitor related. Methods: For each category, topics within follow an ordinal sequence that one might use when designing a surgical education mission. Illustrative examples are provided, as well as a depiction of the ethical principles or theories involved. Results and Conclusions: This article provides a discussion written from visiting and host surgeon perspectives on diverse ethical challenges for which there is limited literature, including location selection, unmet needs at home, role of sponsors, and personal gain. In addition to candid discussion and a solutions-focused approach, the reader is provided with an “ethical checklist” for international surgical education, akin to the World Health Organization surgical safety checklist, to serve as a framework for the design of surgical missions that avoid ethical pitfalls. • Peer-Review Article [ABSTRACT FROM AUTHOR]

BACKGROUND: The goals of this study were to (1) determine the extent of preclerkship surgical participation in American medical colleges; (2) examine policies regarding such surgical participation; and (3) elicit medical school administrators' perceptions about such exposure. METHODS: Surveys were sent to 128 accredited medical schools (1 administrator each). The 54 (42%) replies were analyzed using descriptive statistics and Student's t tests, with significance defined as a P value of < .05. RESULTS: Of the respondents, 55.6% did not permit student surgical participation. Only 22.2% of responding institutions offered preclerkship surgical skills electives. Administrators from the former group of schools perceived significantly greater risk (P = .001) to patient safety with student surgical participation than did administrators at schools permitting such participation, even though no respondents reported malpractice or worker's compensation cases arising from student participation. CONCLUSIONS: Medical students have limited opportunities for preclerkship surgical participation at most American medical institutions, possibly because of unsubstantiated concerns for patient safety. [ABSTRACT FROM AUTHOR]

Summary: A major key to increasing the safety of cranial surgery is a thorough understanding of anatomy. The anatomy of the head is of fundamental interest to dental and medical students early in their studies. Clinically, it is mostly relevant to surgeons who are performing interventions and reconstruction in the maxillofacial region, skull base, and the orbit. However, the level of appropriate anatomical knowledge necessary for general and special medical and surgical practice is still under discussion. This study maps the significant areas and structures of the head that are not normally accessible during dissection courses because of time and difficulties involved in the preparation. The detailed photodocumentation enriched by diagrams provides a view of structures until now only partially documented. Three parasympathetic ganglia are located in hardly accessible areas of the head – inside the orbit, infratemporal fossa, and in the pterygopalatine fossa. No detailed photographs have been found in current anatomical textbooks and atlases in relation to the morphology of fibers (roots) connected to the ciliary, otic, and pterygopalatine ganglia. Therefore, this study focused on the detailed display of sensory, sympathetic, and parasympathetic roots of ganglia to provide relevant photodocumentation and an improvement in human anatomy teaching. This study also confirms that cadaver dissection provides an excellent opportunity for the integration of anatomy and clinical medicine into the early clinical training of undergraduate dental and medical students. We believe this article, because of the details mentioned above, will be beneficial not only for the future anatomical undergraduate but also for postgraduate education. [Copyright &y& Elsevier]

Abstract: Background: All orthopaedic and trauma surgeons attend educational events throughout their careers. Many surgeons find that when they return to practice they are unable to put into effect those things that they have learned. Methods: This study focussed on 708 surgeons from 2 different cultural backgrounds (developed and developing world) who attended 7 separate trauma Educational events. Surgeons were contacted by e-mail at least 6 weeks after the event and asked if they had encountered any Barriers, which had prevented them from putting into practice what they had learned at the event. If Barriers had been encountered they were asked to categorize them and state if they were able to overcome them. Results: Barriers affect nearly every learner and learners are usually unable to overcome them. The study identified what barriers exist for implementation of acquired knowledge, how they vary with the degree of experience of the surgeon and his or her cultural background. Conclusion: The commonest barrier amongst all surgeons is not having contact with a suitable patient to treat with their new knowledge and skills. Inability to get access to equipment and facilities is a major barrier for many surgeons especially in the developing world. This has profound implications for organizers of educational events that will need to incorporate strategies into their educational planning to help surgeon learners avoid or overcome barriers. [Copyright &y& Elsevier]

Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the science of choreography has been applied to a surgical procedure. By analogy, the surgical team, including anesthetists, surgeons, nurses, and technicians, constitutes a complete ensemble, whose physical actions and interactions constitute the 'performance of surgery.' There are very specific 'elements' (tools) that are basic to choreography, such as space, timing, rhythm, energy, cues, transitions, and especially rehearsal. This review explores whether such a metaphor is appropriate and the possibility of applying the science of choreography to the surgical team in the operating theater. [ABSTRACT FROM AUTHOR]

OBJECTIVES∙To evaluate the benefit of a skills laboratory based training programme to urology resident training by end-user assessment. SUBJECTS AND METHODS∙All participants in a urological skills workshop programme conducted at the Royal Australasian College of Surgeons in Melbourne, Australia, between 2004 and 2009 were included.∙This was a retrospective review using a structured questionnaire.∙Topics regarding course organization, content, delivery and relevance to clinical practice were examined.∙Free-text entry responses allowed participants to elaborate on specific points as appropriate. RESULTS∙During the study period, 35 individual workshops were conducted.∙In all, 41 of 43 eligible participants completed the survey for a response rate of 95%.∙Overall, 26 (63%) found the experience valuable, interesting and useful.∙Of the remainder (37%), four (10%) found it interesting but not useful to training, five (12%) found it useful and a good idea but not well conducted, and two (5%) found it neither interesting nor useful for training.∙Workshop success was intimately related to the quality of the simulator or model used: highly rated workshops consistently used models that were 'realistic' and 'lifelike', while poorly rated workshops were associated with models considered 'impossible' and 'not tested'. CONCLUSIONS∙The use of skills laboratory based workshops can enhance the surgical training of urology residents, at least as assessed by the end-users themselves.∙However, closer attention to the selection and use of properly tested and validated models may maximize the educational opportunity.∙Translational research prospectively examining the impact of workshops on live patient surgery and outcomes is still required. [ABSTRACT FROM AUTHOR]

Background: Our appreciation for the increased role of simulation in surgical education has led us to develop a simulator for effective training of fundamental invasive thoracic skills. Materials and Methods: Study subjects were fourth year medical students (MS-4, n = 6) rotating on a surgery clerkship, and surgical interns (PGY-1, n = 6). All subjects completed demographic surveys and rated their comfort level performing the thoracic skills. A computerized instructional module was given to all participants. Additionally, interns attended a boot camp with didactics, live demonstrations, and supervised practice sessions. Subjects were asked to perform a thoracentesis and insert a chest tube on the models, repetitively, during three sessions, and their skills were rated. Participants were asked to rate their comfort levels performing the procedure before and after the sessions. Results: Interns reported a greater exposure to surgery (9.7 ± 3.2 wk versus 6 ± 1.8 wk; P = 0.03). Although interns were initially faster, operative times were comparable by the third session. Initially, technical skill ratings for thoracentesis were significantly lower in the MS-4 group (P < 0.03). The scores significantly increased by the final simulation (P ≤ 0.04), and were similar to the PGY-1 skill ratings. Significant improvement with chest tube placement each week (P ≤ 0.05), resulted in scores comparable to the intern group as well. Both groups reported higher comfort levels after the simulation sessions. Conclusions: Our simulation trainers were effective educational tools for fundamental thoracic procedures. Our study demonstrates improved technical skill and higher comfort levels with the simulated procedures. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a novel educational curriculum using a simulation teaching laboratory improves resident knowledge, comfort with, and surgical performance of hysteroscopic sterilization.Design: An educational prospective, pretest/posttest study.Setting: The Montefiore Institute of Minimally Invasive Surgery Laboratory. PATIENT(S)/SUBJECT(S): Thirty-four OB/GYN residents in an academic medical center.Intervention(s): Hysteroscopic sterilization simulation laboratory and a brief didactic lecture.Main Outcome Measure(s): Differences in scores on validated skill assessment tools: Task specific checklist, Global Rating Scale (GRS), pass fail assessment, and a multiple-choice examination to evaluate knowledge and attitude.Result(s): In the entire cohort improvements were observed on all evaluation tools after the simulation laboratory, with 31% points (SD+/-11.5, 95% confidence interval [CI] 27.3-35.3) higher score on the written evaluation; 63% points (SD+/-15.7, 95% CI 57.8-68.8) higher score on the task specific checklist; and 54% points (SD+/-13.6, 95% CI 48.8-58.3) higher score on the GRS. Higher PGY status was correlated with better pretest performance, but was not statistically significant in posttest scores. Residents reported an improvement in comfort performing the procedure after the laboratory.Conclusion(s): Simulation laboratory teaching significantly improved resident knowledge, comfort level, and technical skill performance of hysteroscopic sterilization. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine 2-year performance retention and certification exam pass rate after completion of a proficiency-based fundamental laparoscopic skills (FLS) curriculum and subsequent interval training. Methods: Surgery residents (postgraduate year [PGY]1–5, n = 91) were enrolled in an Institutional Review Board approved protocol. All participants initially underwent proficiency-based training on all 5 FLS tasks. Subsequently, available residents were enrolled every 6 months in an ongoing training curriculum that included retention tests on tasks 4 and 5, with mandatory retraining to proficiency if the proficiency levels were not achieved. The final retention test included the actual FLS certification examination for PGY4–5 trainees. Results: A 96% participation rate was achieved for all curricular components during the 2-year study period (PGY3–5, n = 33). Skill retention at retention 1–4 was 83%, 94%, 98%, and 91% for task 4 and 85%, 95%, 96%, and 100% for task 5, respectively. All PGY4–5 (n = 20) residents passed the FLS certification examination, achieving 413 ± 28 total score on the skills portion (passing score ≥270) and demonstrating 92% retention for all 5 tasks. Conclusion: Proficiency-based training with subsequent ongoing practice results in a very high level of skill retention after 2 years and uniformly allows trainees to pass the FLS certification examination. [Copyright &y& Elsevier]

Purpose: Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique. We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students, and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy. Materials and Methods: A total of 20 medical students underwent a 1-hour didactic session with video demonstration of laparoscopic suturing and knot tying by an expert laparoscopic surgeon. The students were randomized to a pelvic trainer (10) or virtual reality simulator (10) for a minimum of 2 hours of laparoscopic suturing and knot tying training. Within 1 week of the training session the medical students performed laparoscopic closure of a 2 cm cystotomy in a porcine model. Objective structured assessment of technical skills for laparoscopic cystorrhaphy was performed at the procedure by laparoscopic surgeons blinded to the medical student training format. A video of the procedure was evaluated with an objective structured assessment of technical skills by an expert laparoscopic surgeon blinded to medical student identity and training format. The medical students completed an evaluation questionnaire regarding the training format after the laparoscopic cystorrhaphy. Results: All students were able to complete the laparoscopic cystorrhaphy. There was no difference between the pelvic trainer and virtual reality groups in mean ± SD time to perform the porcine cystorrhaphy at 40 ± 15 vs 41 ± 10 minutes (p = 0.87) or the objective structured assessment of technical skills score of 8.8 ± 2.3 vs 8.2 ± 2.2 (p = 0.24), respectively. Bladder leak occurred in 3 (30%) of the pelvic trainer trained and 6 (60%) of the virtual reality trained medical student laparoscopic cystorrhaphy procedures (Fisher exact test p = 0.37). The only significant difference between the 2 groups was that 4 virtual reality trained medical students considered the training session too short compared to none of those trained on the pelvic trainer (p = 0.04). Conclusions: There is no significant difference between the pelvic trainer and virtual reality trained medical students in proficiency to perform laparoscopic cystorrhaphy in a pig model, although both groups require considerably more training before performing this procedure clinically. The pelvic trainer training may be more user-friendly for the novice surgeon to begin learning these challenging laparoscopic skills. [Copyright &y& Elsevier]

Objective To assess the effect of virtual reality training on an actual laparoscopic operation. Design Prospective randomised controlled and blinded trial. Setting Seven gynaecological departments in the Zeeland region of Denmark. Participants 24 first and second year registrars specialising in gynaecology and obstetrics. Interventions Proficiency based virtual reality simulator training in laparoscopic salpingectomy and standard clinical education (controls). Main outcome measure The main outcome measure was technical performance assessed by two independent observers blinded to trainee and training status using a previously validated general and task specific rating scale. The secondary outcome measure was operation time in minutes. Results The simulator trained group (n=ll) reached a median total score of 33 points (interquartile range 32-36 points), equivalent to the experience gained after 20-50 laparoscopic procedures, whereas the control group (n=10) reached a median total score of 23 (22-27) points, equivalent to the experience gained from fewer than five procedures (P<0.001). The median total operation time in the simulator trained group was 12 minutes (interquartile range 10-14 minutes) and in the control group was 24 (20-29) minutes (P<0.001). The observers' inter-rater agreement was 0.79. Conclusion Skills in laparoscopic surgery can be increased in a clinically relevant manner using proficiency based virtual reality simulator training. The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved. Simulator training should be considered before trainees carry out laparoscopic procedures. Trial registration ClinicalTrials.gov NCT00311792. [ABSTRACT FROM AUTHOR]

Basic science knowledge is a foundational element of surgical practice. Increasing surgical specialization may merit a reconsideration of the ‘whole-body’ approach to basic science curriculum in favour of specialty specific depth. The conundrum of depth or breadth of basic science curriculum is currently being addressed by the Royal Australasian College of Surgeons, which introduced a new surgical education and training programme for nine surgical specialties in 2008. This paper describes an innovative solution to the design of a basic science curriculum in the nine different surgical specialty streams of this programme. The task was to develop a curriculum and rigorous assessment in basic sciences to meet the needs of the training programme, for implementation within the first year. A number of political/cultural and technical issues were identified as critical to success. To achieve a robust assessment within the required time frame attention was paid to engagement, governance, curriculum definition, assessment development, and implementation. The pragmatic solution to curriculum and assessment was to use the existing assessment items and blueprint to determine a new curriculum definition and assessment. The resulting curriculum comprises a generic component, undertaken by all trainees, and specialty specific components. In a time critical environment, a pragmatic solution to curriculum, applied with predetermined, structured and meticulous methodology, allowed explicit definition of breadth for the generic basic science curriculum for surgical training in Australia and New Zealand. Implicit definition of specialty specific-basic science curricula was through the creation of a blueprinted assessment. [ABSTRACT FROM AUTHOR]

BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29–39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29–39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study sought to determine to what extent surgery programs are remediating residents who fail to achieve competency and to offer remediation strategies. Methods: A web-based survey was e-mailed to 253 program directors of all US surgery residency programs. Questions were asked about remediation and probation practices for residents failing to meet the competencies. Results: Programs seem to struggle the least with knowing how to remediate medical knowledge and patient care deficits and struggle more with professionalism and interpersonal communication skills. Most programs have no remediation methods in place for systems-based practice and practice-based learning and improvement deficits. Conclusions: Surgery residency programs are cognizant of the reality that some residents perform unsatisfactorily. Most have remediation plans for residents and understand that a process needs to be in place. Remediation methods tend to vary depending on the deficit and are devised tailored to the resident''s needs. [Copyright &y& Elsevier]

Abstract: Background: Teaching physicians and academic medical centers may find it more difficult to meet clinical productivity expectations and still contribute to scholarly activity in the present economic climate of health care. Methods: A multiquestion survey was developed and distributed via the Association of Program Directors in Surgery list-serve. Results: There were 80 respondents (31% response rate), 29 university program (UP), 43 independent program (IP), and 8 “other.” Although most programs had designated teaching faculty (72% UP, 93% IP), the trend was not to compensate for scholarly activity whether voluntary (100% UP, 91% IP), employed (82% UP, 74% IP), or contracted (57% UP, 85% IP; P = not specified). Most (69% UP, 75% IP) programs had no incentives for scholarly activities, despite dissatisfaction with involvement of volunteer faculty (19% UP, 55% IP; P = .04). Most compensation plans (79% UP, 66% IP) were discretionary or atypical. Conclusions: Most programs, UP and IP, did not compensate for scholarly activity for teaching faculty. There was a significant proportion that believed compensation would improve teaching efforts. [Copyright &y& Elsevier]

Abstract: Background: In 2000, we implemented an evidence-based guideline in the surgical intensive care unit (SICU) using a transfusion threshold of hemoglobin <8 g/dL. We hypothesized that continual education on the transfusion protocol would decrease transfusions. Methods: We analyzed 2-month samples of admissions in even-numbered years from 1998 to 2006. Any infusion of packed red blood cells (PRBCs) was included. Results: We analyzed data from 2,138 patients resulting in 5,130 transfusions. Thirty-six patients received >20 U of blood. The only difference between groups occurred in 2006 when renal failure increased. Transfusions decreased from 3.2 ± 0.34 (SE) to 1.7 ± 0.2. The number of patients who received blood also decreased. Mortality and length of stay (LOS) were not different among the groups. Every unit of blood transfused increased the mortality risk by 14%. Conclusions: Implementation of an evidence-based transfusion guideline reduced the number of infused units and patients transfused without an increase in mortality. [Copyright &y& Elsevier]

Intracranial surgery can be complex and high risk. Safety, ethical and financial factors make training in the area challenging. Head model 3-dimensional (3D) printing is a realistic training alternative to patient and traditional means of cadaver and animal model simulation. To describe important factors relating to the 3D printing of human head models and how such models perform as simulators. Searches were performed in PubMed, the Cochrane Library, Scopus, and Web of Science. Articles were screened independently by 3 reviewers using Covidence software. Data items were collected under 5 categories: study information; printers and processes; head model specifics; simulation and evaluations; and costs and production times. Forty articles published over the last 10 years were included in the review. A range of printers, printing methods, and substrates were used to create head models and tissue types. Complexity of the models ranged from sections of single tissue type (e.g., bone) to high-fidelity integration of multiple tissue types. Some models incorporated disease (e.g., tumors and aneurysms) and artificial physiology (e.g., pulsatile circulation). Aneurysm clipping, bone drilling, craniotomy, endonasal surgery, and tumor resection were the most commonly practiced procedures. Evaluations completed by those using the models were generally favorable. The findings of this review indicate that those who practice surgery and surgical techniques on 3D-printed head models deem them to be valuable assets in cranial surgery training. Understanding how surgical simulation on such models affects surgical performance and patient outcomes, and considering cost-effectiveness, are important future research endeavors. [ABSTRACT FROM AUTHOR]