Search

Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula. PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick's modern concept of validity alongside an LoE score according to McGaghie's translational outcomes. Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5. Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The aim of this study was to systematically review the simulators that are currently available for coronary artery bypass graft and valve surgery and, in addition, to review the validation evidence supporting them and to recommend several simulators for training based on the analysis of results. METHODS A systematic literature search of the MEDLINE® (1946 to May 2021) and EMBASE® (1947 to May 2021) databases was performed to identify simulators for coronary artery and valvular procedures in cardiothoracic surgery. A selection of keywords and MeSH terms was used to execute the literature search. After identification of relevant articles, data were extracted and analysed. RESULTS Thirty-seven simulators were found in 31 articles. Simulators were found for coronary artery bypass graft (n  = 24) and valve surgery (n  = 13). The majority of models were either benchtop (n  = 28) or hybrid (n  = 8) modalities. Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two (59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had 3 or more elements of validity established. CONCLUSIONS Two simulators were recommended for supplemental training in cardiothoracic surgery. Low-fidelity models can provide a broad foundation for surgical skills' development whereas high-fidelity simulators can be used for immersive training scenarios and appraisals. These should be utilized in early training, at which point the learning curve of trainees is steepest. [ABSTRACT FROM AUTHOR]

Objectives: To report the study protocol for the first international multicentre randomized controlled trial investigating the effectiveness of simulation‐based surgical training and the development process for an evidence‐based training curriculum, to be delivered as an educational intervention. Participants and Methods: This prospective, international, multicentre randomized controlled clinical and educational trial will recruit urology surgical trainees who must not have performed ≥10 of the selected index procedure, ureterorenoscopy (URS). Participants will be randomized to simulation‐based training (SBT) or non‐simulation‐based training (NSBT), the latter of which is the current sole standard of training globally. The primary outcome is the number of procedures required to achieve proficiency, where proficiency is defined as achieving a learning curve plateau of 28 or more on an Objective Structured Assessment of Technical Skills (OSATS) assessment scale, for three consecutive operations, without any complications. All participants will be followed up either until they complete 25 procedures or for 18 months. Development of the URS SBT curriculum took place through a two‐round Delphi process. Results: A total of 47 respondents, consisting of trainees (n = 24) with URS experience and urolithiasis specialists (n = 23), participated in round 1 of the Delphi process. Specialists (n = 10) finalized the content of the curriculum in round 2. The developed interventional curriculum consists of initial theoretic knowledge through didactic lectures followed by select tasks and cases on the URO‐Mentor (Simbionix, Lod, Israel) VR Simulator, Uro‐Scopic Trainer (Limbs & Things, Bristol, UK) and Scope Trainer (Mediskills, Manchester, UK) models for both semi‐rigid and flexible URS. Respondents also selected relevant non‐technical skills scenarios and cadaveric simulation tasks as additional components, with delivery subject to local availability. Conclusions: SIMULATE is the first multicentre trial investigating the effect and transferability of supplementary SBT on operating performance and patient outcomes. An evidence‐based training curriculum is presented, developed with expert and trainee input. Participants will be followed and the primary outcome, number of procedures required to proficiency, will be reported alongside key clinical secondary outcomes, (ISCRTN 12260261). [ABSTRACT FROM AUTHOR]

The increasing challenges facing the training of future neurosurgeons have led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and determine their educational effects. In this second part, we aim to identify the available simulators for spine, pediatric neurosurgery, interventional neuroradiology, and nontechnical skills, assess their validity, and determine their effectiveness. Both Medline and Embase were searched for English language articles that validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework, and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness for each simulator or training course. Overall, 114 articles for 108 simulation-based training models or courses were identified. These articles included 24 for spine simulators, 3 for nontechnical skills, 10 for 9 pediatric neurosurgery simulators, and 12 for 11 interventional neuroradiology simulators. Achieving the highest rating for each validity domain were 3 models for content validity; 16 for response processes; 1 for internal structure; 2 for relations to other variables; and only 1 for consequences. For translational outcomes, 2 training courses achieved a level of effectiveness of >2, showing skills transfer beyond the simulator environment. With increasing simulators, there is a need for more validity studies and attempts to investigate translational outcomes to the operating theater when using these simulators. Nontechnical skills training is notably lacking, despite demand within the field. [ABSTRACT FROM AUTHOR]

The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aim to identify the currently available simulators and training courses for neurosurgery, assess their validity, and determine their effectiveness. Both MEDLINE and Embase were searched for English language articles which validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness (LoE) for each simulator or training course. On screening of 6006 articles, 114 were identified to either validate or determine an LoE for 108 simulation-based training models or courses. Achieving the highest rating for each validity domain were 6 models and training courses for content validity, 12 for response processes, 4 for internal structure, 14 for relations to other variables, and none for consequences. For translational outcomes, 6 simulators or training achieved an LoE >2 and thus showed skills transfer beyond the simulation setting. With the advent of increasing neurosurgery simulators and training tools, there is a need for more validity studies. Further attempts to investigate translational outcomes to the operating theater when using these simulators is particularly warranted. More training tools incorporating full-immersion simulation and nontechnical skills training are recommended. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the validity of evidence of the Endo-Uro Trainer (SAMED, Dresden, Germany) for semi-rigid ureteroscopy. Methods: Novice (n = 29), intermediate-level (n = 25), and expert (n = 24) urological surgeons were recruited to participate in the study. Novices were allocated randomly to Groups A and B, where A performed two set procedures using the already validated Uro-Scopic Trainer (Limbs and Things, Bristol, UK), and Group B used the Endo-Uro trainer. Subsequently they were crossed over to perform the same two procedures using the other model. Intermediate and expert groups performed the same procedure on the Endo-Uro trainer only. Objective Structured Assessment of Technical Skills (OSATS) and the procedural times were collected and analyzed. All participants were invited to complete a final evaluation survey. Results: The evaluation survey revealed a realism rating in all aspects, with a mean Likert rating of 4.04/5. Significant differences were observed in performance time between novices and experts (p = 0.0014), and between intermediates and experts (p = 0.0113). OSATS scores differed significantly between all groups (p < 0.0001). Group B novices showed statistically significant improvement in performance time (p = 0.0012) and OSATS scores (p = 0.0439) after the crossover. Significant differences in performance time (p = 0.0025) between groups A and B were also observed post-crossover. Conclusions: This study demonstrated content validity for the Endo-Uro Trainer model. In addition, the model was shown to be capable of differentiating levels of experience, which contributes to the acceptance of the validity hypothesis. Improvement in performance using the model demonstrates its effectiveness for training. [ABSTRACT FROM AUTHOR]

Objectives To identify and review the currently available simulators for prostate surgery and to explore the evidence supporting their validity for training purposes. Materials and Methods A review of the literature between 1999 and 2014 was performed. The search terms included a combination of urology, prostate surgery, robotic prostatectomy, laparoscopic prostatectomy, transurethral resection of the prostate ( TURP), simulation, virtual reality, animal model, human cadavers, training, assessment, technical skills, validation and learning curves. Furthermore, relevant abstracts from the American Urological Association, European Association of Urology, British Association of Urological Surgeons and World Congress of Endourology meetings, between 1999 and 2013, were included. Only studies related to prostate surgery simulators were included; studies regarding other urological simulators were excluded. Results A total of 22 studies that carried out a validation study were identified. Five validated models and/or simulators were identified for TURP, one for photoselective vaporisation of the prostate, two for holmium enucleation of the prostate, three for laparoscopic radical prostatectomy ( LRP) and four for robot-assisted surgery. Of the TURP simulators, all five have demonstrated content validity, three face validity and four construct validity. The Green Light laser simulator has demonstrated face, content and construct validities. The Kansai HoLEP Simulator has demonstrated face and content validity whilst the UroSim HoLEP Simulator has demonstrated face, content and construct validity. All three animal models for LRP have been shown to have construct validity whilst the chicken skin model was also content valid. Only two robotic simulators were identified with relevance to robot-assisted laparoscopic prostatectomy, both of which demonstrated construct validity. Conclusions A wide range of different simulators are available for prostate surgery, including synthetic bench models, virtual-reality platforms, animal models, human cadavers, distributed simulation and advanced training programmes and modules. The currently validated simulators can be used by healthcare organisations to provide supplementary training sessions for trainee surgeons. Further research should be conducted to validate simulated environments, to determine which simulators have greater efficacy than others and to assess the cost-effectiveness of the simulators and the transferability of skills learnt. With surgeons investigating new possibilities for easily reproducible and valid methods of training, simulation offers great scope for implementation alongside traditional methods of training. [ABSTRACT FROM AUTHOR]

Objectives To assess face, content and construct validity, and feasibility and acceptability of the Green Light™ Simulator as a training tool for photoselective vaporisation of the prostate ( PVP), and to establish learning curves and develop an evidence-based training curriculum. Subjects and Methods This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert-level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Results Construct validity was demonstrated in two of five training modules ( P = 0.038; P = 0.018) and in a considerable number of case metrics ( P = 0.034). Learning curves were seen in all five training modules ( P < 0.001) and significant reduction in case operative time ( P < 0.001) and error ( P = 0.017) were seen. An evidence-based training curriculum, to help trainees acquire transferable skills, was produced using the results. Conclusion This study has shown the Green Light Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the Green Light Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency. [ABSTRACT FROM AUTHOR]