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The article discusses simulation-based team training in obstetric emergencies for teaching, rehearsing and analyzing the interdisciplinary performance. Simulation training improves skills, communication and patient outcome. Institute of Medicine (IOM), the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and the American Congress of Obstetricians and Gynecologists (ACOG) strongly support the simulation-based team training due to evidence showing reduced human errors.

Acute compartment syndrome (ACS) represents a surgical emergency requiring effective, complete fasciotomy. The purpose of this study is to evaluate cadaver-based training on the ability of practicing general surgeons to effectively perform upper extremity, thigh, and leg fasciotomies. One hundred seventeen general surgeons underwent a 2-day, cadaver-based course with formative and summative assessments based on validated scoring tools. Overall performance and critical item scores were recorded and compared utilizing analysis of variance with repeated measures and eta-squared values to evaluate effect size. For all three procedures, post-training scores were significantly improved when compared with pre-training scores (p < 0.001). Mean pre-training score for lower leg fasciotomy met the standard for competent performance of the procedure (total score > 80), whereas neither thigh nor upper extremity performance scores met this standard before training. This 2-day, cadaver-based course improves the ability of practicing general surgeons to effectively and independently perform upper extremity, thigh, and lower leg fasciotomies. (Journal of Surgical Orthopaedic Advances 32(4):238-241, 2023).

Summary statement: Intubating adult patients presents numerous challenges for clinicians. Procedural complexities associated with performing pediatric and neonatal intubation, along with a lower frequency of a need for intubating pediatric and neonatal patients, further amplifies the difficulties associated with acquiring and maintaining relevant clinical skills. Clinicians must develop and maintain competency through training and continuing medical education. A systematic review was conducted through June 2012 to examine current instructional methods, assessment tools, and training models in pediatric and neonatal intubation training. Variability among the included literature on instruction, assessment, and models used to support training makes direct comparison problematic. The results of this review emphasize the need for improvement of current instructional methods to promote competency acquisition; development of valid, reliable assessment tools to evaluate clinician competency; and identification of a superior training model to promote acquisition and maintenance of skills associated with intubation of pediatric patients.

Introduction: Laparoscopic tissue handling is quite difficult to measure using virtual-reality laparoscopic simulators and box-trainer exercises, and therefore, completion time is the predominant performance measure for simulation-based laparoscopic training exercises. The purpose of this study was to evaluate the construct validity of a training and assessment model for precise laparoscopic handling of delicate tissue., Methods: Participants (n = 35) completed 2 progressively challenging laparoscopic tissue translocation exercises using delicate foam pieces and templates. Deidentified performances were scored using objective measures for tissue damage, accuracy, percentage complete, and completion time. Evaluation included multiple analysis of variance with repeated measures among the 3 groups as follows: medical students, residents and faculty who perform laparoscopic surgery less than once per week, and faculty members who perform laparoscopic surgery at least once per week., Results: The model demonstrated significant construct validity by discriminating performances between the types of shapes and templates and across the levels of surgical experience on all dimensions. A significant interaction effect between the level of expertise and the difficulty of the exercise revealed excellent discrimination between experienced laparoscopic surgeons and others., Discussion: This low-cost model provides an alternative or adjunct platform for laparoscopic training and assessment that requires precise and measurable handling of a delicate tissue.

Background: Many surgical training programs are introducing virtual-reality laparoscopic simulators into their curriculum. If a surgical simulator will be used to determine when a trainee has reached an "expert" level of performance, its evaluation metrics must accurately reflect varying levels of skill. The ability of a metric to differentiate novice from expert performance is referred to as construct validity. The present study was undertaken to determine whether the LapMentor's metrics demonstrate construct validity., Methods: Medical students, residents and faculty laparoscopic surgeons (n = 5-14 per group) performed 5 consecutive repetitions of 6 laparoscopic skills tasks: 30 degrees Camera Manipulation, Eye-Hand Coordination, Clipping/Grasping, Cutting, Electrocautery, and Translocation of Objects. The LapMentor measured performance in 4 to 12 parameters per task. Mean performance for each parameter was compared between subject groups for the first and fifth repetitions. Pairwise comparisons among the 3 groups were made by post hoc t-tests with Bonferroni technique. Significance was set at P < 0.05., Results: Of the 6 tasks evaluated, only the Eye-Hand Coordination task (3/12 parameters) and the Clipping and Grasping (1/7 parameters) had expert-level discrimination when performance was compared after completion of 1 repetition. Comparison of the fifth repetition performance (representing the plateau of the learning curves), demonstrated that the parameters Time and Score had expert level discrimination on the Eye-Hand Coordination task, and Time on the Cutting task. The remaining LapMentor tasks evaluated did not exhibit the ability to differentiate level of expertise based on the built-in metrics on either repetition 1 or 5., Conclusions: The majority of the LapMentor tasks' metrics were unable to differentiate between laparoscopic experts and less skilled subjects. Therefore, performance on those tasks may not accurately reflect a subject's true level of ability. Feedback to the manufacturer about these findings may encourage the development of evaluation parameters with greater sensitivity.

Background: The goal of this study was to determine if clinical simulation improved resident confidence in performing critical care skills, neonatal resuscitation, and colonoscopy., Methods: Residents participated in clinical simulations utilizing high-fidelity medical simulators in a realistic environment. We compared resident responses on pre- and post-experience surveys., Results: Residents reported satisfaction with quality of demonstrations and opportunity for hands-on learning and practice. Residents felt more confident in their ability to apply these skills independently and in the applied context., Conclusions: Simulation is a well-accepted teaching method for critical care and procedural skills and improves resident confidence.