Simulation Research Papers September - October 2016

Fam Med. 2016 Oct;48(9):696-702.

Effectiveness of Vaginal Delivery Simulation in Novice Trainees.

Shumard KM1, Denney JM, Quinn K, Grandis AS, Whitecar PW, Bailey J, Jijon-Knupp RJ, Huang C, Kesty K, Brost BC, Nitsche JF.

OBJECTIVE: Simulation training has been demonstrated to increase medical student confidence with vaginal deliveries; however, effect on skill performance is still lacking. To determine if integration of simulation training into the OB/GYN clerkship improves performance of vaginal deliveries, we assessed the effectiveness of simulation in third-year medical students.

METHODS: During the OB/GYN clerkship, third-year students were assigned to receive vaginal delivery simulation (n=54) or cervical exam simulation (n=56), with each group serving as a simulation naïve control for the other skill. As a final assessment of their skill, students performed a simulated vaginal delivery scored by a blinded observer using a procedural checklist (score 0-30). A satisfactory score was considered 26 or greater. The individual scores and percentage of satisfactory scores were compared between both groups using a Mann-Whitney U test and chi-square test, respectively.

RESULTS: Vaginal delivery students had a significantly higher mean score (27 +/- 3.2) and percentage of students achieving a passing score (85%) than the cervical exam students (22 +/- 3.5 and 15%). There were no differences in vaginal delivery performance based on gender, nor was there any difference in the number of real-life deliveries performed between vaginal delivery and cervical exam students.

CONCLUSIONS:  Even though medical students had an equivalent clinical rotation experience, a short period of simulation training had a marked effect on their end-of-rotation performance. During initial resident or midwife training more than 5 hours of simulation will likely be required to properly prepare 100% of trainees.

 

Pediatr Emerg Care. 2016 Oct 6. [Epub ahead of print]

Implementation of a 2-Day Simulation-Based Course to Prepare Medical Graduates on Their First Year of Residency.

Bragard I1, Seghaye MC, Farhat N, Solowianiuk M, Saliba M, Etienne AM, Schumacher K.

OBJECTIVES: Residents beginning their specialization in pediatrics and emergency medicine (EM) are rapidly involved in oncall duties. Early acquisition of crisis resource management by novice residents is essential for patient safety, but traditional training may be insufficient. Our aim was to investigate the impact of a 2-day simulation-based course on residents to manage pediatric and neonatal patients.

METHODS: First year residents participated in the course. They completed two questionnaires concerning perceived stress and self-efficacy in technical skills (TSs) and non-TSs (NTSs) at 3 times: before (T0), after (T1), and 6 weeks after the course (T2).

RESULTS: Eleven pediatric and 5 EM residents participated. At T0, stress about "communicating with parents" (P = 0.022) and "coordinating the team" (P = .037) was significantly higher among pediatric compared with EM residents; self-efficacy was not different between the specialities. After training, perceived stress about "managing a critical ill child" and perceived stress total significantly decreased among EM residents, whereas it remained the same among pediatricians (respectively, P = 0.001 and P = 0.016). Regarding self-efficacy, it had significantly increased in both groups (P < 0.001). Specifically, the increase in TSs self-efficacy was significant after the training (p = .008) and after 6 weeks (p < .001), and the increase in NTs self-efficacy was only significant after 6 weeks (P = 0.014).

CONCLUSIONS: Our course improved perceived stress, TSs, and NTSs self-efficacy of residents. This encourages us to formalize this as a prerequisite for admission to the pediatric and EM residency.

Ultrasound Med Biol. 2016 Oct 11. pii: S0301-5629(16)30262-9. doi: 10.1016/j.ultrasmedbio.2016.08.026. [Epub ahead of print]

WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice.

Atkinson NS1, Bryant RV2, Dong Y3, Maaser C4, Kucharzik T5, Maconi G6, Asthana AK7, Blaivas M8, Goudie A9, Gilja OH10, Nolsøe C11, Nürnberg D12, Dietrich CF13.

Author information:

Gastrointestinal ultrasound (GIUS) is an ultrasound application that has been practiced for more than 30 years. Recently, GIUS has enjoyed a resurgence of interest, and there is now strong evidence of its utility and accuracy as a diagnostic tool for multiple indications. The method of learning GIUS is not standardised and may incorporate mentorship, didactic teaching and e-learning. Simulation, using either low- or high-fidelity models, can also play a key role in practicing and honing novice GIUS skills. A course for training as well as establishing and evaluating competency in GIUS is proposed in the manuscript, based on established learning theory practice. We describe the broad utility of GIUS in clinical medicine, including a review of the literature and existing meta-analyses. Further, the manuscript calls for agreement on international standards regarding education, training and indications.

N Z Med J. 2016 Oct 14;129(1443):9-17.

Can team training make surgery safer? Lessons for national implementation of a simulation-based programme.

Weller J(1), Civil I(2), Torrie J(3), Cumin D(4), Garden A(5), Corter A(6), Merry A(4).

AIM: Unintended patient harm is a major contributor to poor outcomes for surgical patients and often reflects failures in teamwork. To address this we developed a

Multidisciplinary Operating Room Simulation (MORSim) intervention to improve teamwork in the operating room (OR) and piloted it with 20 OR teams in two of the

20 District Health Boards in New Zealand prior to national implementation. In this study, we describe the experience of those exposed to the intervention, challenges to implementing changes in clinical practice and suggestions for successful implementation of the programme at a regional or national level.

METHODS: We undertook semi-structured interviews of a stratified random sample of MORSim participants 3-6 months after they attended the course. We explored their  experiences of changes in clinical practice following MORSim. Interviews were recorded, transcribed and analysed using a general inductive approach to develop  themes into which interview data were coded. Interviews continued to the point of thematic saturation.

RESULTS: Interviewees described adopting into practice many of the elements of the MORSim intervention and reported positive experiences of change in communication, culture and collaboration. They described sharing MORSim concepts  with colleagues and using them in teaching and orientation of new staff. Reported barriers to uptake included uninterested colleagues, limited team orientation, communication hierarchies, insufficient numbers of staff exposed to MORSim and failure to priorities time for team information sharing such as pre-case briefings.

CONCLUSION: MORSim appears to have had lasting effects on reported attitudes and  behaviors in clinical practice consistent with more effective teamwork and communication. This study adds to the accumulating body of evidence on the value of simulation-based team training and offers suggestions for implementing widespread, regular team training for OR teams.

Surg Endosc. 2016 Oct 12. [Epub ahead of print]

Outcomes of Fundamentals of Laparoscopic Surgery (FLS) mastery training standards applied to an ergonomically different, lower cost platform.

Placek SB(1,)(2), Franklin BR(3,)(4), Haviland SM(3,)(4), Wagner MD(3,)(4),

O'Donnell MT(3,)(4), Cryer CT(3), Trinca KD(3), Silverman E(3,)(4), Matthew

Ritter E(3,)(4).

OBJECTIVE: Using previously established mastery learning standards, this study compares outcomes of training on standard FLS (FLS) equipment with training on an ergonomically different (ED-FLS), but more portable, lower cost platform.

METHODS: Subjects completed a pre-training FLS skills test on the standard platform and were then randomized to train on the FLS training platform (n = 20)  or the ED-FLS platform (n = 19). A post-training FLS skills test was administered to both groups on the standard FLS platform.

RESULTS: Group performance on the pretest was similar. Fifty percent of FLS and

32 % of ED-FLS subjects completed the entire curriculum. 100 % of subjects completing the curriculum achieved passing scores on the post-training test.

There was no statistically discernible difference in scores on the final FLS exam

(FLS 93.4, ED-FLS 93.3, p = 0.98) or training sessions required to complete the curriculum (FLS 7.4, ED-FLS 9.8, p = 0.13).

CONCLUSIONS: These results show that when applying mastery learning theory to an  ergonomically different platform, skill transfer occurs at a high level and prepares subjects to pass the standard FLS skills test.

JMIR Med Educ. 2016 Mar 7;2(1):e2.

Feasibility of Augmented Reality in Clinical Simulations: Using Google Glass With Manikins.

Chaballout B(1), Molloy M, Vaughn J, Brisson Iii R, Shaw R.

BACKGROUND: Studies show that students who use fidelity-based simulation technology perform better and have higher retention rates than peers who learn in traditional paper-based training. Augmented reality is increasingly being used as

a teaching and learning tool in a continual effort to make simulations more realistic for students.

OBJECTIVE: The aim of this project was to assess the feasibility and acceptability of using augmented reality via Google Glass during clinical simulation scenarios for training health science students.

METHODS: Students performed a clinical simulation while watching a video through

Google Glass of a patient actor simulating respiratory distress. Following participation in the scenarios students completed two surveys and were questioned

if they would recommend continued use of this technology in clinical simulation experiences.

RESULTS: We were able to have students watch a video in their field of vision of  a patient who mimicked the simulated manikin. Students were overall positive about the implications for being able to view a patient during the simulations, and most students recommended using the technology in the future. Overall, students reported perceived realism with augmented reality using Google Glass.

However, there were technical and usability challenges with the device.

CONCLUSIONS: As newer portable and consumer-focused technologies become available, augmented reality is increasingly being used as a teaching and learning tool to make clinical simulations more realistic for health science students. We found Google Glass feasible and acceptable as a tool for augmented reality in clinical simulations.

JMIR Med Educ. 2016 Jun 14;2(1):e8.

A Critical Review of Mechanical Ventilation Virtual Simulators: Is It Time to Use Them?

Lino JA(1), Gomes GC, Sousa ND, Carvalho AK, Diniz ME, Viana Junior AB, Holanda

MA.

BACKGROUND: Teaching mechanical ventilation at the bedside with real patients is  difficult with many logistic limitations. Mechanical ventilators virtual simulators (MVVS) may have the potential to facilitate mechanical ventilation (MV) training by allowing Web-based virtual simulation.

OBJECTIVE: We aimed to identify and describe the current available MVVS, to compare the usability of their interfaces as a teaching tool and to review the literature on validation studies.

METHODS: We performed a comparative evaluation of the MVVS, based on a literature/Web review followed by usability tests according to heuristic principles evaluation of their interfaces as performed by professional experts on MV.

RESULTS: Eight MVVS were identified. They showed marked heterogeneity, mainly regarding virtual patient's anthropomorphic parameters, pulmonary gas exchange, respiratory mechanics and muscle effort configurations, ventilator terminology, basic ventilatory modes, settings alarms, monitoring parameters, and design. The

Hamilton G5 and the Xlung covered a broader number of parameters, tools, and have easier Web-based access. Except for the Xlung, none of the simulators displayed monitoring of arterial blood gases and alternatives to load and save the simulation. The Xlung obtained the greater scores on heuristic principles assessments and the greater score of easiness of use, being the preferred MVVS for teaching purposes. No strong scientific evidence on the use and validation of the current MVVS was found.

CONCLUSIONS: There are only a few MVVS currently available. Among them, the Xlung showed a better usability interface. Validation tests and development of new or improvement of the current MVVS are needed.

Laryngoscope. 2016 Oct 12. doi: 10.1002/lary.26326. [Epub ahead of print]

Pediatric laryngeal simulator using 3D printed models: A novel technique.

Kavanagh KR(1), Cote V(1), Tsui Y(2), Kudernatsch S(3), Peterson DR(3), Valdez

TA(4).

OBJECTIVE: Simulation to acquire and test technical skills is an essential component of medical education and residency training in both surgical and nonsurgical specialties. High-quality simulation education relies on the availability, accessibility, and reliability of models. The objective of this work was to describe a practical pediatric laryngeal model for use in otolaryngology residency training. Ideally, this model would be low-cost, have tactile properties resembling human tissue, and be reliably reproducible.

STUDY DESIGN: Pediatric laryngeal models were developed using two manufacturing methods: direct three-dimensional (3D) printing of anatomical models and casted anatomical models using 3D-printed molds. Polylactic acid, acrylonitrile butadiene styrene, and high-impact polystyrene (HIPS) were used for the directly  printed models, whereas a silicone elastomer (SE) was used for the casted models.

METHODS: The models were evaluated for anatomic quality, ease of manipulation, hardness, and cost of production. A tissue likeness scale was created to validate the simulation model. Fleiss' Kappa rating was performed to evaluate interrater agreement, and analysis of variance was performed to evaluate differences among the materials.

RESULTS: The SE provided the most anatomically accurate models, with the tactile  properties allowing for surgical manipulation of the larynx. Direct 3D printing was more cost-effective than the SE casting method but did not possess the material properties and tissue likeness necessary for surgical simulation.

CONCLUSION: The SE models of the pediatric larynx created from a casting method demonstrated high quality anatomy, tactile properties comparable to human tissue, and easy manipulation with standard surgical instruments. Their use in a reliable, low-cost, accessible, modular simulation system provides a valuable training resource for otolaryngology residents.

 

Surg Innov. 2016 Oct 10. pii: 1553350616672963. [Epub ahead of print]

Allowing New Opportunities in Advanced Laparoscopy Training Using a Full High-Definition Training Box.

Achurra P(1), Lagos A(1), Avila R(1), Tejos R(1), Buckel E(1), Alvarado J(1),

Boza C(1), Jarufe N(1), Varas J(2).

Introduction Simulated laparoscopy training is limited by its low-quality image.

A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery. Objective To describe and test a new HD laparoscopic training box for advanced simulation training. Methods We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item questionnaire.

To assess the effectiveness of training using this simulation box, 15 general surgery residents were trained to perform a laparoscopic jejuno-jejunostomy in a  validated simulation program. They were assessed with objective rating scales before and after the training program, and their results were compared with that  of experts. Results The training box was assembled using high-density fiberglass  shaped as an insufflated abdomen. It has an adapted full-HD camera with a LED-based illumination system. A manually self-regulated monopod attached to the camera enables training without assistance. Of the expert surgeons who answered the questionnaire, 91% said that the simulation box had a high-quality image and  that it was very similar to real laparoscopy. 

All residents trained improved their rating scores significantly when comparing their initial versus final assessment (P < .001). Their performance after completing the training in the box was similar to that of experts (P > .2). Conclusions This novel laparoscopic training box presents a high-resolution image and allows training different types of advanced laparoscopic procedures. The simulator box was positively assessed by experts and demonstrated to be effective for laparoscopy training in resident surgeons.

 

Int J Pediatr Otorhinolaryngol. 2016 Nov;90:113-118. doi:

10.1016/j.ijporl.2016.08.027. Epub 2016 Aug 31.

3D-printed pediatric endoscopic ear surgery simulator for surgical training.

Barber SR(1), Kozin ED(2), Dedmon M(1), Lin BM(1), Lee K(1), Sinha S(1), Black

N(3), Remenschneider AK(1), Lee DJ(1).

INTRODUCTION: Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator.

METHODS: The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service.

RESULTS: All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant  hand (p < 0.05) and average completion time for junior and senior residents (p < 0.05) suggest construct validity.

CONCLUSIONS: A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation.

Nurse Educ. 2016 Oct 5. [Epub ahead of print]

Using Simulation to Teach Responses to Lateral Violence: Guidelines for Nurse Educators.

Sanner-Stiehr E(1).

Lateral violence among nurses persists as a pervasive problem in health care, contributing to detrimental individual and organizational consequences. Nurse educators can prepare students to respond effectively to lateral violence before  they graduate and enter the workplace, where it is likely to be encountered. Simulation provides an effective platform for delivering this type of student-centered education. This article presents step-by-step guidelines for educators to integrate lateral violence response training into simulations in prelicensure nursing education.

 

Eur J Obstet Gynecol Reprod Biol. 2016 Sep 30;206:177-180. doi:

10.1016/j.ejogrb.2016.09.026. [Epub ahead of print]

Do laparoscopic pelvic trainer exercises improve residents' surgical skills? A randomized controlled trial.

Dubuisson J(1), Vilmin F(2), Boulvain M(2), Combescure C(3), Petignat P(2),

Brossard P(4).

OBJECTIVE: The impact of surgical simulation devices on the training of gynecology residents has not been well defined. The aim of this study was to investigate whether the use of a laparoscopic pelvic trainer improved the surgical performance of residents.

STUDY DESIGN: This randomized controlled trial enrolled gynecology residents who  were randomized into group A or group B in a 1:1 fashion. All participants performed three pelvitrainer assessments (T1, T2, T3) consisting of suturing a 4-cm incision in a porcine bladder. The baseline assessment (T1) was performed before training. Group A underwent training before the second assessment (T2) and group B underwent training between the second and third assessments (T3).

RESULTS: A total of 26 residents were enrolled (group A, n=14; group B, n=12). At the first assessment (T1), there was no significant difference in the time taken to perform the procedure between the two groups (group A, 30min vs group B, 30min; p=.35), indicating homogeneity of the two groups. At T2, there was a difference between the two groups in the time taken to perform the leak-free closer (group A, 19min vs group B, 30min; p=.08). The time taken to complete the procedure was shorter after training for each group: 30min (T1) vs 19min (T2); p=.02 for group A and 30min (T2) vs 17min (T3); p=.009 for group B. Residents in group A did not receive any training during the 4-week period between T2 and T3,  but their acquired skills persisted during this time.

 

CONCLUSION: The training on a laparoscopic pelvic trainer improves the surgical

skills of residents, with performance persisting over time. It may be beneficial

to use a laparoscopic pelvic trainer during residency programs.

J Surg Educ. 2016 Oct 5. pii: S1931-7204(16)30156-8. doi:

10.1016/j.jsurg.2016.09.002. [Epub ahead of print]

Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial.

Soucisse ML(1), Boulva K(2), Sideris L(2), Drolet P(3), Morin M(2), Dubé P(2).

BACKGROUND: As surgical training is evolving and operative exposure is decreasing, new, effective, and experiential learning methods are needed to ensure surgical competency and patient safety. Video coaching is an emerging concept in surgery that needs further investigation.

DESIGN: In this randomized controlled trial conducted at a single teaching hospital, participating residents were filmed performing a side-to-side intestinal anastomosis on cadaveric dog bowel for baseline assessment. The Surgical Video Coaching (SVC) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon, during which constructive feedback was given. The control group went on with their normal clinical duties without coaching or debriefing. All participants were filmed making a second intestinal anastomosis. This was compared to their first anastomosis using a 7-category-validated technical skill global rating scale, the Objective Structured Assessment of Technical Skills. A single independent surgeon who did not participate in coaching or debriefing to the SVC group reviewed all videos. A satisfaction survey was then sent to the residents in the coaching group.

SETTING: Department of Surgery, HôpitalMaisonneuve-Rosemont, tertiary teaching hospital affiliated to the University of Montreal, Canada.

PARTICIPANTS: General surgery residents from University of Montreal were recruited to take part in this trial. A total of 28 residents were randomized and completed the study.

RESULTS: After intervention, the SVC group (n = 14) significantly increased their Objective Structured Assessment of Technical Skills score (mean of differences

3.36, [1.09-5.63], p = 0.007) when compared to the control group (n = 14) (mean of differences 0.29, p = 0.759). All residents agreed or strongly agreed that video coaching was a time-efficient teaching method.

CONCLUSIONS: Video coaching is an effective and efficient teaching intervention to improve surgical residents' technical skills.

J Surg Educ. 2016 Oct 4. pii: S1931-7204(16)30135-0. doi:

10.1016/j.jsurg.2016.08.006. [Epub ahead of print]

Evaluation of Procedural Simulation as a Training and Assessment Tool in General Surgery-Simulating a Laparoscopic Appendectomy.

Bjerrum F(1), Strandbygaard J(2), Rosthøj S(3), Grantcharov T(4), Ottesen B(2),

Sorensen JL(2).

BACKGROUND: Laparoscopic appendectomy is a commonly performed surgical procedure, but few training models have been described for it. We examined a virtual reality module for practising a laparoscopic appendectomy.

METHODS: A prospective cohort study with the following 3 groups of surgeons (n =

45): novices (0 procedures), intermediates (10-50 procedures), and experienced

(>100 procedures).  After being introduced to the simulator and 1 familiarization attempt on the procedural module, the participants practiced the module 20 times.

Movements, task time, and procedure-specific parameters were compared over time.

RESULTS: The time and movement parameters were significantly different during the first attempt, and more experienced surgeons used fewer movements and less time than novices (p < 0.01), although only 2 parameters were significantly different between novices and intermediates. All 3 groups improved significantly over 20 attempts (p < 0.0001). The intraclass correlation coefficient varied between 0.55 and 0.68 and did not differ significantly between the 3 groups (p > 0.05). When comparing novices with experienced surgeons, novices had a higher risk of burn damage to cecum (odds ratio [OR] = 3.0 [95% CI: 1.3; 7.0] p = 0.03), pressure damage to appendix (OR = 3.1 [95% CI: 2.0; 4.9] p < 0.0001), and grasping of the appendix (OR = 2.9 [95% CI: 1.8; 4.7] p < 0.0001). The risk of causing a perforation was not significantly different among the different experience levels (OR = 1.9 [95% CI: 0.9; 3.8] p = 0.14). Only 3 out of 5 error parameters differed significantly when comparing novices and experienced surgeons. Similarly, when comparing intermediates and novices, it was only 2 of the parameters that differed.

DISCUSSION: The simulator module for practising laparoscopic appendectomy may be useful as a training tool, but further development is required before it can be used for assessment purposes. Procedural simulation may demonstrate more variation for movement parameters, and future research should focus on developing better procedure-specific parameters.

 

J Surg Educ. 2016 Oct 4. pii: S1931-7204(16)30120-9. doi:

10.1016/j.jsurg.2016.07.012. [Epub ahead of print]

Changing the Learning Curve in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program.

Dawidek MT(1), Roach VA(2), Ott MC(3), Wilson TD(4).

OBJECTIVE: A major challenge in laparoscopic surgery is the lack of depth perception. With the development and continued improvement of 3D video technology, the potential benefit of restoring 3D vision to laparoscopy has received substantial attention from the surgical community. Despite this, procedures conducted under 2D vision remain the standard of care, and trainees must become proficient in 2D laparoscopy. This study aims to determine whether incorporating 3D vision into a 2D laparoscopic simulation curriculum accelerates  skill acquisition in novices.

DESIGN: Postgraduate year-1 surgical specialty residents (n = 15) at the Schulich School of Medicine and Dentistry, at Western University were randomized into 1 of 2 groups. The control group practiced the Fundamentals of Laparoscopic Surgery peg-transfer task to proficiency exclusively under standard 2D laparoscopy conditions. The experimental group first practiced peg transfer under 3D direct visualization, with direct visualization of the working field. Upon reaching proficiency, this group underwent a perceptual switch, changing to standard 2D laparoscopy conditions, and once again trained to proficiency.

RESULTS: Incorporating 3D direct visualization before training under standard 2D  conditions significantly (p < 0.0.5) reduced the total training time to proficiency by 10.9 minutes or 32.4%. There was no difference in total number of repetitions to proficiency. Data were also used to generate learning curves foreach respective training protocol.

CONCLUSIONS: An adaptive learning approach, which incorporates 3D direct visualization into a 2D laparoscopic simulation curriculum, accelerates skill acquisition. This is in contrast to previous work, possibly owing to the proficiency-based methodology employed, and has implications for resource savings in surgical training.

Semin Perinatol. 2016 Sep 27. pii: S0146-0005(16)30066-0. doi:

10.1053/j.semperi.2016.08.004. [Epub ahead of print]

Procedural training and assessment of competency utilizing simulation.

Sawyer T(1), Gray MM(2).

This review examines the current environment of neonatal procedural learning, describes an updated model of skills training, defines the role of simulation in  assessing competency, and discusses potential future directions for simulation-based competency assessment. In order to maximize impact, simulation-based procedural training programs should follow a standardized and evidence-based approach to designing and evaluating educational activities.

Simulation can be used to facilitate the evaluation of competency, but must incorporate validated assessment tools to ensure quality and consistency. True competency evaluation cannot be accomplished with simulation alone: competency assessment must also include evaluations of procedural skill during actual clinical care. Future work in this area is needed to measure and track clinically meaningful patient outcomes resulting from simulation-based training, examine the use of simulation to assist physicians undergoing re-entry to practice, and to examine the use of procedural skills simulation as part of a maintenance of competency and life-long learning.

Plast Reconstr Surg. 2016 Oct;138(4):739e-47e. doi: 10.1097/PRS.0000000000002456.

Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.

Rodriguez JR(1), Yañez R, Cifuentes I, Varas J, Dagnino B.

BACKGROUND: Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.

METHODS: Postgraduate year-3 general surgery residents were assessed in a

17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant.

RESULTS: Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures  (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50percent for artery and vein, respectively.

CONCLUSIONS: Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.