66 Escape Room as an Educational Strategy for Foundation Doctors Basic Surgical Skills Induction

The Accreditation Council for Graduate Medical Education (ACGME) and American Board of Orthopaedic Surgery (ABOS) recently mandated major changes to curricular requirements for the PGY-1 (intern) year for categorical orthopaedic surgery residents. Since July 1, 2013, PGY-1 residents are required to have 6 months of orthopaedic surgery rotations, 6 months of nonorthopaedic surgery rotations, and complete a mandatory surgical skills curriculum [1, 2]. The ACGME and ABOS executed these changes in an effort to improve the quality and breadth of education for interns, preparing them for more advanced orthopaedic education. These changes were prompted by shifts in general surgery procedures (from open to laparoscopic), which have reduced the operating room experience of suturing and knot tying for interns, as well as by duty hour requirements that further reduce the operating room experience for interns. Together, these shifts in first-year resident experience have resulted in less surgical training for the orthopaedic surgery intern. The new ABOS requirements, which commence on July 1, 2014, seek to offset those losses [1, 2]. This column describes the changes mandated by the ABOS and ACGME for the orthopaedic intern year, discusses some limitations associated with these changes, and offers program strategies for effective implementation.

AimsAccording to literature,newly qualified doctors are at risk of being unable to perform practical procedures safely. This has been exacerbated by the disruptions to training and education which the covid-19 pandemic has caused. This intensive course has been developed to improve basic surgical skills and improve confidence in simple wound closure, to mitigate these disruptions.MethodsCandidates attended a three-part course in small groups, where they learned hand ties, basic laparoscopic skills and wound closure on animal models. Self assessment data were collected pre and post workshop on a Likert scale. All data was assessed using basic descriptive analysis.ResultsData was collected from 13 participants (M:F, 5:8) at the level of foundation year 1(61.5%,n=8) and foundation year 2(38.5%,n=5). Only 38.5% (n = 5) had previous basic surgical skills training. Our delegates reported an improvement in the following surgical skills: suturing (n = 11, 84.6%), hand tying (n = 10, 76.9%), laparoscopic skills (n = 10, 76.9%). Overall 61.5% (n = 8) of our delegates reported an improvement in all three domains.ConclusionsParticipants reported limited exposure prior to this course despite successfully completing an undergraduate curriculum. Overall, participants' self-scores improved in all three taught surgical skills. We believe ourcourse is a practical and reproducible solution to help bridge training gaps, which can be safely conducted with social distancing measures.

Aim Attention to surgical skills development of UK foundation trainees within the UK foundation training programme appears to be neglected. This study aimed to ascertain junior doctors’ perceptions of surgical skills within the foundation training programme, irrespective of their future career intentions. Method An online survey generated using SurveyMonkey was distributed to all 18 UK foundation training schools. This survey assessed foundation trainees’ surgical skills experience in medical school, current career intentions, confidence at basic surgical skills and perceptions of the level of surgical skills training within the foundation programme. Results A total of 245 responses were collected. Career intentions amongst foundation trainee respondents was evenly distributed with 39.6% aiming for a career in surgery, 41.6% opting for a non-surgical career and 18.8% of participants were undecided on their future career path. Trainees felt that they did not have adequate exposure to surgical skills (4.5, Likert scale 1–10) and did not have adequate exposure to specialty specific skills within the foundation training programme (3.3, Likert scale 1–10). On average, 75% of participants believed further exposure to surgical skills training would be beneficial to their professional development. Furthermore, 67% believed that surgical skills should be incorporated in the core competencies for the foundation training programme. Conclusions Our study shows that foundation trainees feel that there is a lack of adequate exposure to surgical skills within the foundation programme. Foundation trainees feel change is required to help improve competency in basic surgical skills and as an extension increase interest in a surgical career.

Development of an Interactive Remote Basic Surgical Skills Mini-Curriculum for Medical Students During the COVID-19 Pandemic.

Integrating Surgical Skills Education into the Anatomy Laboratory

The complexity of acquiring minimally invasive surgical (MIS) skills, combined with smaller case volumes for residents have pushed the development of skills training facilities on simulators outside the operating room (OR). Medico-legal and financial constraints have stimulated this development even more. However, the implementation of simulator training into a residency curriculum is shown to be troublesome. MIS skills training is organized in a uniform and easily applicable way in the Dutch obstetrics and gynecology residency curriculum. Every resident is obliged to attend the same basic surgical skills course, named Cobra-alpha course, intentionally during postgraduate year (PGY) 1 or 2. Furthermore, surgical skills are trained, evaluated and expanded on simulators in teaching hospitals. Additional to the Cobra-alpha course, residents may attend advanced training courses and congresses focusing on laparoscopy and hysteroscopy. This organization guarantees a uniform introduction to MIS skills training for every resident. However, preconditions for continuous training and evaluation after this introduction have to be optimized.

Aim To evaluate the impact of a novel program of weekly, lunchtime BSS sessions on quantitative and qualitative factors. Method A weekly, lunchtime BSS course was designed to achieve the outcomes of the Royal College of Surgeons BSS course over one foundation doctor rotation. Sessions included knot tying, suturing, abscess drainage, application of plaster of Paris, joint aspirations and reductions, abdominal wall closure, and basic laparoscopic skills. The hospital canteen sourced unwanted pig skin and belly from the local butcher. Out-of-date surgical equipment was used. Pre- and post-session feedback was assessed for perceived increase in confidence. Thematic analysis of voluntary semi structured interview transcripts were performed to understand the impact of the course on perceived well-being, quality of training, and interest in a surgical career. Results There were 64 responses. Confidence was significantly improved from 47% to 73% (95% CI 15%-27%; P<.001; t13=5.3117) across all surgical skills over 4 iterations. In 7 semi-structured interviews, 100% of the participants reported improved perceived well-being, value added to training, and positivity toward near-peer teaching and 71% preferred local weekly teaching. Interest in a surgical career was unchanged. Conclusions This course was feasible around clinical workloads, resourced locally at next to no cost, environmentally sustainable, and free to attend. The course offered junior doctors not only a weekly opportunity to learn but also to teach. Peer-led, decentralized surgical education increases confidence and has a positive effect on perceptions about well-being and training. We hope to disseminate this course, leading to reproduction in other centres, refinement, and wide implementation.

To report the development of minimally invasive training courses and workshops in the Caribbean and specifically the establishment of the Basic Surgical Skills Course of the Royal College of Surgeons of England (RCSEng) in Trinidad with respect to their value toward Surgical laparoscopic or minimally invasive training in the Caribbean. & Methods: The literature written on laparoscopy in the region was reviewed and in particular that related to the minimally invasive training courses provided over the period 2004 to 2019 and the development of laparoscopic surgical training described from a historic perspective. The factors that contribute to sustainability of courses were identified. Laparoscopic surgical training courses were sporadically introduced into the Caribbean over the period 2004 to 2019 in countries including Barbados, Curacao, Guyana, St. Lucia, Jamaica and Trinidad & Tobago. These were timed and closely related to the establishment of the Caribbean College of Surgeons (CCOS) with the help of the Royal College of Surgeons of England. However, the only certified course introduced was the Basic Surgical Skills (BSS) course of the RCSEng into Trinidad in 2012. This has now been established as a recognised overseas centre by the RCSEng and provides the Intercollegiate BSS course annually forming a solid basis for trainees to learn safe surgical and laparoscopic skills prior to commencing formal surgical training. This has resulted in the sustainable development of minimally invasive training in Trinidad in particular. Laparoscopic skills courses and workshops have been established in the Caribbean for 15 years beginning circa. 2004 to 2019 and have grown in number and locations throughout the Caribbean. The RCSEng and the CCOS have been instrumental in the development process. Of note, the only recognised overseas training centre for Basic Surgical Skills Course was established in Trinidad & Tobago with the support of the RCSEng and seems to be the main contributor to the successful, regular maintenance of these and other minimally invasive courses in General Surgery, ENT, Gynaecology and other fields on an annual, sustainable basis.

This chapter presents a review of the literature on learning programming through virtual reality (VR) and introduces an empirical study of our VR-based escape room platform designed for this purpose. The platform comprises two modules. The first module introduces learners to fundamental object-oriented programming (OOP) concepts through an engaging escape room experience. The storyline involves creatures trapped in a spaceship, and users must solve programming puzzles to unlock spaceship doors and progress through the levels. The second module focuses on more advanced programming concepts, such as conditional statements and loops. Similar to the first module, this module is structured as an escape room, with a storyline about a person trapped in a house who must solve programming puzzles to escape. The primary objective of this study was to examine whether the VR-based gamified escape room enhances students’ perceptions of their learning performance and motivation in learning fundamental and OOP concepts. Additionally, we sought to determine if there is a difference in engagement levels between the VR version and the computer display version of the escape room platform. To evaluate students’ perceptions of learning performance and motivation, we conducted pre-test and post-test surveys using a Likert scale, supplemented by interviews at the conclusion of the study. The findings indicate an improvement in participants’ learning performance and underscore the benefits of learning programming through the VR-based escape room, aligning with the trends and insights reported in existing literature.

Background: The role and scope of general practitioners in semi-urban and rural areas is poorly understood and documented. An absence of specialist support results in generalists being called to perform surgical procedures. It is imperative that they competently and confidently perform specific surgical procedures.Method: This cross-sectional study identified a list of agreed surgical procedures in which generalists should be competent. Enquires were made about generalists’ competence in performing such skills and training junior doctors how to use these them. Interns were asked about the quality of their exposure to and their perceived competence in the skills. A questionnaire was given to interns who completed their internship in 2008 in Mpumalanga and Gauteng, and another to generalists affiliated to the University of Pretoria. Data were analysed descriptively using Microsoft® Excel®.Results: The response rate was 31% and 21% for the interns and generalists, respectively. There was agreement on specific core skills in training. Most generalists (81%) lacked the competence to provide training on some of the specific core skills needed for independent practice. Most of the internships were completed in semi-urban areas (62%). The majority of the interns perceived themselves to be competent in Caesarean sections, the excision of lumps and bumps, and abscess drainage. Interns from urban areas rated themselves as being incompetent in the core surgical skills. Interns who worked in semi-urban regions felt competent in core surgical skills.Conclusion: The training of interns should be supervised by senior doctors in in-service training settings. Basic surgical skills and in-service training can be taught during family medicine rotation internships by surgically skilled family physicians and generalists in semi-urban areas and district hospitals.

BackgroundThe Basic Surgical Skills (BSS) course is a common component of postgraduate surgical training programmes in sub-Saharan Africa, but was originally designed in a UK context, and its efficacy and relevance have not been formally assessed in Africa.MethodsAn observational study was carried out during a BSS course delivered to early-stage surgical trainees from Rwanda and the Democratic Republic of the Congo. Technical skill in a basic wound closure task was assessed in a formal Objective Structured Assessment of Technical Skills (OSAT) before and after course completion. Participants completed a pre-course questionnaire documenting existing surgical experience and self-perceived confidence levels in surgical skills which were to be taught during the course. Participants repeated confidence ratings and completed course evaluation following course delivery.ResultsA cohort of 17 participants had completed a pre-course median of 150 Caesarean sections as primary operator. Performance on the OSAT improved from a mean of 10.5/17 pre-course to 14.2/17 post-course (mean of paired differences 3.7, p < 0.001). Improvements were seen in 15/17 components of wound closure. Pre-course, only 47% of candidates were forming hand-tied knots correctly and 38% were appropriately crossing hands with each throw, improving to 88 and 76%, respectively, following the course (p = 0.01 for both components). Confidence levels improved significantly in all technical skills taught, and the course was assessed as highly relevant by trainees.ConclusionThe Basic Surgical Skills course is effective in improving the basic surgical technique of surgical trainees from sub-Saharan Africa and their confidence in key technical skills.

Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments. We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills. The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study. We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15-18] vs. 20 [range, 19.75-22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75-14] vs. 15 and median 20.5 [range, 19-22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains. Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.

BackgroundEndoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures (errors) in surgeons with different training levels.MethodsFinal-year medical students (n = 9), residents (n = 14) and consultants (n = 10) from the Department of Otorhinolaryngology, Head and Neck Surgery at the University Hospital of Bern, Switzerland were enrolled in the present study. After randomization every participant had to complete a standard set of grasping and dissecting surgical tasks in a temporal bone model. After the first session the participants were crossed over to the other technique.ResultsTime required for completion of the surgical tasks was similar for both techniques, but highly dependent on the training status. A significant increase in the number of damages to the ossicular chain was observed with the microscopic as compared to the endoscopic technique (p < 0.001). Moreover, students beginning with the endoscopic technique showed an overall significantly lower amount of time to complete the tasks (p = 0.04). From the subjective feedback a preference towards the endoscopic technique mainly in medical students was observed.ConclusionsThe endoscopic approach is useful and beneficial for teaching basic surgical skills, mainly by providing a reduction of damage to surrounding tissues with similar operating times for both techniques. Moreover, medical students performed significantly faster, when first taught in the endoscopic technique. Especially for young surgeons without previous training in ear surgery, the endoscope should be considered to improve surgical skills in the middle ear.

Background: Objective structured assessment of technical skills (OSATS) are crucial in assessing operative skills. The education of basic surgical skill (BSS) depends on precise assessment of their surgical skill levels and competency level. Hence, this study aimed to determine the effectiveness of BSS module on intern's competency and confidence. Materials and Methods: Fifty-four interns were included in the module. Three faculty members were included in the module. The module has been prepared on: (1) Asepsis – surgical hand scrubbing, gloving, gowning. (2) Simple interrupted suturing. Intervention: Small group teaching was given to each batch, and hands-on training in dry skill laboratory on simulation was given. Interns were assessed by OSATS, and feedbacks were taken at the end of the assessment. Results: The score of global rating scale for each trainee increased within the 15 days of posting. The knowledge domain of posttest score also improved. Conclusion: BSS module was found to be effective, aiding for the interns to improve their knowledge and skills.

Escape rooms have gained popularity as innovative educational tools in recent years. Despite this, traditional Chinese nursing education remains largely teacher-centered, and research on the use of escape room–based teaching methods in nursing education is limited. This study represents a preliminary application of escape rooms to assess basic nursing skills, aiming to explore undergraduate nursing students’ experiences with escape room–style evaluations through qualitative interviews. A descrip