EP.TU.153Face to face teaching in the covid era: Basic Surgical Skill Development

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.

Aim Simulation-based surgical education in the form of an Escape room is a well-published method of teaching surgical content and skills. However, little has been published on the use of Kirkpatrick model in the design of basic surgical skills as part of foundation doctors’ induction. We wanted to evaluate the use of an educational escape room for teaching surgical skills as part of foundation doctors’ induction. Method We designed and implemented an escape room for the Induction programme of Foundation Year One doctors in the United Kingdom at our local district general hospital. In groups, the doctors had to work through several tasks including gowning and gloving, knot tying and suturing in order to "escape the room". Pre- and post-session feedback were collected as surveys using Likert scale and semi-structured free-text questions were thematically analysed. Kirkpatrick model was used as a method of designing and evaluating the study. Results In total, 11/24 participants completed the feedback forms. On a scale of 1-5 where 1 is strongly agree and 5 is strongly disagree, 9/11 agreed they found escape rooms as a useful method for learning, and 10/11 understood how to scrub in, placing interrupted sutures; all felt confident in putting a hand-tie. Participants highly recommended this for future training. We were unable to evaluate longer term wider impact of this project within the wider surgical team. Conclusions Our pilot study indicates that the Kirkpatrick model is useful in the design and evaluation of in the use of Escape room in teaching basic surgical skills induction.

Objective This study aimed to compare the difference between the performance of medical students and young residents during the laparoscopic simulation training in basic laparoscopic procedures, and providing objective data for simulation training in basic laparoscopic procedures. Methods By comparing the task completion time and errors of medical students and young residents on transferring, accurate positioning, cutting, knotting, suturing and knotting, and analysis of learning curves were done. Results After 10 times of training, the scores in the training tasks of transferring, accurate positioning, cutting, knotting, suturing and knotting in group A and group B were as follows: (89.81±2.07) vs (93.91±3.46), (89.00±6.39)vs(91.21±6.69), (84.35±5.94)vs(86.69±6.46), (93.88±3.01) vs(93.51±2.65), (87.34±3.22)vs(92.09±4.10). No significant differences were observed between group A and group B in the training tasks of accurate positioning, cutting and knotting (P>0.05). However, significant statistical differences existed between group A and group B in the tasks of transferring and suturing and knotting (P<0.05). In learning curve, the performance of the participants from group A and group B demonstrated the form of inverse curve in the tasks of transferring, knotting, and suturing and knotting, while the performance of both groups linearly increased in the tasks of accurate positioning and cutting. Conclusions The basic laparoscopic skills of group A and group B improved significantly by means of simulation training. Through repetitive training, the performance of group A can reach the level of group B in the tasks of accurate positioning, cutting and knotting. Both groups had reached the plateau in the tasks of transferring, knotting, and suturing and knotting, whereas their performance was still in the growth stage in the tasks of accurate positioning and cutting. Key words: Basic laparoscopic surgical skills; Simulation training; Learning curves

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.

Computer-based surgical training simulators are instrumental in skill-based training and performance measurement. However, to date, the educational employment of these tools lacks empirically founded insights and effective practical guidelines. This study examined surgical residents during computer-based simulator training of basic laparoscopic surgical skills. The quantitative analysis of residents’ performance averages from training onset to completion produced mixed results, revealing skill improvements as well as decreases, depending on the parameter. The results obtained from the simulator parameters and questionnaires showed that residents with either prior laparoscopic experience or gaming experience significantly outperformed their colleagues. Based on feedback and video-recorded performance analysis, the study concluded that autonomous training with the simulator is not sufficient for developing a minimum standard of performance. Residents need an adequate level of content-based feedback and supervisor support during training. We advise a more detailed and pedagogically informative measurement and feedback system, including specialist-instructor guidance, be developed.

Introduction : Patient safety is the important priority in surgical education. The new training models and curriculum are needed for maintaining safety and quality of surgical performance. An established laparoscopic surgical skill(LSS) grade 1 level 1 programme running for surgical residents is being already taken up in various european countries under the support of European Association of Endoscopic Surgeons. Aim : The aim of the paper is to evaluate the perception of surgery residents on LSS Grade 1 Level 1 course in South India. Material and methods : A total of 5 accredited LSS Grade I Level 1 courses were held in GSL SMART LAB between April 2013 and December 2016. The demographic data and pre-course surgical experience in laparoscopic surgery of the participants were recorded. After completion of 12 hrs practice on endotrainer and lap mentor combined, the participants attended two days of basic laparoscopic surgical skill programme with different modes of assessment/examination related to basic laparoscopic skills. The participants filled the course evaluation form to evaluate course progress, course materials, assessment, staff, course location and overall impression of the course on a 1-10 scale to evaluate feedback information. Results : 34 surgery residents were enrolled in an LSS Grade I Level 1 programme. The mean age of the participants was 28.294 years (SD = 3.51), the male/female ratio was 31/3 and previous experience with laparoscopic surgery was limited. Overall impression of the course was rated with 8.8 points (SD = 0.78). The applicability of the course content in practice and the balance between theory and hands-on training were also rated very well – mean 8.8 (SD = 1.01) and 8.1 points (SD = 0.80) respectively. Conclusions : The result of this study shows that the course is a well balanced training programme, meeting the expectations of individual surgery residents. Hence, the overall interest in the programme suggests that it might become the future Indian standard of surgical education in laparoscopic surgery. Success of the course may be drawn after the completion of clinical assessment of enrolled participants.

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.

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.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery as a Rescue for Total Vaginal Hysterectomy

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.

Traditional surgical training faces challenges related to sustainability, cost, and ethical considerations. Limited access to resources, ethical concerns about cadaver-based learning, limited availability of surgical cases, and the high costs associated with hands-on training impede the effectiveness and accessibility of surgical education. Despite these challenges, the need for direct tactile experience remains critical, as it fosters the development of essential motor skills and tactile abilities vital for surgical practice. However, advancements in immersive technologies such as virtual reality (VR), augmented reality (AR), and haptics offer a promising solution to address these challenges. VR and AR technologies offer realistic, controlled environments where learners can visualise anatomical structures and practice surgical procedures without risks. The integration of haptic feedback in these immersive simulations further enriches the learning process by adding the sense of touch and physical interaction, aiding in mastering critical surgical skills. The incorporation of immersive technologies in surgical training presents an opportunity to address the constraints of conventional methods. These technologies offer the possibility of creating platforms that replicate real-life surgical scenarios, allowing learners to hone their skills and build confidence in a safe and controlled environment. Moreover, immersive learning offers an ethical alternative to cadaver-based training and extends access to training materials irrespective of geographical limitations. Such an approach allows for step-based training, where students may begin acquiring skills through immersive learning, then move to special surgical simulators, and finally to patients. This article deals with the impact of immersive technologies such as VR, AR, and haptics on reshaping conventional surgical training, by focusing specifically on basic surgical skills. Targeting educators, medical experts, and involved parties, the article aims to stimulate additional exploration and adoption of immersive technologies to elevate surgical competencies and patient care standards.

Background: To evaluate the effectiveness of surgical skills training for wound debridement using animal tissue as simulator.Methods: House officers (HOs), Senior House officers (SHOs) and Medical Officers (MOs) were taught basic surgical skills during a 3-day intensive course at the Tamale Teaching Hospital Basic Surgical Skills Training centre. Wound debridement forms part of thetraining. Results of treatment of dirty wounds by participants were compared with those of a control group.Results: Eighty-three (83) patients with dirty wounds were randomised for treatment by the study group and the control group. General characteristics of patients in both groups were comparable: the median age was 25.5±13.1SD; sex and age was similar between groups. Wound infection was found in 3(7.9%) patients treated by simulation-trained participants and 18 (40%) patients in the control group p&lt;0.0001. Simulationtrained doctors prescribed antibiotic for less than five days in 33 (86.8%), as compared to 2 (4.4%) in the control group (p&lt;0.001). Mean hospital stay in the study group and control group was 1.55 ± 2.35 and 2.29 ± 1.16 days respectively (p=0.07). Conclusion: Surgical skills training for wound debridement, using animal tissue as simulator is effective. It is suggested that all HOs, SHOs and MOs should undergo similar training before undertaking any surgical rotation or before they start surgical residency.Simulation of surgical procedures using animal tissues, if incorporated at each level of the curriculum, would make significant impact.

Use of a Novel Measure of Nontechnical Skills in Surgical Trainees: Is There an Association With Technical Skills Performance?

Video assessment of basic surgical trainees' operative skills

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.