Absence of Stressful Conditions Accelerates Dexterous Skill Acquisition in Surgery

Pavlidis, Ioannis; Zavlin, Dmitry; Khatri, Ashik; Wesley, Amanveer; Panagopoulos, George; Echo, Anthony

doi:10.1038/s41598-019-38727-z

Cited by 21 publications

(29 citation statements)

References 22 publications

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“…Preliminary studies show the detrimental effect of external stressors and cognitive distraction to the accuracy of microsurgical performance [ 38 ]. Simulation assists learners to become more dexterous and competent in controlling their level of anxiety or stress [ 39 ], thus decreasing hand tremor and improving their overall performance in simulated settings [ 40 ]. As a result, trainees begin being capable of handling challenging situations in the real clinical environment.…”

Section: Resultsmentioning

confidence: 99%

Superiority of living animal models in microsurgical training: beyond technical expertise

et al. 2021

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Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.

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Section: Resultsmentioning

confidence: 99%

Superiority of living animal models in microsurgical training: beyond technical expertise

et al. 2021

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“…Participant performance was also measured by an independent assessor using the validated OSATS suggesting that the simulator could be easily incorporated into surgical training evaluation. 31…”

Section: Discussionmentioning

confidence: 99%

Simulating the IMA Recipient Site for DIEP Flap Surgery: A New Model for Dynamic Microsurgery Simulation with Real-Time Respiration and a Pilot Study

Ziolkowski

Sun

McMillan

et al. 2022

J Reconstr Microsurg

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Background Breast reconstruction (BR) using autologous free flaps has been shown to have numerous psychosocial and quality-of-life benefits. Unfortunately, the microsurgical learning curve is quite steep due to some unique operative challenges. Currently, there is no realistic simulation model that captures real-life respiratory excursion and the depth of internal mammary vessels within the compact recipient site. The purpose of this study was to delineate intraoperative measurements of depth and motion, describe the resulting simulation model, and conduct a pilot study evaluating the simulator as an educational resource. Methods This is a single-center, ethics-approved study. For the intraoperative measurements, all consecutive patients undergoing free flap BR using internal mammary vessels as recipients were recruited. Patient and intraoperative factors as well as intraoperative measurements were recorded. A dynamic model was developed based on intraoperative parameters. For the pilot study, plastic and reconstructive surgery trainees were recruited to complete a hand-sewn internal mammary artery (IMA) anastomosis using the new simulator and completed objective questionnaires pre- and postsimulation. Subjective feedback was recorded and themes determined. Results Fifteen operative sites were analyzed. Flap pocket was found to be between 4 and 5 cm in depth with vertical excursion of 3.7 ± 1.0mm and a respiratory rate of 9 to 14 breaths/minute. Previous radiation, rib space, body mass index (BMI), blood pressure, heart rate, tidal volume, and respiratory rate showed no correlation to vessel depth/excursion. Laterality, rib space, BMI, radiation, vitals, and tidal volume had no correlation with vessel movement. Twenty-two trainees were included in the pilot. An increase in confidence and mixed results for anxiety was reported. Conclusion This study reports a novel microsurgical simulation model that provides a realistic deep inferior epigastric perforator free flap BR IMA anastomosis experience. It replicates movement of vessels in situ with real-time respiratory excursion and similar physical structures of the internal mammary system. This model shows promising results for increased use in microsurgical education.

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“…These subjective variables would be interesting to assess in subsequent studies as well in the surgical field. We believe that GEN could decrease students' anxiety when learning advanced suturing techniques compared to the traditional method [39]. In our study, we will assess user experience on GEN using the System Usability Scale.…”

Section: Study Limitationsmentioning

confidence: 99%

An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial

Guérard-Poirier¹,

Beniey²,

Meloche-Dumas³

et al. 2020

JMIR Res Protoc

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Background Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training. Objective Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students’ ability to identify and perform the correct technique. We will also assess the students’ satisfaction with regard to GEN. Methods We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students’ ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students’ acceptance of the intervention. Results The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet. Conclusions Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative. Trial Registration ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499 International Registered Report Identifier (IRRID) PRR1-10.2196/21273

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Absence of Stressful Conditions Accelerates Dexterous Skill Acquisition in Surgery

Cited by 21 publications

References 22 publications

Superiority of living animal models in microsurgical training: beyond technical expertise

Superiority of living animal models in microsurgical training: beyond technical expertise

Simulating the IMA Recipient Site for DIEP Flap Surgery: A New Model for Dynamic Microsurgery Simulation with Real-Time Respiration and a Pilot Study

An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial

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