FLS Skill Retention (Learning) in First Year Surgery Residents

Edelman, David A.; Mattos, Mark A.; Bouwman, David L.

doi:10.1016/j.jss.2010.03.057

Cited by 58 publications

(11 citation statements)

References 13 publications

(21 reference statements)

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“…Yet, over a time frame measured in days, short breaks from cardiac surgery have been shown to substantially increase a cardiac surgeon's mortality rate in Taiwan possibly due to skill set degradation (Hockenberry, Lien, & Chou, ). Similar deterioration over slightly longer timeframes has been observed in other surgical specialties in the United States (Edelman, Mattos, & Bouwman, ; Sinha, Hogle, & Fowler, ).…”

supporting

confidence: 75%

The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California

Huesch¹

2014

Journal for Healthcare Quality

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The well-known "learning by doing" may operate in reverse as "forgetting after not doing." If so, patient outcomes such as length of stay (LOS) or mortality may be affected after a surgeon returns from a month-long vacation or break from surgery. In a small, exploratory and hypothesis-screening study, we examined all 56,956 patients undergoing isolated coronary artery bypass grafts (CABGs) in California in 2003-2005. We compared the outcomes of patients operated on by surgeons who had or had not performed any isolated CABG procedures in the calendar month prior to the month of their own surgery. Sensitivity analyses considered surgeons who had performed less than their own typical monthly workload, rather than none at all. We used multivariate regressions and controlled for patient risk factors and long-run surgeon average monthly volume. Patients operated on by surgeons who had not performed isolated CABG in the prior calendar month stayed in hospital 0.5 day longer (p = .037). This LOS difference was not robust to corrections for skewed data and in models correcting for clustering of patients within the practices of surgeons. There were no significant differences in hospital or 30-day mortality. These preliminary findings from a small, exploratory study suggest that short breaks by cardiac surgeons do not affect key patient outcomes. However, the patient safety ramifications of the underlying question deserve more research and more granular data to more convincingly rule out "forgetting" effects among physicians taking short breaks from practice.

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confidence: 75%

The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California

Huesch¹

2014

Journal for Healthcare Quality

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“…The development of robotic assistance will require the evaluation of specific modules of simulation or of robot learning, although the latter method seems difficult to organize because of logistical and financial constraints. The criteria of the FLS have appeared particularly suitable for interpreting the learning curve of novice students [8,9] even if we chose to modify certain parameters (fall of peg, more-than-300-second disqualifying test) to strictly adapt to the novice status of our students.…”

Section: Discussionmentioning

confidence: 99%

Role of robotic assistance in the learning of laparoscopy: Comparison of novice students’ results in two FLS trials

Frigenza¹,

Delotte²,

Fontas³

et al. 2013

OJOG

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Background: To investigate the learning curve of "robotic surgery" versus "conventional laparoscopy" in two trials of the FLS program in a population of medical students with no experience in laparoscopy. Methods: A prospective trial. Students, all novices in training and surgical practice, were randomized into 2 groups: the "traditional laparoscopy" group and the "robotic assistance" group. Students were evaluated during two tests from the FLS: peg transfer and intracorporeal knot tying. Results: The median laparoscopic knot completion time was significantly lower in the "robotic surgery" group (p = 0.038). Conclusions: Robotic assistance training in neophytes is effective in improving the completion time of laparoscopic knots.

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“…The FLS curriculum including the previous five tasks underwent a rigorous validation processes demonstrating its reliability (Vassiliou, Ghitulescu, Leffondré, Sigman, & Fried, 2006), construct validity (McCluney, et al, 2007), improved technical performance in the operating room as measured using a validated assessment tool (Sroka, Feldman, Vassiliou, Kaneva, Fayez, & G.M., 2010), and retention of learned skills (Edelman, Mattos,, & Bouwman, 2010). The Proficiency criteria were set (Fraser, Klassen, Feldman, Ghitulescu, Stanbridge, & Fried, 2003) and the FLS curriculum was endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American College of Surgeons (ACS).…”

Section: Related Workmentioning

confidence: 99%

Achieving interface and environment fidelity in the Virtual Basic Laparoscopic Surgical Trainer

Chellali

Mentis

Miller

et al. 2016

International Journal of Human-Computer Studies

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Virtual reality trainers are educational tools with great potential for laparoscopic surgery. They can provide basic skills training in a controlled environment and free of risks for patients. They can also offer objective performance assessment without the need for proctors. However, designing effective user interfaces that allow the acquisition of the appropriate technical skills on these systems remains a challenge. This paper aims to examine a process for achieving interface and environment fidelity during the development of the Virtual Basic Laparoscopic Surgical Trainer (VBLaST). Two iterations of the design process were conducted and evaluated. For that purpose, a total of 42 subjects participated in two experimental studies in which two versions of the VBLaST were compared to the accepted standard in the surgical community for training and assessing basic laparoscopic skills in North America, the FLS box-trainer. Participants performed 10 trials of the peg transfer task on each trainer. The assessment of task performance was based on the validated FLS scoring method. Moreover, a subjective evaluation questionnaire was used to assess the fidelity aspects of the VBLaST relative to the FLS trainer. Finally, a focus group session with expert surgeons was conducted as a comparative situated evaluation after the first design iteration. This session aimed to assess the fidelity aspects of the early VBLaST prototype as compared to the FLS trainer. The results indicate that user performance on the earlier version of the VBLaST resulting from the first design iteration was significantly lower than the performance on the standard FLS box-trainer. The comparative situated evaluation with domain experts permitted us to identify some issues related to the visual, haptic and interface fidelity on this early prototype. Results of the second experiment indicate that the performance on the second generation VBLaST was significantly improved as compared to the first generation and not significantly different from that of the standard FLS box-trainer. Furthermore, the subjects rated the fidelity features of the modified VBLaST version higher than the early version. These findings demonstrate the value of the comparative situated evaluation sessions entailing hands on reflection by domain experts to achieve the environment and interface fidelity and training objectives when designing a virtual reality laparoscopic trainer. This suggests that this method could be used successfully in the future to enhance the value of VR systems as an alternative to physical trainers for laparoscopic surgery skills. Some recommendations on how to use this method to achieve the environment and interface fidelity of a VR laparoscopic surgical trainer are identified.

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FLS Skill Retention (Learning) in First Year Surgery Residents

Cited by 58 publications

References 13 publications

The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California

The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California

Role of robotic assistance in the learning of laparoscopy: Comparison of novice students’ results in two FLS trials

Achieving interface and environment fidelity in the Virtual Basic Laparoscopic Surgical Trainer

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