Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study

Jukes, Alistair; Mascarenhas, Annika; Murphy, Jae; Stepan, Lia; Muñoz, Tamara N.; Callejas, Claudio; Valentine, Rowan; Wormald, Peter‐John; Psaltis, Alkis J.

doi:10.1002/alr.21941

Cited by 16 publications

(15 citation statements)

References 51 publications

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“…Demographic details are presented in Table 1. An average of 12 surgeons participated per session (range [7][8][9][10][11][12][13][14][15][16][17][18][19]. A mixture of residents of all levels (n = 43, 59.7%) and attendings (n = 29, 40.3%) participated.…”

Section: Resultsmentioning

confidence: 99%

“…9 These models provide the opportunity for high-fidelity simulation, including simulated or real vital sign responses to acute hemorrhage 10 and team-based simulations. 11 Despite the increasing popularity of these models, it remains unknown whether these models can be feasibly implemented on a larger scale, how costly they are, and how to determine trainee success. We sought to answer these questions using our objectively validated perfused cadaveric model of ICAI, a component of our cadaveric skills curriculum.…”

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confidence: 99%

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Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

Donoho

Johnson

Hur

et al. 2019

Int Forum Allergy Rhinol

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Background: Internal carotid artery injury (ICAI) is a rare, life-threatening complication of endoscopic endonasal approaches (EEAs). High-fidelity simulation methods exist, but optimization of the training cohort, training paradigm, and costs of simulation training remain unknown.Methods: Using our previously validated, high-fidelity, perfused-cadaver model, participants a empted to manage a simulated ICAI. A er a brief instructional video and coaching, the simulation was repeated. Training success was defined as successful ICAI control on the second a empt a er failure on the initial a empt. Marginal costs were measured.Results: Seventy-two surgeons participated in the standardized simulation, which lasted ࣘ15 minutes. The marginal cost of simulation was $275.00 per surgeon. A total of 44.4% (n = 32) succeeded on the first a empt before training (previously proficient); 44.4% (n = 32) failed the first a empt, but succeeded a er training (training successes); and 11.1% (n = 8) failed both a empts. The cost per training success was $618.75. Forty-two surgeons had never treated an ICAI, with 24 becoming training successes (57.1% overall, 82.8% when excluding previously proficient surgeons). Twenty-nine had experienced a real or simulated ICAI, with 8 (27.6% overall, 72.7% excluding previously proficient surgeons) becoming training successes. The cost per training success was lowest in the ICAI-naive group ($481.25) and highest among surgeons with simulated and real ICAI experience ($1650). Conclusions:Surgeons can be trained to manage ICAI in a single, brief, low-cost session. Although all groups improved, training an ICAI-naive or resident cohort may maximize training results. A perfused-cadaver model is a reproducible, realistic, and low-cost method for training surgeons to manage life-threatening ICAI during an EEA. C 2019 ARS-AAOA, LLC. How to Cite this Article: Donoho DA, Johnson CE, Hur KT, et al. Costs and training results of an objectively validated cadaveric perfusionbased internal carotid artery injury simulation during endoscopic skull base surgery. Int Forum Allergy Rhinol. 2019;9:787-794.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

Donoho

Johnson

Hur

et al. 2019

Int Forum Allergy Rhinol

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“…Furthermore, this model incorporates the animal's innate haemostatic mechanisms to increase the reality of the simulation [32,33]. The results of the latest study by Jukes et al suggest that participants find the course realistic, that it is able to induce a stress response and that it provides participants with an increased level of confidence in their ability to deal with major vessel bleeding in an endoscopic environment [34]. However, it is important to note that this model is a hybrid that utilises the sinonasal anatomy of a physical model coupled with the vasculature of the sheep neck following neck dissection.…”

Section: Animal Modelsmentioning

confidence: 99%

Rhinology: Simulation Training (Part 2)

Tornari

Tedla

Šurda

2020

Curr Otorhinolaryngol Rep

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Purpose of Review Recently, there has been an expansion of novel technologies in simulation training. The aim of this review was to examine existing evidence about training simulators in rhinology, their incorporation into real training programmes and translation of these skills into the operating room. The first part focuses on the virtual and augmented reality simulators. The second part describes the role of physical (i.e. non-computer-based) models of endoscopic sinus surgery. Recent Findings We learned that an ideal sinus surgery model would score highly in all standard measures of validity whilst maintaining an attainable cost. This is a challenging goal that is worthy of pursuit given that simulation training has been shown to be cost-effective option in other domains. Non-AR or VR models are attractive ways to fill gaps in simulation training whilst reducing compared with computer-based models. Summary In an era of improved computer technology and improved 3D printing, it will be increasingly important to focus on both the manufacture and validation process. One area that will benefit from further technological advancement is the realistic simulation of bleeding as this would obviate the need for animal models. Future studies on ESS simulation will also need to robustly demonstrate the validity of each model with the emphasis on the ability of a model to predict performance in operative environment.

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“…Surgical navigation (also known as image-guided surgery, or IGS) and augmented reality (AR) might be a way to overcome this problem. IGS provides a way for surgeons to track, during surgery, their instruments' tips relative to the preoperative imaging data (54) (sinus CT scan for example). Recently, IGS systems are being combined with AR, which fuses computer-generated images of preoperative imaging data with real-time views of the surgical field (57,58) .…”

Section: Navigation and Augmented Realitymentioning

confidence: 99%

Training in ENT; a comprehensive review of existing evidence

Šurda¹,

Barac²,

Deghani³

et al. 2018

RHINOL

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Despite an expansion of fellowship opportunities over the last three decades, there is still incomplete regulation and standardisation of fellowship training. The aim of this comprehensive review was to examine existing evidence about the ear, nose and throat (ENT) training, especially focused on surgical and non-surgical aspects of the training. It is challenging to critically evaluate and compare training programmes across nations for several reasons. Studies on the subject rely entirely on trainee self-reports, without any objective comparators between groups. No evidence exists that directly compares the theoretical or practical attainment of trainees between nations. More fundamentally, trainee exposure to, and competence in, elective surgical procedures, is not the sole measure of a training programme, nor can it be viewed in isolation from the health system's expectations of a newlyqualified specialist, which may vary. During recent years, the Internet and e-learning methods were implemented into the training curriculum. Also, there is an increasing number of platforms that can host the ENT learning content free of charge. Novel educational tools are powerful alternative to standard teaching techniques within otorhinolaryngology education for both residents and medical students. Overall evidence for virtual reality (VR) simulators could be implemented as adjunct in training programs but cannot replace conventional methods. This is mainly due to the fact that actual surgical outcomes after VR training have not been studied so far, but may be the content of future larger scale studies. The otolaryngologists' non-surgical training needs to extend beyond the limits of ENT as skills and experience in areas of ENT, respiratory medicine, allergology, infectious diseases, radiology and oncology are required in the diagnosis and management of ENT diseases.

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Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study

Abstract: Results from this study indicate that this highly realistic simulation model provides surgeons with an increased level of confidence in their ability to deal with the rare but potentially catastrophic event of major vessel injury in endoscopic skull-base surgery.

Cited by 16 publications

References 51 publications

Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

Costs and training results of an objectively validated cadaveric perfusion‐based internal carotid artery injury simulation during endoscopic skull base surgery

Rhinology: Simulation Training (Part 2)

Training in ENT; a comprehensive review of existing evidence

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