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Surgical Skills (surgical + skill)

Distribution by Scientific Domains

Medical Sciences	96%

Selected Abstracts

Program Directors' Opinions about Surgical Competency in Otolaryngology Residents

THE LARYNGOSCOPE, Issue 7 2005
FRCSC, M M. Carr DDS
Abstract Objectives: The purpose of this study was to determine whether certain surgical procedures could be used as benchmark skills to monitor resident progress in developing surgical competency. Study Design: Survey. Methods: A two-stage survey was sent to otolaryngology residency program directors in the United States. Respondents were given a list of otolaryngology surgical procedures monitored by the American Board of Otolaryngology (ABO) and were asked to indicate whether they felt residents should be able to do each as a primary surgeon. The appropriate level of training for competency in each procedure and estimated number of procedures to competency was indicated by respondents. Results: Respondents selected 16 common procedures they felt residents at different levels of training should be able to perform independently. There were discrepancies between estimated number of procedures needed for competence and the numbers reported by ABO graduates. Conclusions: Surgical skill is one aspect of clinical competency, and this indicates agreement among program directors with regard to a set of benchmark skills we can use for concentrated evaluation efforts. [source]

Surgical skills training: simulation and multimedia combined

MEDICAL EDUCATION, Issue 9 2001
Roger Kneebone
Context Basic surgical skills are needed throughout the medical profession, but current training is haphazard and unpredictable. There is increasing pressure to provide transparency about training and performance standards. There is a clear need for inexperienced learners to build a framework of basic skills before carrying out surgical procedures on patients. Effective learning of a skill requires sustained deliberate practice within a cognitive framework, and simulation offers an opportunity for safe preparation. Objectives This paper presents a new approach to basic surgical skills training, where tuition using a specially designed computer program is combined with structured practice using simulated tissue models. This approach to teaching has evolved from practical experience with surgical skills training in workshops. Methods Pilot studies with 72 first-year medical students highlighted the need for separate programs for teaching and for self-directed learning. The authors developed a training approach in the light of this experience. Subsequent in-depth observational and interview studies examined (a) individual teaching sessions between surgical teachers and learners (five consultant surgeons and five senior house officers) and (b) group teaching sessions with general practitioners (14 participants in three group interviews). Further work has resulted in a self-directed learning program. Conclusions Qualitative analysis of observational and interview data provides strong preliminary support for the effectiveness of this approach. The response of teachers and learners was extremely positive. The combination of information (presented by computer) and practice of psychomotor skill (using simulated tissue models) could be extended to other surgical and practical skills. [source]

Anatomy of Complications Workshop: An educational strategy to improve performance in obstetricians and gynaecologists

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2003
Ian Hammond
Abstract Many specialist obstetricians and gynaecologists feel inadequately trained to deal with certain situations such as injury to bowel, bladder, ureter and major vessels, and value further training to prevent and manage these problems. We present the structure, objectives and rationale for a surgical skills workshop, which is an intensive practical learning experience aimed to improve the performance of obstetricians and gynaecologists. The overall objective of the workshop is improvement in the prevention and management of complications in obstetric and gynaecological surgery. Over 100 participants have completed the workshop so far. Pre-workshop preparation includes anatomical illustrations to guide reading and a training video describing surgical skills, ewe anatomy and hysterectomy in the ewe. There are four modules: anatomy includes an interactive lecture, cadaveric dissection and examination of prosections with specific learning tasks. Surgical skills involves the demonstration, practice and learning of techniques needed to deal with unexpected operative injury to bowel, bladder, ureter and major blood vessels. Live animal surgery on a ewe allows further supervised practice of the previously learned skills plus the repair of serious vascular injury. Case presentations allow each participant to present a complicated case in a facilitated group session with discussion and feedback from their peers. This session is controlled, non-threatening and a valuable interactive learning experience. Participant feedback suggests that this workshop format is useful and appears to improve the confidence, competence and performance of the participants. This workshop is presented as a template on which other educational activities can be developed. [source]

Perioperative fluid management: prospective audit

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2008
S. R. Walsh
Summary Background:, Postoperative fluid management is a core surgical skill but there are few data regarding current fluid management practice and the incidence of potential fluid-related complications in general surgical units. We conducted a prospective audit of postoperative fluid management and fluid-related complications in a consecutive cohort of patients undergoing midline laparotomy. Methods:, Over a 6-month period, the peri-operative fluid management of 106 consecutive patients was prospectively audited. Serum electrolyte data, fluid balance data, co-morbidities, operative and anaesthetic variables and quantities of fluid and electrolytes prescribed were recorded. The development of fluid-related and other complications was noted. Results:, There were no correlations between routinely available fluid balance parameters and the quantities of fluid and electrolytes prescribed, suggesting that doctors do not consult fluid balance data when prescribing. Fifty-seven patients (54%) developed at least one fluid-related complication. These patients received significantly greater volumes of fluid and sodium each day postoperatively. They had higher rates of other non-fluid-related complications and death. They had a longer hospital stay. In a multivariate model, mean daily fluid load predicted the development of fluid-related complications. Conclusion:, Fluid prescription practice in general surgical units is sub-optimal, resulting in avoidable iatrogenic complications. Involvement of senior staff, education and possibly the introduction of prescribing protocols may improve the situation. [source]

Attitudes towards skills examinations for basic surgical trainees

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2005
S.D. Bann
Summary Objective measures of surgical skill and cognition are becoming available. A questionnaire study examining surgeons' beliefs towards a skills-based examination, current standards and possible benefits was devised. Three hundred pairs of standardised anonymous questionnaires were sent to consultants and their basic surgical trainees (BSTs) irrespective of surgical speciality. Responses were requested using a Likert scale (1,5, 3 = neutral response). Two-hundred and two replies were received (including 54 pairs). BST experience ranged from 6 to 60 months (mean 24 months). When questioned regarding current training in basic surgical skills, only 34% believed that they were given adequate training at present. Sixty-four per cent of respondents believed the introduction of a skills examination would raise standards and 66% believed it necessary. Eighty-three per cent of respondents believed that they or their BST would practice these skills, if an examination were introduced and 85% wanted or would provide dedicated teaching time for this. However, 68% had no access to a dedicated skills facility, and uptake of these, where available, was variable. When questioned about their ability to perform the six appropriate tasks, there was a poor correlation of scoring between the groups. Consultants and their BSTs do not believe that they are given adequate training in basic skills. The introduction of an examination would lead to practice of these skills and is seen as a positive move. [source]

Electromagnetic motion analysis in the assessment of surgical skill: Relationship between time and movement

ANZ JOURNAL OF SURGERY, Issue 9 2002
Sean Mackay
Introduction: Electromagnetic motion analysis is a promising method of assessing surgical skill in a skills-laboratory setting. There is a very strong correlation between movement and time data, and this study was conducted to determine whether this relationship is fixed, or whether it can vary. Methods : After a pilot study, four subjects were recruited. Each performed 30 trials of a simple standardized suturing task, alternating between ,normal', ,precise', and ,fast' strategies. The number of movements, and time to complete each task were recorded. Results: Comparing the ,fast' to ,normal' strategies, there was a significant decrease in total number of movements per trial (P < 0.001), and time taken (P < 0.001). Regression analysis was performed to examine the relationship between the time taken and the number of movements, and revealed significant differences between both the fast (P = 0.006), and precise (P = 0.002) strategies, when compared to the normal strategy. Discussion: This study confirms that the relationship between time and movements is not fixed, but varies with the operative strategy adopted for this simple suturing task. [source]

Virtual reality simulators: Current status in acquisition and assessment of surgical skills

ANZ JOURNAL OF SURGERY, Issue 1 2002
Peter H. Cosman
Medical technology is currently evolving so rapidly that its impact cannot be analysed. Robotics and telesurgery loom on the horizon, and the technology used to drive these advances has serendipitous side-effects for the education and training arena. The graphical and haptic interfaces used to provide remote feedback to the operator , by passing control to a computer , may be used to generate simulations of the operative environment that are useful for training candidates in surgical procedures. One additional advantage is that the metrics calculated inherently in the controlling software in order to run the simulation may be used to provide performance feedback to individual trainees and mentors. New interfaces will be required to undergo evaluation of the simulation fidelity before being deemed acceptable. The potential benefits fall into one of two general categories: those benefits related to skill acquisition, and those related to skill assessment. The educational value of the simulation will require assessment, and comparison to currently available methods of training in any given procedure. It is also necessary to determine , by repeated trials , whether a given simulation actually measures the performance parameters it purports to measure. This trains the spotlight on what constitutes good surgical skill, and how it is to be objectively measured. Early results suggest that virtual reality simulators have an important role to play in this aspect of surgical training. [source]

Effects of Screw Eccentricity on the Initial Stability of the Acetabular Cup in Artificial Foam Bone of Different Qualities

ARTIFICIAL ORGANS, Issue 1 2010
Jui-Ting Hsu
Abstract Acetabular cup loosening is one of the major failure models of total hip replacement (THR), which is mostly due to insufficient initial stability of the cup. Previous studies have demonstrated that cup stability is affected by the quality of the host bone and the surgical skill when inserting screws. The purpose of this study was to determine the effects on the initial stability of the acetabular cup of eccentric screws in bone of different qualities. In this study, hemispherical cups were fixed into bone specimens constructed from artificial foam with three elastic moduli using one to three screws. The effects of two types of screw eccentricity (offset and angular) on the stability of the acetabular cup were also evaluated. The experimental results indicate that in the presence of ideal screwing, the cup was stable in bone specimens constructed from foam with the highest elastic modulus. In addition, increasing the number of ideal screws enhanced the cup stability, especially in bone specimens constructed from soft foam. Moreover, the cup stability was most affected by offset eccentric screw(s) in the hard-foam bone specimens and by angular eccentric screw(s) in the soft-foam bone specimens. The reported results indicate that the presence of screw eccentricity affects the initial stability of the acetabular cup. Surgeons should keep this in mind when performing screw insertions in THR. However, care is necessary when translating these results to the intraoperative situation due to the experiments being conducted under laboratory conditions, and hence, future studies should attempt to replicate the results reported here in vivo. [source]

Reaction time does not predict surgical skill

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2003
J. Shah
Fast is not always best [source]

Assessing competency in Dentoalveolar surgery: a 3-year study of cumulative experience in the undergraduate curriculum

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2007
J. A. Durham
Aim:, To assess and observe the development of competence in oral surgical skills during a 3-year undergraduate programme. Method:, Over a 3-year period 75 students were followed through from the beginning of their clinical course to their Bachelor of Dental Surgery graduation and their surgical experience monitored by the use of logbooks. Their development of competence was assessed objectively through structured assessments and subjectively by a single tutor responsible for each year. Assessments were made of their ability in exodontia, pre-surgical assessment and the surgical extraction of teeth/roots. Results:, Seventy-three students completed the course (97%). Successful completion rates for the objective testing were 100% for both exodontia and pre-surgical assessment. The surgical assessment, (surgical extraction of a tooth or root) had a successful completion rate of only 23% and the caseload for students was low with a mean of four teeth removed surgically upon graduation. Relationships were examined between total numbers of teeth extracted, total number of minor oral surgical procedures completed and the successful completion of the surgical competence assessment, but no significant relationships were found. Conclusions:, This study demonstrates that it is possible to achieve objectively measurable levels of competence in undergraduates undertaking oral surgery procedures. It is however, a labour and time intensive process and appropriate clinical and teaching resources are required. National co-operation towards agreed standardised competencies should be encouraged to allow data to be pooled and more powerful analyses to occur. [source]

The need for venovenous bypass in liver transplantation

HPB, Issue 3 2008
Hamidreza Fonouni
Abstract Since introduction of the conventional liver transplantation (CLTx) by Starzl, which was based on the resection of recipient inferior vena cava (IVC) along the liver, the procedure has undergone several refinements. Successful use of venovenous bypass (VVB) was first introduced by Shaw et al., although in recent decades there has been controversy regarding the routine use of VVB during CLTx. With development of piggyback liver transplantation (PLTx), the use of caval clamping and VVB is avoided, leading to fewer complications related to VVB. However, some authors still advocate VVB in PLTx. The great diversity among centers in their use of VVB during CLTx, or even along the PLTx technique, has led to confusion regarding the indication setting for VVB. For this reason, we present an overview of the use of VVB in CLTx, the target of patients for whom VVB could be beneficial, and the needs assessment of VVB for patients undergoing PLTx. Recent studies have shown that with the advancement of surgical skills, refinement of surgical techniques, and improvements in anesthesiology, there are only limited indications for doing CLTx with VVB routinely. PLTx with preservation of IVC can be performed in almost all primary transplants and in the majority of re-transplantations without the need for VVB. Nevertheless, in a few selective cases with severe intra-operative hemodynamic instability, or with a failed test of transient IVC occlusion, the application of VVB is still justifiable. These indications should be judged intra-operatively and the decision is based on each center's preference. [source]

Attitudes towards skills examinations for basic surgical trainees

Surgical skills training: simulation and multimedia combined

Graphic and haptic modelling of the oesophagus for VR-based medical simulation

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 3 2009
Changmok Choi
Abstract Background Medical simulators with vision and haptic feedback have been applied to many medical procedures in recent years, due to their safe and repetitive nature for training. Among the many technical components of the simulators, realistic and interactive organ modelling stands out as a key issue for judging the fidelity of the simulation. This paper describes the modelling of an oesophagus for a real-time laparoscopic surgical simulator. Methods For realistic simulation, organ deformation and tissue cutting in the oesophagus are implemented with geometric organ models segmented from the Visible Human Dataset. The tissue mechanical parameters were obtained from in vivo animal experiments and integrated with graphic and haptic devices into the laparoscopic surgical simulation system inside an abdominal mannequin. Results This platform can be used to demonstrate deformation and incision of the oesophagus by surgical instruments, where the user can haptically interact with the virtual soft tissues and simultaneously see the corresponding organ deformation on the visual display. Conclusions Current laparoscopic surgical training has been transformed from the traditional apprenticeship model to simulation-based methods. The outcome of the model could replace conventional training systems and could be useful in effectively transferring surgical skills to novice surgeons. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Advanced da Vinci surgical system simulator for surgeon training and operation planning

THE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 3 2007
L. W. Sun
Abstract Background Although patients benefit considerably from minimally invasive surgery, the use of new instruments such as robotic systems is challenging for surgeons, and extensive training is required. Method We developed a computer-based simulator of the da Vinci Surgical System, modelling the robot and designing a new interface. Results The simulator offers users a two-handed interface to control a realistic model of the da Vinci robot. The simulator can be applied (i) to provide an environment in which to practice simple surgical skills and (ii) to serve as a visualization platform on which to validate port placement and robot pose for operation planning. Conclusions Virtual reality is a useful technique for medical training. The simulator is currently in its early stages, but this preliminary work is promising. Copyright © 2007 John Wiley & Sons, Ltd. [source]

ORIGINAL RESEARCH,INTERSEX AND GENDER IDENTITY DISORDERS: A Report from a Single Institute's 14-Year Experience in Treatment of Male-to-Female Transsexuals

THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
Ciro Imbimbo MD
ABSTRACT Introduction., Gender identity disorder or transsexualism is a complex clinical condition, and prevailing social context strongly impacts the form of its manifestations. Sex reassignment surgery (SRS) is the crucial step of a long and complex therapeutic process starting with preliminary psychiatric evaluation and culminating in definitive gender identity conversion. Aim., The aim of our study is to arrive at a clinical and psychosocial profile of male-to-female transsexuals in Italy through analysis of their personal and clinical experience and evaluation of their postsurgical satisfaction levels SRS. Methods., From January 1992 to September 2006, 163 male patients who had undergone gender-transforming surgery at our institution were requested to complete a patient satisfaction questionnaire. Main Outcome Measures., The questionnaire consisted of 38 questions covering nine main topics: general data, employment status, family status, personal relationships, social and cultural aspects, presurgical preparation, surgical procedure, and postsurgical sex life and overall satisfaction. Results., Average age was 31 years old. Seventy-two percent had a high educational level, and 63% were steadily employed. Half of the patients had contemplated suicide at some time in their lives before surgery and 4% had actually attempted suicide. Family and colleague emotional support levels were satisfactory. All patients had been adequately informed of surgical procedure beforehand. Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina's esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets. Conclusions., Our patients' high level of satisfaction was due to a combination of a well-conducted preoperative preparation program, competent surgical skills, and consistent postoperative follow-up. Imbimbo C, Verze P, Palmieri A, Longo N, Fusco F, Arcaniolo D, and Mirone V. A Report from a single institute's fourteen year experience in treatment of male-to-female transsexuals. J Sex Med 2009;6:2736,2745. [source]

An unrecognized contributor towards the introduction of surgical skills training

ANZ JOURNAL OF SURGERY, Issue 3 2010
Kamran Ahmed MRCS
No abstract is available for this article. [source]

Workplace-based assessment: assessing technical skill throughout the continuum of surgical training

ANZ JOURNAL OF SURGERY, Issue 3 2009
Jonathan Beard
Abstract The Royal Colleges of Surgeons and Surgical Specialty Associations in the UK have introduced competence-based syllabi and curricula for surgical training. The syllabi of the Intercollegiate Surgical Curriculum Programme (ISCP) and Orthopaedic Curriculum and Assessment Programme (OCAP) define the core competencies, that is, the observable and measureable behaviours required of a surgical trainee. The curricula define when, where and how these will be assessed. Procedure-based assessment (PBA) has been adopted as the principal method of assessing surgical skills. It combines competencies specific to the procedure with generic competencies such as safe handling of instruments. It covers the entire procedure, including preoperative and postoperative planning. A global summary of the level at which the trainee performed the assessed elements of the procedure is also included. The form has been designed to be completed quickly by the assessor (clinical supervisor) and fed-back to the trainee between operations. PBA forms have been developed for all index procedures in all surgical specialties. The forms are intended to be used as frequently as possible when performing index procedures, as their primary aim is to aid learning. At the end of a training placement the aggregated PBA forms, together with the logbook, enable the Educational Supervisor and/or Programme Director to make a summary judgement about the competence of a trainee to perform index procedures to a given standard. [source]

Virtual reality simulators: Current status in acquisition and assessment of surgical skills

Minimally invasive surgical technologies: Challenges in education and training

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010
J Sándor
Abstract The laparoscopic revolution has fundamentally changed surgical technology. However, this new technology, with its unique psychomotor adaptations, has been a challenge for both experienced and novice surgeons. This review summarizes the history of practical education and training methods and those currently used to ensure surgeons safely practice these new surgical skills. Traditional training boxes, augmented reality simulators and virtual reality simulators represent recently developed educational tools. There are objective programs that subsequently assess the results of training by these simulation methods. Additionally, the advent of robotics in laparoscopic surgery has been accompanied by the introduction of computer-based robotic surgical simulators. Surgical curricula should also include non-technical skills training, particularly as global certification of technical and non-technical surgical skills is expected in the near future. Ultimately, these new systems of surgical simulation contribute to a decrease in surgical error as well as with reduced morbidity and mortality. [source]

New horizons in simulation training for endoscopic surgery

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010
D. King
Abstract In recent years there has been both a paradigm shift in the way surgery is carried out and also in the way in which we train health professionals undertaking interventional procedures. Endoscopic procedures have replaced many traditional operations and the benefits of such an approach to patient care are well documented. However, evidence exists of higher patient complications during a surgeon's learning curve in endoscopic surgery, and it is now considered essential that endoscopic skills are learned in training laboratories rather than on patients. A new model of structured education, where surgical skills are practiced on models and virtual reality simulators, is set to replace the traditional apprenticeship model of training. Simulation is a rapidly evolving field that can provide a safe and increasingly realistic learning environment for trainees to practice in. This paper explores the current role of simulation in endoscopic training and provides a review of the developments in the field, including advances in simulation technology, progress in curriculum design and the use of simulation in nontechnical skills training. [source]

Survey of surgical skills of RANZCOG trainees

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009
Andreas OBERMAIR
Background: In Australia, the Integrated Training Program (ITP) of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) offers training in obstetrics and gynaecology. There is anecdotal concern among trainees and Fellows that the surgical component of training is inadequate, with new specialists lacking the confidence and competence to perform many ,standard' surgical procedures. These concerns have not previously been quantified in Australia and New Zealand. Aim: To determine trainees' subjective competence and confidence with surgical procedures and trainees' satisfaction with their surgical training. Methods: All 430 active RANZCOG trainees and 108 Fellows elevated within the previous two years were invited to complete a self-administered questionnaire (65% response rate), which assessed details of procedures performed and confidence to perform them; satisfaction with the surgical training; and perceived teaching ability of the supervising consultants. Results: Those in ITP year 6 rated their confidence high (, 4 of 5) for procedures performed very frequently, but lower for other procedures. No procedure regarding the management of complications reached a confidence score of , 4. Teaching abilities were rated best for obstetric procedures, with 54% rating their consultants' teaching ability as ,excellent'; but for laparoscopic procedures and procedures dealing with complications, 21.2% and 23.4% of respondents rated their consultants' teaching ability as ,poor', respectively. Conclusions: Advanced trainees lacked confidence in a range of surgical procedures; and possible weaker areas were identified in the teaching experience of trainers. These limitations must be addressed by medical educators and training program coordinators. [source]

Anatomy of Complications Workshop: An educational strategy to improve performance in obstetricians and gynaecologists

Galen and his anatomic eponym: Vein of Galen

CLINICAL ANATOMY, Issue 6 2004
Cagatay Ustun
Abstract Galen or Galenus was born at Pergamum (now Bergama in Turkey) in 129 A.D., and died in the year 200 A.D. He was a 2nd century Greek philosopher-physician who switched to the medical profession after his father dreamt of this calling for his son. Galen's training and experiences brought him to Alexandria and Rome and he rose quickly to fame with public demonstrations of anatomical and surgical skills. He became physician to emperor Marcus Aurelius and the emperor's ambitious son, Commodus. He wrote prodigiously and was able to preserve his medical research in 22 volumes of printed text, representing half of all Greek medical literature that is available to us today. The structures, the great cerebral vein and the communicating branch of the internal laryngeal nerve, bear his eponym. Clin. Anat. 17:454,457, 2004. © 2004 Wiley-Liss, Inc. [source]