Julian Varas

Purpose To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback.
Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsu- pervised practice as needed at their homes. When they felt competent, trainees uploaded a… Mostrar más

Purpose To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback.
Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsu- pervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment.
Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07).
Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months. Mostrar menos

Summary Statement: The global pandemic of COVID-19 had strong repercussions in healthcare simulation-based education around the world. Different adaptations to imposed restraints such as social distancing have been developed to address the educational needs of healthcare professionals. However, the lack of access to simulators in low-income coun- tries or rural areas may restrict the access to distance simulation-based training.
(Sim Healthcare 00:00–00, 2022)

BACKGROUND:
The advantages of laparoscopic surgery over traditional open surgery have changed the surgical education paradigm in the past 20 years. Among its benefits are an improvement in clinical outcomes and patient safety, becoming the standard in many surgical procedures. However, it encompasses an additional challenge due to the complexity to achieve the desired competency level. Simulation-based training has emerged as a solution to this problem. However, there is a relative scarcity… Mostrar más

BACKGROUND:
The advantages of laparoscopic surgery over traditional open surgery have changed the surgical education paradigm in the past 20 years. Among its benefits are an improvement in clinical outcomes and patient safety, becoming the standard in many surgical procedures. However, it encompasses an additional challenge due to the complexity to achieve the desired competency level. Simulation-based training has emerged as a solution to this problem. However, there is a relative scarcity of experts to provide personalized feedback. Technology-Enhanced Learning could be a valuable aid in personalizing the learning process and overcoming geographic and time-related barriers that otherwise would preclude the training to happen. Currently, various educational digital platforms are available, but none of them is able to successfully provide personalized feedback.
AIMS:
The aim of this study was to develop and test a proof of concept of a novel Technology-Enhanced Learning laparoscopic skills platform with personalized remote feedback.
METHODS:
The platform “Lapp,” a web and mobile cloud-based solution, is proposed. It consists of a web and mobile application where teachers can evaluate remotely and asynchronously exercises performed by students, adding personalized feedback for trainees to achieve a learning curve wherever and whenever they train. To assess the effectiveness of this platform, two groups of students were compared: 130 participants received in-person feedback and 39 participants received remote asynchronous feedback throughout the application.
RESULTS:
The results showed no significant differences regarding competency levels among both groups.
CONCLUSION:
A novel Technology-Enhanced Learning strategy consisting of remote asynchronous feedback throughout Lapp facilitates and optimizes learning, solving traditional spatiotemporal limitations. Mostrar menos

Practicallearninginphysiotherapyeducationbecamechallengingdur- ing the pandemic. Socio-sanitary constraints limited hands-on scenarios and instructors’ opportunities to provide timely feedback to their students. Asyn- chronous remote training through a feedback-oriented platform is an alterna- tive with potential benefits beyond emergency distance learning. This preliminary quantitative study analyzes the results of the implementation of an asynchronous remote strategy for teaching manual… Mostrar más

Practicallearninginphysiotherapyeducationbecamechallengingdur- ing the pandemic. Socio-sanitary constraints limited hands-on scenarios and instructors’ opportunities to provide timely feedback to their students. Asyn- chronous remote training through a feedback-oriented platform is an alterna- tive with potential benefits beyond emergency distance learning. This preliminary quantitative study analyzes the results of the implementation of an asynchronous remote strategy for teaching manual techniques to Physiotherapy undergraduate students. Sixty-one students reviewed a procedure video, recorded their execution of the procedure, and uploaded it to an online platform. An instructor assessed the video through an observation scale, providing students with different feedback inputs. Students repeated the process if they did not meet the cut-off score. In the development of two procedural skills, the results showed that students with lower performance received more feedback, especially in the form of “common mistakes videos”. Finally, instructors showed significant differences in the number of feedback inputs assigned to students with the same performance. This strategy allowed students to train in practical skills remotely, receiving feedback in a spe- cific and unique way. While feedback in different formats was valued, we believe that further research is needed on feedback content and its impact on learning beyond just quantity and format. Mostrar menos

Objective. In a context of increasingly limited surgical exposi- tion, enhanced by the coronavirus disease 2019 (COVID- 19) pandemic context, the objective of this article is to explain the development of a novel low-cost and simple replication animal-based septoplasty training model for oto- laryngology residents, to assess its face and construct valid- ity, and to validate a specific rating scale for each task.
Study Design. Experimental study.
Setting. Surgical simulation… Mostrar más

Objective. In a context of increasingly limited surgical exposi- tion, enhanced by the coronavirus disease 2019 (COVID- 19) pandemic context, the objective of this article is to explain the development of a novel low-cost and simple replication animal-based septoplasty training model for oto- laryngology residents, to assess its face and construct valid- ity, and to validate a specific rating scale for each task.
Study Design. Experimental study.
Setting. Surgical simulation laboratory.
Methods. Septoplasty experts divided the procedure into key tasks. A simulator model to perform tasks was developed using pig ears to imitate human nasal septum cartilage, and a Specific Rating Scale was constructed. Trainees and faculty performed all tasks in the model. The participants were videotaped, and operative time, hand movements, and path length were recorded using a motion sensor device. Two blinded experts evaluated the videos with Global and Specific Rating Scales. All participants answered a satisfaction survey.
Results. Fifteen subjects were recruited (7 trainees and 8 faculty). Significantly higher Global Rating Scale score, shorter operative time and path length, and fewer hand movements were observed in the faculty group. The satis- faction survey showed high applicability to a real scenario (mean score of 4.6 out of 5). Specific Rating Scale showed construct and concurrent validity and high reliability.
Conclusion. This simulation model and its specific rating scale can be accurately used as a validated surgical assessment tool for endonasal septoplasty skills. Its low cost and simple replicability make it a potentially useful tool in any otolaryn- gology surgical training program. Mostrar menos

Introduction A limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training… Mostrar más

Introduction A limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algo- rithm and expert evaluators in assessing basic laparoscopic-simulated training exercises.
Methods The AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evalu- ators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise.
Results After the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively.
Conclusion This first approach of AI...https://doi.org/10.1007/s00464-022-09576-1 Mostrar menos

Objective Knee arthrocentesis is frequently performed as a diagnostic or therapeutic procedure. Although considered a key competency for medical doctors, most students never execute the procedure during their training. We aimed to assess technical and nontechnical skills for knee arthrocentesis through high-fidelity hybrid simulation.
Design Trainees received educational documentation prior to training. Trainees took a medical history and obtained informed consent from a patient-actor, then… Mostrar más

Objective Knee arthrocentesis is frequently performed as a diagnostic or therapeutic procedure. Although considered a key competency for medical doctors, most students never execute the procedure during their training. We aimed to assess technical and nontechnical skills for knee arthrocentesis through high-fidelity hybrid simulation.
Design Trainees received educational documentation prior to training. Trainees took a medical history and obtained informed consent from a patient-actor, then encountered a simulated knee to execute the procedure. We adapted a direct observation scale to assess technical and nontechnical skill performance. Personalized feedback was received after each session. Per- formance among trainees (learning curves) and between trainees and experts was compared using a mixed-effects model. Setting Pontifical Catholic University of Chile Simulation Center.
Participants Medical students and general physicians were recruited for training; orthopedic surgeons were recruited as experts.
Results Trainees significantly improved from the first session to the second and third. The third session was the learning curve plateau. Performance obtained in the third and fourth sessions were similar to expert performance. The assessment tool evaluated technical and nontechnical skills with high internal consistency and showed high interobserver reliability. Discussion Learning curve analysis showed that high-fidelity simulation allowed trainees to become proficient in technical and nontechnical skills required to perform a safe knee arthrocentesis.
Level of evidence Level II (prospective cohort study). Mostrar menos

Abstract
Background Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts’ ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback… Mostrar más

Abstract
Background Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts’ ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. Methods Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing educa- tion were identified. The simulation centers (“skills labs”) at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously.
Results Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salva- dor, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic ...https://doi.org/10.1007/s00464-022-09386-5 Mostrar menos

BACKGROUND:

The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents’ surgical training and supervised clinical practice.

AIMS:

This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD:

A literature review was performed between April and May 2021, divided into two… Mostrar más

BACKGROUND:

The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents’ surgical training and supervised clinical practice.

AIMS:

This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD:

A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world.

RESULTS:

In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested.

CONCLUSIONS:

Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations. Mostrar menos

Background Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents’ exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. Methods A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a… Mostrar más

Background Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents’ exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. Methods A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high defini- tion and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training.
Results Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. Conclusion An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self- confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in ....https://doi.org/10.1007/s00464-022-09098-w Mostrar menos

Introduction: since the reduced in-person scenarios caused by the COVID-19 pandemic, the methodology of remote simulation with asynchronous feedback through a platform, which considers practical skills remotely, and a feedback process to improve the performance and learning of students, was incorporated in the Physiotherapy degree. The purpose of the study is to describe the implementation and results of this methodology. Methods: a pilot remote training was conducted with physiotherapy… Mostrar más

Introduction: since the reduced in-person scenarios caused by the COVID-19 pandemic, the methodology of remote simulation with asynchronous feedback through a platform, which considers practical skills remotely, and a feedback process to improve the performance and learning of students, was incorporated in the Physiotherapy degree. The purpose of the study is to describe the implementation and results of this methodology. Methods: a pilot remote training was conducted with physiotherapy students of the Pontificia Univer- sidad Católica de Chile, which consisted of 7 stages of different musculoskeletal manual techniques. A final survey was applied to know the students’ perceptions, and a descriptive analysis of the results was performed. Results: 468 videos of 78 students were evaluated through 4040 feedback inputs. Most of the students reported a positive perception regarding the methodology (92,7%) and feedback received (71,4%). Sixty per cent of the students reported feeling confident when performing the techniques for the last time. A low percentage of students reported having difficulties with the training. Conclusion: The implementation of the proposed methodology allowed students to continue acquiring practical skills in musculoskeletal manual techniques in a context where face-to-face learning was not possible, with a high valuation. This methodology revealed the existence of hidden training before the instructor’s evaluation, which would allow students to move towards an autonomous learning curve for a subsequent transfer in a real context. Mostrar menos

Background: Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have dimin- ished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models.
Objective: The aim of this study was to evaluate under a contemporary validity framework, an… Mostrar más

Background: Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have dimin- ished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models.
Objective: The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery.
Methods: An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung in- jury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY- 2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their per- formance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure.
Results: Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average Mostrar menos

Managing traumatic injuries of the gastroesophageal junction (GEJ) is infrequent due to associated lesions of adjacent highly vascularized organs. Its anatomical localization in the upper abdomen makes the repair challenging to perform. A stable 23- year-old male was presented at the emergency department with two thorax gunshot wounds. Computed tomography revealed air in the periesophageal space and right hemopneumothorax with no injury of the major vessels. A chest tube was placed and the… Mostrar más

Managing traumatic injuries of the gastroesophageal junction (GEJ) is infrequent due to associated lesions of adjacent highly vascularized organs. Its anatomical localization in the upper abdomen makes the repair challenging to perform. A stable 23- year-old male was presented at the emergency department with two thorax gunshot wounds. Computed tomography revealed air in the periesophageal space and right hemopneumothorax with no injury of the major vessels. A chest tube was placed and the patient was transferred hemodynamically stable to the operating. Abdominal exploration identified injuries to the left diaphragm; liver lateral segment; 1-cm transfixing perforation of the GEJ and right diaphragmatic pillar. Primary repair of the GEJ was performed and patched with a partial fundoplication. The diaphragm was repaired and the liver bleeding controlled. Finally, drains and a feeding jejunostomy were placed. The patient had an uneventful early postoperative course and was discharged home on the 12th postoperative day. Mostrar menos

Abstract
Background: The purpose of this study is to develop and validate a low-cost simulation model and training program for the acquisition of basic skills in endoscopic sinus surgery.
Methodology: Experimental study. An eight-task low-cost simulation model was developed based on feeding bottles. Junior residents, general otolaryngologists, and fellowship-trained rhinologists (experts) were recorded performing each task. Operative time and number of errors were measured. Videos were… Mostrar más

Abstract
Background: The purpose of this study is to develop and validate a low-cost simulation model and training program for the acquisition of basic skills in endoscopic sinus surgery.
Methodology: Experimental study. An eight-task low-cost simulation model was developed based on feeding bottles. Junior residents, general otolaryngologists, and fellowship-trained rhinologists (experts) were recorded performing each task. Operative time and number of errors were measured. Videos were evaluated by two blinded experts using a validated global rating scale (GRS) and a specific rating scale (SRS). A group of residents completed a six-session training program and then were recorded and evaluated using the same methodology.
Results: Twenty-five participants were recruited. Statistically significant higher scores in the GRS and SRS and lower operative time and errors at higher levels of expertise were found. A significant correlation between SRS and GRS was found. Seven resi- dents completed the training program. A significant improvement of SRS and GRS scores and reduction of operative time and errors were observed after training. Moreover, compared to experts, statistically significant fewer errors were made by residents after training, and no significant differences were found in terms of performance quality and operative time among these groups.
Conclusions: Our low-cost simulation model can be accurately used as a validated objective assessment and training tool for ba- sic endoscopic skills necessary for FESS, and can be potentially used in any otolaryngology surgical training program for residents.
Key words: rhinosurgery, otorhinolatyngologic surgical procedures, simulation training, medical education Mostrar menos

Summary Statement: The sudden rise of critically ill patients secondary to the SARS- CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses… Mostrar más

Summary Statement: The sudden rise of critically ill patients secondary to the SARS- CoV-2 pandemic has triggered a surge in healthcare response. This project's goal was to provide essential cognitive and technical skills to healthcare professionals returning to the workforce or reassigned to critical care clinical duties during the COVID-19 pandemic. The plan included the implementation of 4 distance-based simulation training programs, with asynchronous personalized feedback. The courses allowed the acquisition of skills for the complete critical care patient management chain: use of personal protection equip- ment, use of a high-flow nasal cannula, endotracheal intubation, and prone positioning. Participants logged into the platform, reviewed material, practiced while recording the ses- sion, and uploaded the video through the training platform. The expert tutor remotely deliv- ered asynchronous feedback. Participants trained remotely until achieving course approval. Remote-based simulation seems a feasible and attractive alternative to provide adequate educational solutions, especially for remote and rural areas.
(Sim Healthcare 00:00–00, 2021) Mostrar menos

Objectives: . In the last decade, concern regarding the preparedness of general surgery graduates to ef- fectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experi- ence implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation.
Design: . Firstly, for… Mostrar más

Objectives: . In the last decade, concern regarding the preparedness of general surgery graduates to ef- fectively manage thoracic trauma cases has been raised. However, due to limited availability and elevated costs, access to cardiopulmonary trauma simulation models is limited. This article describes our experi- ence implementing a low-cost blended ex vivo tissue-based simulation model using animal by-products that incorporates pump perfusion and ventilation.
Design: . Firstly, for validation purposes 8 junior residents, 8 recently graduated general surgeons, and 3 cardiothoracic surgery attendings from Pontificia Universidad Católica de Chile Clinical Hospital were recruited. Proficiency in performing a pulmonary tractotomy and a myocardial injury repair was assessed with global and specific rating scales. Secondly, to evaluate the effectiveness of the model as a learning tool, 16 general surgery residents from different programs across the country were recruited receiving intensive, personalized training on the models. Proficiency was measured before and after the training.
Results: . For the validation phase, significant differences among groups according to the previous level of expertise were shown, and therefore construct validity was established. The results of the second phase showed a significant overall improvement in participant’s performance.
Conclusion: . Effective training and assessment for advanced surgical skills in cardiothoracic trauma can be achieved using a low-cost pulsatile simulation model. Mostrar menos

Introduction: Local flaps are a widely used surgical tool for the repair of primary defects. Most of the training models have been made on flat structures; however, their application in non-uniform structures requires prior training. Objective: To evaluate the performance of medical students in the acquisition of local flap techniques in a simulated model of the scalp. Material and methods: Non- randomized experimental study. We designed a simulation model of pig skin mounted on a human skull… Mostrar más

Introduction: Local flaps are a widely used surgical tool for the repair of primary defects. Most of the training models have been made on flat structures; however, their application in non-uniform structures requires prior training. Objective: To evaluate the performance of medical students in the acquisition of local flap techniques in a simulated model of the scalp. Material and methods: Non- randomized experimental study. We designed a simulation model of pig skin mounted on a human skull. The training program consisted of two sessions. Each participant was videotaped performing an advancement and a rotation flap before and after the training. Then they trained the advancement and rotation flaps on the model. Student performance was evaluated according to OSATS guideline. Statistical analysis was performed with non-parametric statistics. Results: 21 participants were included. All participants significantly increased their OSATS scores when comparing the initial with the final evaluation both in advancement flap (15 [range 13-16] vs 23 [range 22-24] p < 0.001), and in rotation flap (15 [range 14-17] vs 24 [range 23-25] p < 0.001). Conclusion: The use of a model of local flaps is effective in developing basic skills of local flaps of rotation and advancement in medical students. Mostrar menos

Abstract

Recent coronavirus outbreak and "stay at home" policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after… Mostrar más

Abstract

Recent coronavirus outbreak and "stay at home" policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak.

Methods: Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed.

Results: Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department.

Conclusions: In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.

Keywords: COVID-19 pandemic; Postoperative care; Telemedicine. Mostrar menos

Background: Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. Aim: To develop and validate a new neonatal/ reduced-space endotrainer. Methods: The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the… Mostrar más

Background: Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. Aim: To develop and validate a new neonatal/ reduced-space endotrainer. Methods: The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the performance of each subject on nine exercises. Results: A 10.5 x 10 x 18 cm acrylic simulator was created, with an internal working surface of 9 x 9 cm. An HD camera was incorporated, with a 0-180° range of movement. All exercises of a Basic Laparoscopic Training Program were adapted on a scale of 1:0.5 to fit in. From 49 participants, 42 (85.71%) answered the survey; 80.5% considered that the simulator reproduces similar conditions to procedures performed in children under one year of age; 61.1% thought that the simulator represents a difficulty identical to procedures performed in newborns; 73.7% considered that the neonatal simulator is more complicated than the adult simulator. Experts showed significantly better performance in all proposed exercises. Conclusion: The simulator has a high-quality image and design that allows training with basic tasks. The endotrainer permitted to discriminate between these different skill levels and was well evaluated by users with diverse surgical experience. Mostrar menos

Background
Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective.

Methods
A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches… Mostrar más

Background
Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective.

Methods
A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores.

Results
No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5–21); 16.6 (15.5–17.5)) and (20.3 (19.88–21); 16.8 (16–17.5)) vs (15.7 (15–16); 13.3 (12.5–14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5–9) and 7.4 (4.88–10) vs 3.5 (1.5–6) (p < 0.05)] and SRS scores [5.4 (3.5–7) and 6.3 (4–8.5) vs 3.1 (1.13–4.88) (p < 0.05)], respectively.

Conclusion
The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education. Mostrar menos

Patient management has significantly changed since the COVID‐19 pandemic appeared. Social distancing protocols, virus‐free spaces, and telemedicine programs are now essential for clinical practice. The way surgery is performed also restructured to prioritize resources and keep teams safe from contagion1-3. Surgical societies worldwide recommend performing only emergency procedures and minimizing the number of surgeons involved in patient care1, 2. These actions help controlling infection but… Mostrar más

Patient management has significantly changed since the COVID‐19 pandemic appeared. Social distancing protocols, virus‐free spaces, and telemedicine programs are now essential for clinical practice. The way surgery is performed also restructured to prioritize resources and keep teams safe from contagion1-3. Surgical societies worldwide recommend performing only emergency procedures and minimizing the number of surgeons involved in patient care1, 2. These actions help controlling infection but also affect resident surgical volume.

Simulation‐based education has emerged as the leading solution to train procedural skills when the exposition of residents to them is suboptimal or high risk. Feedback and deliberate practice are critical tools to learn, but many simulation centers remain closed due to social‐distancing protocols, thus stopping face‐to‐face feedback.

Web‐based solutions are being increasingly helpful in supporting clinical and academic activities during the COVID‐19 pandemic. Most educational platforms provide useful content to students but are unable to deliver cost‐effective personalized feedback. We describe a validated technology‐based methodology for remote skill training that has shown to be safe and efficient before and during the pandemic.

Since early 2019, our group developed LAPP, a web‐mobile‐based platform to train laparoscopic surgeons remotely. The platform connects trainees to an online network of certified tutors who teach procedural skills by delivering remote, deferred, and personalized feedback4. The methodology comprises four steps:
Trainees watch instructional clips on their phones.
They practice at their own pace and then upload a video of the exercise to the platform.
Within 72 hours, an expert evaluates that recording giving feedback through text, audio, drawings, and videos, also assessing performance using validated rating scales and procedural time.
.... Mostrar menos

Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje mas larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Material y método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino… Mostrar más

Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje mas larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Material y método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semi-estructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento. Mostrar menos

Introducción: El entrenamiento estandarizado mediante simulación ha demostrado mejorar habilidades de residentes y cirujanos. Sin embargo, los centros de simulación que imparten programas validados son escasos y centralizados. Favorecer el acceso de la comunidad quirúrgica a estos programas constituye el desafío actual.

Objetivo: Describir el primer “Learning Center” (LC) realizado durante el 90º Congreso Chileno de Cirugía, evaluar su impacto y percepción de los asistentes sobre… Mostrar más

Introducción: El entrenamiento estandarizado mediante simulación ha demostrado mejorar habilidades de residentes y cirujanos. Sin embargo, los centros de simulación que imparten programas validados son escasos y centralizados. Favorecer el acceso de la comunidad quirúrgica a estos programas constituye el desafío actual.

Objetivo: Describir el primer “Learning Center” (LC) realizado durante el 90º Congreso Chileno de Cirugía, evaluar su impacto y percepción de los asistentes sobre simulación en cirugía mínimamente invasiva (CMI) en los programas de formación actual.

Metodología: Estudio de corte transversal. Se describieron las características del LC. Se aplicó encuesta tipo Likert para evaluar impacto y percepción de los asistentes. Criterios de inclusión: completar ≥1 sesión de entrenamiento, exclusión: encuesta incompleta. Se aplicó estadística descriptiva y analítica no paramétrica.

Resultados: LC se compuso de 10 estaciones de entrenamiento con distintos niveles de dificultad. 9 instructores monitorizaron y entregaron feedback efectivo a los asistentes. 84 asistentes contestaron la encuesta completa, 39% mujeres. La muestra se conformó por 41,6% Residentes de Cirugía General, 35,7% Cirujanos, 17,9% Internos de Medicina, y 4,8% Médicos Generales. 85% manifestó acuerdo con el impacto positivo del LC como recurso educacional continuo durante el congreso, y la utilidad de la práctica simulada para el desarrollo de habilidades en CMI. No hubo diferencias significativas según sexo o nivel de formación.

Conclusión: El primer LC se desarrolló con amplia aceptación entre sus participantes, constituyendo un posible recurso permanente. El entrenamiento simulado en CMI parece ser un recurso aceptado y percibido como una necesidad por la comunidad quirúrgica nacional. Mostrar menos

Vela, Javier; Contreras, Caterina; Jarry, Cristián; Varas, Julián; Corvetto, Marcia.
La simulación se define como una técnica que recrea elementos de eventos reales de forma controlada con un propósito educacional, evaluativo o de investigación. Su uso es cada vez más frecuente en el Área de Ciencias de la Salud, y se utiliza en los procesos de enseñanza-aprendizaje o en la evaluación o acreditación de los profesionales. Sin embargo, existe una gran heterogeneidad respecto al diseño y… Mostrar más

Vela, Javier; Contreras, Caterina; Jarry, Cristián; Varas, Julián; Corvetto, Marcia.
La simulación se define como una técnica que recrea elementos de eventos reales de forma controlada con un propósito educacional, evaluativo o de investigación. Su uso es cada vez más frecuente en el Área de Ciencias de la Salud, y se utiliza en los procesos de enseñanza-aprendizaje o en la evaluación o acreditación de los profesionales. Sin embargo, existe una gran heterogeneidad respecto al diseño y reporte de los resultados de diversos programas de simulación, lo que dificulta la comparación y recolección de evidencia científica. El presente artículo de reflexión busca revisar los principales aspectos que se deben considerar a la hora de desarrollar un programa de simulación con la esperanza de ayudar a mejorar la calidad de la evidencia y de la educación mediante la simulación clínica.
Simulación, modelo, entrenamiento, validez, transferencia, programa. Mostrar menos

Abstract

Background: Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training.

Methods: A smartphone(iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their… Mostrar más

Abstract

Background: Simulation training is a validated, highly effective tool for learning laparoscopy. Feedback plays a crucial role in motor skills training. We present an app to guide students during advanced laparoscopy simulation training and evaluate its effect on training.

Methods: A smartphone(iOS)-app was developed. A group of trainees were randomized to use the app (YAPP) or not use the app (NAPP). We used blinded analysis with validated rating scales to assess their performance before and after the training. The number of requests for tutor feedback per session was recorded. Finally, the participants in the YAPP group completed a survey about their experience with the app.

Results: Fifteen YAPP and 10 NAPP completed the training program. There were no statistically significant differences between their skills performance scores (P = .338). The number of tutor feedback requests in the YAPP and NAPP was of 4 (3-6) and 13 (10-14) (P < .001), respectively. All participants in the YAPP group found the app was useful.

Conclusion: The use of a smartphone app reduces the need for expert tutor feedback without decreasing the degree of skills acquisition. Mostrar menos

Jarry, Cristián, Vidal, Cristina, Varas, Julián, Poblete, Rodrigo, Abbott, Eduardo, Vega, Eduardo, Zamorano, Elga, Letelier, Luz María.
Introducción: Dado un contexto clínico cada vez más restringido y orientado a la minimización de riesgo para pacientes, la exposición de los alumnos de medicina para realizar procedimientos ha disminuido. La simulación médica permite el entrenamiento y adquisición de competencias procedimentales; sin embargo, la retención de este conocimiento no ha sido… Mostrar más

Jarry, Cristián, Vidal, Cristina, Varas, Julián, Poblete, Rodrigo, Abbott, Eduardo, Vega, Eduardo, Zamorano, Elga, Letelier, Luz María.
Introducción: Dado un contexto clínico cada vez más restringido y orientado a la minimización de riesgo para pacientes, la exposición de los alumnos de medicina para realizar procedimientos ha disminuido. La simulación médica permite el entrenamiento y adquisición de competencias procedimentales; sin embargo, la retención de este conocimiento no ha sido ampliamente estudiada. Objetivo: Evaluar la retención del aprendizaje de habilidades transversales a procedimientos, una vez entrenadas en simulación. Material y métodos: Se elaboró una pauta de evaluación de competencias procedimentales transversales, definidas como aquellas comunes y necesarias para la mayoría de los procedimientos médicos invasivos. Se incluyeron alumnos de medicina en su octavo semestre lectivo, quienes habían recibido, dos semestres atrás, entrenamiento en simulación en dichas competencias. Se aplicó esta pauta mediante una evaluación clínica objetiva estructurada a los seleccionados. Resultados: 108 alumnos fueron incluidos. El porcentaje de logro promedio para el set de competencias transversales fue de 95.83% en la evaluación inicial y 91.31% para la final (aproximadamente un año después). No se correlacionó el porcentaje de logro basal con el obtenido en la evaluación final, tampoco con la exposición previa a procedimientos ni la edad. Conclusiones: Aproximadamente a un año del entrenamiento, se demostró un porcentaje aceptable de logro en la realización de las competencias transversales entrenadas, evaluadas mediante una evaluación clínica objetiva estructurada. El conocimiento adquirido es retenido por un plazo considerable, aun cuando las habilidades aprendidas no sean practicadas con regularidad en un escenario clínico real.
Simulación, competencias procedimentales, educación médica. Mostrar menos

BACKGROUND:
A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents' surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce.
AIM:
To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by… Mostrar más

BACKGROUND:
A General Surgery Residency may last between 2-6 years, depending on the country. A shorter General Surgery Residency must optimize residents' surgical exposure. Simulated surgical training is known to shorten the learning curves, but information related to how it affects a General Surgery Residency regarding clinical exposure is scarce.
AIM:
To analyze the effect of introducing a validated laparoscopic simulated training program in abdominal procedures performed by residents in a three-year General Surgery Residency program.
METHODS:
A non-concurrent cohort study was designed. Four-generations (2012-2015) of graduated surgeons were included. Only abdominal procedures in which the graduated surgeons were the primary surgeon were described and analyzed. The control group was of graduated surgeons from 2012 without the laparoscopic simulated training program. Surgical procedures per program year, surgical technique, emergency/elective intervention and hospital-site (main/community hospitals) were described.
RESULTS:
Interventions of 28 graduated surgeons were analyzed (control group=5; laparoscopic simulated training program=23). Graduated surgeons performed a mean of 372 abdominal procedures, with a higher mean number of medium-to-complex procedures in laparoscopic simulated training program group (48 vs. 30, p=0.02). Graduated surgeons trained with laparoscopic simulated training program performed a higher number of total abdominal procedures (384 vs. 319, p=0.04) and laparoscopic procedures (183 vs. 148, p<0.05).
CONCLUSIONS:
The introduction of laparoscopic simulated training program may increase the number and complexity of total and laparoscopic procedures in a three-year General Surgery Residency.
PMID: 31038561 PMCID: PMC6488269 DOI: 10.1590/0102-672020190001e1436 Mostrar menos

BACKGROUND:
Simulation training is a validated method for acquiring laparoscopic skills. Training sessions may be sporadic or lack continuity in oversight by instructors since traditional programs mandate in-person teaching and evaluation. This study presents the development, implementation, and results of a novel smartphone application that enables remote teacher-student interaction. This interface is used to complete a validated program that provides learner-specific feedback. Outcomes of… Mostrar más

BACKGROUND:
Simulation training is a validated method for acquiring laparoscopic skills. Training sessions may be sporadic or lack continuity in oversight by instructors since traditional programs mandate in-person teaching and evaluation. This study presents the development, implementation, and results of a novel smartphone application that enables remote teacher-student interaction. This interface is used to complete a validated program that provides learner-specific feedback. Outcomes of training via Lapp were compared to outcomes of traditional in-person training.
METHODS:
A web-based and mobile iOS and Android application (Lapp) was developed to enable a remote student-teacher interaction. Instructors use Lapp to assess video recorded training sessions of students at distant locations and guide them through the laparoscopic skill course with specific and personalized feedback. Surgical trainees at two remote training centers were taught using Lapp. A control group was assessed during traditional simulation training at the training facility, with in-person feedback. Pre- and post-training performances were video recorded for each trainee and blindly evaluated by two experts using a global rating scale (GRS) and a specific rating scale (SRS).
RESULTS:
A total of 30 trainees were trained via Lapp and compared with 25 locally taught. Performance in the Lapp group improved significantly after the course in both GRS and SRS scores, from 15 [6-17] to 23 [20-25], and from 12 [11-15] to 18 [15-20], respectively. The results between both groups were comparable.
CONCLUSION:
Laparoscopic simulation training using a mobile app is as effective as in-person instruction in teaching advanced laparoscopic surgical skills. Lapp provides an effective method of teaching through simulation remotely and may allow expansion of robust simulation training curriculums.

DOI: 10.1007/s00464-019-07024-1 Mostrar menos

Vela U, Javier, Jarry T, Cristián, Contreras B, Caterina, Mosso G, Lorena, Varas C, Julián, Lustig F, Nicole.
Introducción: Los nódulos tiroideos son un problema clínico frecuente en cuya solución, la punción mediante una aguja fina guiada por ecografía, juega un rol fundamental. El entrenamiento en esta técnica aumenta su tasa diagnóstica. Objetivos: Desarrollar un modelo de punción tiroidea de bajo costo y una pauta de cotejo para su evaluación. Material y métodos: Se consultó la… Mostrar más

Vela U, Javier, Jarry T, Cristián, Contreras B, Caterina, Mosso G, Lorena, Varas C, Julián, Lustig F, Nicole.
Introducción: Los nódulos tiroideos son un problema clínico frecuente en cuya solución, la punción mediante una aguja fina guiada por ecografía, juega un rol fundamental. El entrenamiento en esta técnica aumenta su tasa diagnóstica. Objetivos: Desarrollar un modelo de punción tiroidea de bajo costo y una pauta de cotejo para su evaluación. Material y métodos: Se consultó la literatura médica existente y a los expertos locales en punción tiroidea. Se elaboró un modelo tiroideo tras la iteración por expertos, los cuales evaluaron mediante un cuestionario en línea los aspectos como ecogenicidad, puncionabilidad, consistencia, similitud anatómica y costos del modelo. La pauta de evaluación se construyó con base en el consenso de expertos determinando los ítems fundamentales para el procedimiento. Resultados: Se logró construir un modelo con aceptable puncionabilidad, ecogenicidad, consistencia y similitud anatómica según los expertos. El costo de cada modelo es alrededor de 2,6 dólares, tiene una durabilidad aproximada de cuatro semanas y límite de punciones, según la cantidad de nódulos. Se elaboró una pauta de 12 ítems que evalúa aspectos técnicos y clínicos. Esta pauta fue creada para ser aplicada tanto en un ambiente simulado como en el paciente real. Conclusión: En este trabajo se presenta un modelo de punción tiroidea de bajo costo y de fácil replicabilidad junto a una pauta para evaluar el entrenamiento, con miras a desarrollar en el futuro un programa de entrenamiento validado para punción tiroidea.
Punción tiroidea, ecografía, simulación. Mostrar menos

Abstract
BACKGROUND AND AIMS:
Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students.
METHODS:
A workshop was implemented using a specially designed and validated simulation model for… Mostrar más

Abstract
BACKGROUND AND AIMS:
Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students.
METHODS:
A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop.
RESULTS:
247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5.
CONCLUSIONS:
Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.

PMID: 30471721 DOI: 10.1016/j.gastrohep.2018.10.001 Mostrar menos

Jarry, Cristián, Inzunza, Martín, Quezada, José, Marino, Carlo, Zamorano, Elga, Alvarado, Valeria, Martínez, Carlos, Machuca, Eduardo, Achurra, Pablo, Varas, Julián.
Introducción: Adquirir competencias en cirugía laparoscópica requiere completar largas curvas de aprendizaje que son susceptibles de acortarse mediante el entrenamiento simulado. Sin embargo, las instancias de formación de este tipo suelen ser breves, esporádicas y poco costo-efectivas. Como ocurre en otras disciplinas, contar… Mostrar más

Jarry, Cristián, Inzunza, Martín, Quezada, José, Marino, Carlo, Zamorano, Elga, Alvarado, Valeria, Martínez, Carlos, Machuca, Eduardo, Achurra, Pablo, Varas, Julián.
Introducción: Adquirir competencias en cirugía laparoscópica requiere completar largas curvas de aprendizaje que son susceptibles de acortarse mediante el entrenamiento simulado. Sin embargo, las instancias de formación de este tipo suelen ser breves, esporádicas y poco costo-efectivas. Como ocurre en otras disciplinas, contar con un formato de entrenamiento continuo a modo de "gimnasio" permitiría mejorar la adquisición de habilidades. Objetivos: Describir la implementación de un gimnasio quirúrgico donde realizar programas de aprendizaje laparoscópico dirigidos a profesionales laparoscopistas. Material y métodos: Estudio descriptivo. Se implementó un espacio físico donde realizar entrenamiento tutorizado por instructores expertos en educación médica y laparoscopia. Se ofrecieron a los alumnos cuatro cursos de simulación para el desarrollo de habilidades básicas y avanzadas de laparoscopia y la posibilidad de asistir a entrenar bajo su propia disponibilidad de tiempo. Resultados: En siete años se han formado 435 personas en laparoscopia, todas ellas en laparoscopia básica, 240 en laparoscopia avanzada, 62 en el módulo de laparoscopia esofagogástrica y bariátrica (EGB) y 11 en laparoscopia hepatobiliar y pancreática (HBP). La evaluación por parte de los asistentes externos como residentes es positiva. Conclusiones: El establecimiento de un gimnasio de simulación para el desarrollo y mantenimiento de habilidades quirúrgicas es una opción factible y atractiva para residentes y cirujanos.
Simulación, laparoscopia, gimnasio. Mostrar menos

Uno de los principales avances que ha tenido la cirugía en los últimos años, ha sido el desarrollo de las intervenciones mini-invasivas. Este tipo de procedimientos está siendo utilizado en la mayoría de las especialidades quirúrgicas, pero es especial- mente relevante en la cirugía del aparato digestivo. Si bien las operaciones de vesícula se realizan por laparoscopía con éxito hace décadas, hoy en día se utiliza en casos tan complejos como gastrecto- mías por cáncer gástrico, cirugías de la… Mostrar más

Uno de los principales avances que ha tenido la cirugía en los últimos años, ha sido el desarrollo de las intervenciones mini-invasivas. Este tipo de procedimientos está siendo utilizado en la mayoría de las especialidades quirúrgicas, pero es especial- mente relevante en la cirugía del aparato digestivo. Si bien las operaciones de vesícula se realizan por laparoscopía con éxito hace décadas, hoy en día se utiliza en casos tan complejos como gastrecto- mías por cáncer gástrico, cirugías de la obesidad, páncreas, resecciones de hígado, colon y recto, etc. Sus resultados son al menos comparables con la vía tradicional o abierta, pero con claras ventajas en la recuperación de los pacientes con lo que se logra menos dolor posoperatorio, menos días de hospita- lización y se acorta el período de reintegro laboral, además de los claros beneficios estéticos. Ya están apareciendo reportes donde se comprueba incluso mejores resultados en morbimortalidad para algunos procedimientos gracias al menor volumen de sangra- do descrito para la cirugía laparoscópica. En casos de pacientes oncológicos, estos se encontrarían en mejores condiciones y de manera más rápida, dis- ponibles para el inicio de quimioterapia adyuvante de ser necesario.
Todas estas bondades descritas de la cirugía mini-invasiva, contrasta con la realidad no sólo na- cional sino también en grandes centros americanos y europeos, donde ha sido difícil de implementar y, por sobre todo, difícil de entrenar, debido en parte a su larga curva de aprendizaje. El modelo mentor- aprendiz, utilizado clásicamente en la enseñanza y entrenamiento quirúrgico, es muy dependiente de variables como la capacidad, calidad y experiencia de tutores donde pueden existir dramáticas diferen- cias que hacen disímil la transferencia del aprendi-
zaje a los alumnos. Si a lo anterior agregamos las restricciones al horario laboral de los residentes, el elevado costo en sus formaciones y ...
Mostrar menos

INTRODUCTION:
Our objective was to assess reliability and validity of a visual-spatial secondary task (VSST) as a method to measure automaticity on a basic simulated laparoscopic skill model. In motor skill acquisition, expertise is defined by automaticity. The highest level of performance with less cognitive and attentional resources characterizes this stage, allowing experts to perform multiple tasks. Conventional validated parameters as operative time, objective assessment skills scales… Mostrar más

INTRODUCTION:
Our objective was to assess reliability and validity of a visual-spatial secondary task (VSST) as a method to measure automaticity on a basic simulated laparoscopic skill model. In motor skill acquisition, expertise is defined by automaticity. The highest level of performance with less cognitive and attentional resources characterizes this stage, allowing experts to perform multiple tasks. Conventional validated parameters as operative time, objective assessment skills scales (OSATS), and movement economy, are insufficient to distinguish if an individual has reached the more advanced learning phases, such as automaticity. There is literature about using a VSST as an attention indicator that correlates with the automaticity level.
METHODS:
Novices with completed and approved Fundamentals of Laparoscopic Surgery course, and laparoscopy experts were enrolled for an experimental study and measured under dual tasks conditions. Each participant performed the test giving priority to the primary task while at the same time they responded to a VSST. The primary task consisted of 4 interrupted laparoscopic stitches (ILS) on a bench-model. The VSST was a screen that showed different patterns that the surgeon had to recognize and press a pedal while doing the stitches (PsychoPsy software, Python, MacOS). Novices were overtrained on ILS until they reach at least 100 repetitions and then were retested. Participants were video recorded and then assessed by 2 blinded evaluators who measured operative time and OSATS. These scores were considered indicators of quality for the primary task. The VSST performance was measured by the detectability index (DI), which is a ratio between correct and wrong detections. A reliable evaluation was defined as two measures of DI with less than 10% of difference, maintaining the cutoff scores for performance on the primary task (operative time <110 seg and OSATS >17 points).
......
PMID: 29287751 DOI: 10.1016/j.jsurg.2017.11.007 Mostrar menos

Abstract
BACKGROUND:
Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops.
AIM:
To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures.
MATERIAL AND METHODS:
Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct… Mostrar más

Abstract
BACKGROUND:
Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops.
AIM:
To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures.
MATERIAL AND METHODS:
Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument.
RESULTS:
A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability.
CONCLUSIONS:
The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.
PMID: 30148911 DOI: 10.4067/s0034-98872018000600786 Mostrar menos

INTRODUCTION:
Simulated laparoscopy training is limited by its low-quality image. A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery.
OBJECTIVE:
To describe and test a new HD laparoscopic training box for advanced simulation training.
METHODS:
We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item… Mostrar más

INTRODUCTION:
Simulated laparoscopy training is limited by its low-quality image. A high-definition (HD) laparoscopic training box was developed under the present necessity of simulating advanced surgery.
OBJECTIVE:
To describe and test a new HD laparoscopic training box for advanced simulation training.
METHODS:
We describe the features and image quality of the new training box. The simulator was tested and then evaluated by a group of 76 expert surgeons using a 4-item questionnaire. To assess the effectiveness of training using this simulation box, 15 general surgery residents were trained to perform a laparoscopic jejuno-jejunostomy in a validated simulation program. They were assessed with objective rating scales before and after the training program, and their results were compared with that of experts.
RESULTS:
The training box was assembled using high-density fiberglass shaped as an insufflated abdomen. It has an adapted full-HD camera with a LED-based illumination system. A manually self-regulated monopod attached to the camera enables training without assistance. Of the expert surgeons who answered the questionnaire, 91% said that the simulation box had a high-quality image and that it was very similar to real laparoscopy. All residents trained improved their rating scores significantly when comparing their initial versus final assessment ( P < .001). Their performance after completing the training in the box was similar to that of experts ( P > .2).
CONCLUSIONS:
This novel laparoscopic training box presents a high-resolution image and allows training different types of advanced laparoscopic procedures. The simulator box was positively assessed by experts and demonstrated to be effective for laparoscopy training in resident surgeons.
KEYWORDS:
image-guided surgery; simulation; surgical education
PMID: 27729567 DOI: 10.1177/1553350616672963 Mostrar menos

BACKGROUND:
Multiple simulation training programs have demonstrated that effective transfer of skills can be attained and applied into a more complex scenario, but evidence regarding transfer to the operating room is limited.
OBJECTIVE:
To assess junior residents trained with simulation performing an advanced laparoscopic procedure in the OR and compare results to those of general surgeons without simulation training and expert laparoscopic surgeons.
METHODS:
Experimental study:… Mostrar más

BACKGROUND:
Multiple simulation training programs have demonstrated that effective transfer of skills can be attained and applied into a more complex scenario, but evidence regarding transfer to the operating room is limited.
OBJECTIVE:
To assess junior residents trained with simulation performing an advanced laparoscopic procedure in the OR and compare results to those of general surgeons without simulation training and expert laparoscopic surgeons.
METHODS:
Experimental study: After a validated 16-session advanced laparoscopy simulation training program, junior trainees were compared to general surgeons (GS) with no simulation training and expert bariatric surgeons (BS) in performing a stapled jejuno-jejunostomy (JJO) in the OR. Global rating scale (GRS) and specific rating scale scores, operative time and the distance traveled by both hands measured with a tracking device, were assessed. In addition, all perioperative and immediate postoperative morbidities were registered.
RESULTS:
Ten junior trainees, 12 GS and 5 BS experts were assessed performing a JJO in the OR. All trainees completed the entire JJO in the OR without any takeovers by the BS. Six (50 %) BS takeovers took place in the GS group. Trainees had significantly better results in all measured outcomes when compared to GS with considerable higher GRS median [19.5 (18.8-23.5) vs. 12 (9-13.8) p < 0.001] and lower operative time. One morbidity was registered; a patient in the trainees group was readmitted at postoperative day 10 for mechanical ileus that resolved with medical treatment.
CONCLUSION:
This study demonstrated transfer of advanced laparoscopic skills acquired through a simulated training program in novice surgical residents to the OR.

PMID: 27139703 DOI: 10.1007/s00464-016-4942-6 Mostrar menos

J Reconstr Microsurg. 2016 Nov;32(9):699-705. Epub 2016 Aug 19.



Abstract
Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex… Mostrar más

J Reconstr Microsurg. 2016 Nov;32(9):699-705. Epub 2016 Aug 19.



Abstract
Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. Methods In 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested. Results We were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable. Conclusion Due to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PMID: 27542106 DOI: 10.1055/s-0036-1586749 Mostrar menos

BACKGROUND:
Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.
METHODS:
Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using… Mostrar más

BACKGROUND:
Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.
METHODS:
Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant.
RESULTS:
Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively.
CONCLUSIONS:
Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.
PMID: 27673544 DOI: 10.1097/PRS.0000000000002456 Mostrar menos

Abstract
Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be… Mostrar más

Abstract
Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery.
KEYWORDS:
Thoracic surgery; simulation training; uniportal VATS; video-assisted
PMID: 29078541 PMCID: PMC5637571 DOI: 10.21037/jovs.2016.08.12 Mostrar menos

BACKGROUND:
Central venous catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a… Mostrar más

BACKGROUND:
Central venous catheterization (CVC) is a basic requirement for many medical specialties. Simulated training in CVC may allow the acquisition of this competency but few reports have established a valid methodology for learning and acquiring procedural skills for CVC. This study aims to validate the use of a tracking motion device, the imperial college surgical assessment device (ICSAD), by comparing it with validated global rating scales (GRS) to measure CVC performance in a simulated torso.
METHODS:
Senior year medical students, first and last year residents (PGY1, LYR), and expert anesthesiologists performed a jugular CVC assessment in a simulated model (Laerdal IV Torso). A validated GRS for objective assessment of technical skills and motion analysis by ICSAD was used. Statistical analysis was performed through Mann-Whitney and Kruskal-Wallis tests for construct validity and Spearman correlation coefficients between the ICSAD and GRS scores for concurrent validity between both.
RESULTS:
32 subjects were recruited (10 medical students, 8 PGY1, 8 LYR and 8 experts). Total path length measured with ICSAD and GRS scores were significantly different between all groups, except for LYR compared to experts (p = 0.664 for GRS and p = 0.72 for ICSAD). Regarding jugular CVC procedural time, LYR and experts were faster than PGY1 and MS (p < 0.05). Spearman correlation coefficient was -0.684 (p < 0.001) between ICSAD and GRS scores.
CONCLUSIONS:
ICSAD is a valid tool for assessment of jugular CVC since it differentiates between expert and novice subjects, and correlates with a validated GRS for jugular CVC in a simulated torso.
KEYWORDS:
Central venous catheterization; Medical simulation; Medical training; Objective skills assessment; Tracking motion device
PMID: 26877764 PMCID: PMC4751733 DOI: 10.1186/s13022-016-0025-6 Mostrar menos

BACKGROUND:
Intensive training programs arose from limitations in access to simulation centers. The aim of this study is to evaluate the effect and associated factors involved in an intensive course for learning advanced laparoscopic skills
METHODS:
General surgeons and final-year residents were analyzed after completing an intensive 5-session advanced laparoscopy course. Initial (IA) and final assessment (FA) consisted in performing a jejunojejunal anastomosis in a live porcine model,… Mostrar más

BACKGROUND:
Intensive training programs arose from limitations in access to simulation centers. The aim of this study is to evaluate the effect and associated factors involved in an intensive course for learning advanced laparoscopic skills
METHODS:
General surgeons and final-year residents were analyzed after completing an intensive 5-session advanced laparoscopy course. Initial (IA) and final assessment (FA) consisted in performing a jejunojejunal anastomosis in a live porcine model, measured using objective structured assessment of technical skill (OSATS) (GRS and SRS, that is, global rating scale and specific rating scale, respectively) and operative time (OT). The 3-session training was structured in a bench model with an ex vivo bowel. For the demographic analysis, 3 groups were defined according to the presentation of relevant changes in OSATS and in OT between IA and FA: group A, no changes; group B, change in 1 variable; and group C, change in both variables.
RESULTS:
After the course, all 114 participants presented a significant improvement in OT (37 vs 24.6min, p < 0.001) and in OSATS; global rating scale (10.5 vs 16 points; p < 0.001) and Specific Rating Scale (8.5 vs 12.7 points; p < 0.001). In the IA, 70 (61%) participants completed the jejunojejunal anastomosis and 105(92%) in the FA (p < 0.01). In the FA, 56% of participants presented relevant changes in both variables (group C). This group was significantly younger (34 vs 45 vs 40y old; p < 0.001), had fewer years of surgical experience (2 vs 9 vs 5y; p < 0.001), and had a proportionally higher concentration of residents (p = 0.01).
CONCLUSIONS:
This intensive course is set out as a viable alternative to teach basic skills in advanced laparoscopy in a short period of time, which is ideal for surgeons with difficult access to training centers. It remains necessary to establish the participant profile for which this type of course is most beneficial.


PMID: 26073475 DOI: 10.1016/j.jsurg.2015.01.016 Mostrar menos

BACKGROUND:
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective surgical therapy for morbid obesity. It is an advanced laparoscopic surgical procedure and has a protracted learning curve. Therefore, it is important to develop innovative ways of training and assessing surgeons. The aim of this study is to determine if a cadaveric porcine jejuno-jejunostomy model is an accurate way of assessing a surgeon's technical skills by determining if a correlation exists with how he… Mostrar más

BACKGROUND:
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the most effective surgical therapy for morbid obesity. It is an advanced laparoscopic surgical procedure and has a protracted learning curve. Therefore, it is important to develop innovative ways of training and assessing surgeons. The aim of this study is to determine if a cadaveric porcine jejuno-jejunostomy model is an accurate way of assessing a surgeon's technical skills by determining if a correlation exists with how he performs in the operating room.
METHODS:
Eight surgeons of varying experience performed a side-to-side stapled jejuno-jejunostomy on a cadaveric bench model before proceeding to perform the procedure on a real patient scheduled for LRYGBP. Performance was assessed using a motion tracking device, the Imperial College Surgical Assessment Device. Each procedure was recorded in video and scored by two blinded expert surgeons using procedure-specific rating scales.
RESULTS:
The cadaveric bench model demonstrated concurrent validity with significant correlations between performance on the cadaveric model and patient for dexterity measures. Left-hand path length, r = 0.857 (median, 27, 41.3; P = 0.007), right-hand path length, r = 0.810 (median, 31.5, 60; P = 0.015) and total number of movements, r = 0.743 (median, 422, 637; P = 0.035). This correlation in performance was also demonstrated in the video rating scales, r = 0.727 (median, 13.2, 14.8; P = 0.041). No correlation was found in operative time (median, 541, 742; P = 0.071).
CONCLUSIONS:
This study demonstrates the concurrent validity of the cadaveric porcine model, showing similar performances in surgeons completing a jejuno-jejunostomy on the cadaveric model and the patient.
PMID: 23404238 DOI: 10.1007/s11695-012-0807-9 Mostrar menos

Abstract
Clinical simulation is defined as a technique (not a technology) to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Over the past few years, there has been a significant growth in its use, both as a learning tool and as an assessment for accreditation. Example of this is the fact that simulation is an integral part of medical education curricula abroad. Some authors have… Mostrar más

Abstract
Clinical simulation is defined as a technique (not a technology) to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Over the past few years, there has been a significant growth in its use, both as a learning tool and as an assessment for accreditation. Example of this is the fact that simulation is an integral part of medical education curricula abroad. Some authors have cited it as an unavoidable necessity or as an ethical imperative. In Chile, its formal inclusion in Medical Schools' curricula has just begun. This review is an overview of this important educational tool, presenting the evidence about its usefulness in medical education and describing its current situation in Chile.

PMID: 23732417 DOI: 10.4067/S0034-98872013000100010 Mostrar menos

BACKGROUND:
Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model.
METHODS:
First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after… Mostrar más

BACKGROUND:
Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model.
METHODS:
First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after training assessments at the bench model were compared to a single performance of six expert laparoscopic surgeons. Results obtained by trainees at the porcine model assessment were compared to those of 11 general surgeons without any laparoscopic lab-simulation training and 6 expert laparoscopic surgeons. In all assessments, global and specific OSATS scores, operative time, and covered path length of hands were registered.
RESULTS:
Twenty-five residents improved significantly their global and specific OSATS score median at the bench model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05 and 7 (range, 4-8) vs. 18 (range, 18-19); p < 0.05, respectively] and obtained significantly better scores on the porcine model compared with general surgeons with no lab-simulation training [21 (range, 20.5-21) vs. 8 (range, 12-14); p < 0.05]. The results were comparable to those achieved by expert certificated bariatric surgeons. Total path lengths registered for trainees were more efficient post-training and significantly lower compared with general surgeons on the porcine model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05] with no statistical difference compared with experts.
CONCLUSIONS:
Trainees significantly improved their advanced laparoscopic skills to a level compared with expert surgeons. More importantly, these acquired skills were transferred to a more complex live model.
PMID: 22733192 DOI: 10.1007/s00464-012-2391-4 Mostrar menos

INTRODUCTION:
Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg.
METHODS:
A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a… Mostrar más

INTRODUCTION:
Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg.
METHODS:
A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a perforator-based flap was raised.
RESULTS:
The anatomical dissection revealed a constant intramuscular perforator with a median length of 5.7 cm. Median proximal and distal vessel diameters were 0.93 and 0.4 mm, respectively. The median dissection time was 77.5 minutes.
CONCLUSION:
This study introduces a novel, affordable, and reproducible model for the intramuscular dissection of a perforator-based flap using an ex vivo animal model. Its consistent perforator and appropriate-sized vessels make it useful for training.
KEYWORDS:
chicken; microsurgery; perforator flap; training
PMID: 27616823 PMCID: PMC5017028 DOI: 10.1055/s-0036-1581124 Mostrar menos