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A low-cost phantom for ultrasound-guided thyroid fine-needle aspiration training: face and construct validity 超声引导甲状腺细针抽吸训练的低成本假体:外观和结构效度
Pub Date : 2020-11-01 DOI: 10.1102/2051-7726.2020.0004
David Z Liao, V. Mehta, E. Du, V. Tabatabaie, I. M. Levy, Richard V. Smith, Marc J. Gibber
Background: There are currently no formally validated training phantoms for teaching ultrasound-guided thyroid fineneedle aspiration (FNA). We designed and established face and construct validity of a low-cost phantom for ultrasoundguided thyroid fine-needle aspiration. Methods: We designed an affordable, gelatin-based thyroid FNA phantom. Participants included 9 medical students, 7 novice residents/fellows (55 thyroid FNAs), and 7 expert residents/fellows (55 thyroid FNAs). Participants performed 6 trials of thyroid FNA, which were scored on completion time, accuracy, and errors. Participants also completed questionnaires to assess the benefit and realism of the simulation. Results: Simulation scores at trial 1 significantly discriminated expert participants from novice participants (P = 0.028) and from medical students (P 5 0.001). Median novice resident/fellow participant scores increased with repeated trials and were no longer significantly different from expert scores by trial 2. The scores for this group were significantly better compared with medical student scores by trial 4. Between trial 1 and trial 6, significant score improvements were observed in both medical students (P = 0.018) and novice residents (P = 0.018). All participants found the phantom to be beneficial in learning thyroid FNA. Both attending endocrinologists and 6 of 7 expert participants found the ultrasound visualization of the phantom to be realistic. One of two attending endocrinologists and 5 of 7 expert participants found the haptic feedback to be realistic. Conclusion: We designed a low-cost thyroid FNA phantom that demonstrates face and construct validity. This phantom can be used to train procedural skills in a residency program and can also be used to evaluate skill acquisition.
背景:目前尚无正式验证的超声引导甲状腺细针穿刺(FNA)教学训练模型。我们设计并建立了一种低成本的超声引导甲状腺细针穿刺假体,并构建了其有效性。方法:我们设计了一种价格合理的明胶基甲状腺FNA假体。参与者包括9名医学生、7名新手住院医师/研究员(55名甲状腺FNAs)和7名专家住院医师/研究员(55名甲状腺FNAs)。参与者进行了6次甲状腺FNA试验,并对完成时间、准确性和错误进行了评分。参与者还完成了问卷调查,以评估模拟的益处和真实性。结果:试验1的模拟得分显著区分了专家参与者与新手参与者(P = 0.028)和医学生(P 5 0.001)。新住院医师/同行参与者的中位数得分随着重复试验而增加,并且在试验2时与专家得分不再有显著差异。与试验4的医学生得分相比,该组得分显著提高。在试验1和试验6之间,医学生(P = 0.018)和住院医师新手(P = 0.018)的得分均有显著提高。所有参与者都发现幻像在学习甲状腺FNA方面是有益的。主治内分泌学家和7名专家参与者中的6名都发现,超声显示的幻肢是真实的。两名主治内分泌学家中的一名和7名专家参与者中的5名认为触觉反馈是真实的。结论:我们设计了一种低成本的甲状腺FNA假体,具有良好的外观和结构效度。这个幻影可以用来训练住院医师项目中的程序技能,也可以用来评估技能的获得。
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引用次数: 0
Observational clinical human reliability analysis (OCHRA) for assessing and improving quality of surgical performance: the current status and future 观察性临床人的可靠性分析(OCHRA)用于评估和提高手术质量:现状和未来
Pub Date : 2020-11-01 DOI: 10.1102/2051-7726.2020.0009
B. Tang
Morbidity and mortality data (MMD), as the traditional measure of surgical performance, have major limitations when used to assess and ensure quality of surgical performance. To improve and ensure the safest possible surgical performance, there is a need for prospective observational multidisciplinary studies, for which surgeons and human factor specialists should work together towards this objective. These considerations have led to the development of new systematic approaches for assessing and improving surgical operative performance. One of these is human reliability analysis (HRA), which eventually progressed to observational clinical human reliability analysis (OCHRA). HRA techniques are widely used in the risk management of safety-critical systems, e.g. nuclear power industry, aviation industry, and military operations. HRA techniques determine the impact of human error within a system. Surgical complications are related to techniques and result from errors most commonly committed during the intervention. Therefore, these errors can be influenced, i.e. deducted, by an HRA system that proactively reduces risk by preventing errors during human activities to the ‘as low as reasonably possible’. Two major limitations of OCHRA are its labour-intensive nature and the requirement for human factors engineering expertise in the assessment. These issues will be resolved in the short term by the significant progress based on artificial intelligence and machine learning, alongside with increased clinical use of OCHRA in surgical practice and health care in general.
发病率和死亡率数据(MMD)作为传统的外科手术效果衡量指标,在用于评估和确保外科手术质量时存在很大的局限性。为了提高和确保尽可能安全的手术效果,有必要进行前瞻性观察性多学科研究,外科医生和人为因素专家应该共同努力实现这一目标。这些考虑导致了评估和提高外科手术性能的新系统方法的发展。其中之一是人类可靠性分析(HRA),最终发展为观察性临床人类可靠性分析(OCHRA)。HRA技术广泛应用于安全关键系统的风险管理,例如核动力工业、航空工业和军事行动。HRA技术确定系统中人为错误的影响。手术并发症与技术有关,并由干预过程中最常见的错误引起。因此,这些错误可以被HRA系统影响,即扣除,该系统通过预防人类活动中的错误来主动降低风险,使其“尽可能低”。ohchra的两个主要限制是其劳动密集型性质和评估中对人因工程专业知识的要求。这些问题将在短期内通过基于人工智能和机器学习的重大进展,以及OCHRA在外科实践和一般医疗保健中的临床应用的增加而得到解决。
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引用次数: 0
Simulation training: a novel and effective way to improve knowledge and attitudes towards coroner’s court attendance 模拟训练:提高对验尸官出庭的认识和态度的新颖有效途径
Pub Date : 2020-11-01 DOI: 10.1102/2051-7726.2020.0007
C. Escobar, D. Pape, Kimberly L. Ferrante, M. Chuang, D. Szyld, V. Lerner
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引用次数: 0
Conflicting intra-departmental views on the importance of simulation in general surgery 科室内部对模拟在普外科中的重要性的不同看法
Pub Date : 2020-07-01 DOI: 10.1102/2051-7726.2020.0001
K. Lang, T. Hoover, Marie A. Hunsinger, M. Shabahang
Background: Although the technology has improved over the years, simulation is not used as widely in general surgery resident education as it is in other medical specialties. The aim of this study was to examine what general surgery residents and general surgeons like and do not like about simulation-based education. Methods: Unstructured focus groups were conducted at a moderate-sized general surgery residency program involving three groups of residents (interns, mid-levels, and chiefs) and two groups of attending physicians ( n = 27). In each of the groups, respondents were asked to articulate their views concerning the importance of simulation training. A qualitative analysis of the data was performed. Results: The attending physicians perceive the value of the simulation lab to be less effective than the operating room in terms of teaching surgical skills. In general, they see being part of an actual surgery to be more beneficial than working in a simulated environment. Conversely, the residents perceive simulation labs to be hands-on and educational, and as a low-stress environment to develop their surgical skills. Conclusions: This study demonstrates that faculty and residents have different views concerning the importance of surgical simulation. It also suggests that residents are in a bind. Many of them seek to be more involved in actual surgeries but feel that active learning in the simulation lab is more beneficial than passive learning in the operating room.
背景:虽然多年来技术已经得到了改进,但模拟在普通外科住院医师教育中的应用并不像在其他医学专业中那样广泛。本研究的目的是调查普通外科住院医师和普通外科医生喜欢和不喜欢基于模拟的教育。方法:在一个中等规模的普外科住院医师项目中进行非结构化焦点小组研究,该项目包括三组住院医师(实习生、中层和主任)和两组主治医师(n = 27)。在每个小组中,受访者都被要求阐明他们对模拟训练重要性的看法。对数据进行定性分析。结果:主治医师认为模拟实验室在外科技能教学方面不如手术室有效。总的来说,他们认为作为实际手术的一部分比在模拟环境中工作更有益。相反,住院医生认为模拟实验室是动手和教育的,是一个低压力的环境,可以发展他们的手术技能。结论:本研究表明,教师和住院医师对手术模拟的重要性有不同的看法。这也表明居民们陷入了困境。他们中的许多人寻求更多地参与实际手术,但觉得在模拟实验室的主动学习比在手术室的被动学习更有益。
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引用次数: 0
Limitations and challenges of laparoscopic surgery in a low-income country: example of the Gaston Berger Teaching Hospital of Saint-Louis (Senegal) 低收入国家腹腔镜手术的局限性和挑战:以圣路易斯加斯顿·伯杰教学医院为例(塞内加尔)
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2021.0002
A. Ndong, M. Diao, J. Tendeng, O. Thiam, A. Diallo, A. Diouf, D. Dia, Saer Diop, M. Dieng, M. Diedhiou, P. Nyemb, M. Cissé, I. Konaté
Introduction: Despite the advances in minimally invasive surgery in developed countries, laparoscopy remains less used in low-resource settings. Our aim is to describe our first experience in laparoscopic surgery at the Saint-Louis Hospital (Senegal). Methods: This is a descriptive cross-sectional study over the period from November 1, 2018, to June 31, 2020. We included patients operated on by laparoscopy. The parameters studied were age, sex, indications, operative time, reasons, conversion rate, intraoperative difficulties, hospital stay, and postoperative complications. Results: We operated on 83 patients. The mean age was 33.3 years (range, 11–74 years). There were 37 men (44.5%) and 46 women (55.5%). The procedures included appendectomy (49.3%), cholecystectomy (18.1%), exploration of infertility (10.8%), exploratory laparoscopy (7%), and transabdominal preperitoneal (TAPP) for inguinal hernia repair (5.1%). The conversion rate was 9.6% (n = 8). The mean operative time was 81 min (range, 20–210 min). The average length of hospital stay was 2.7 days (range, 1–8 days). The mortality rate was 2.4% (n = 2). Conclusion: Laparoscopy has a real benefit even in a low-resource context. To develop minimally invasive surgery, emphasis must be placed on training the medical team and improving equipment.
导论:尽管在发达国家微创手术取得了进步,腹腔镜手术在资源匮乏的环境中仍然很少使用。我们的目的是描述我们在圣路易医院(塞内加尔)腹腔镜手术的第一次经验。方法:这是一项描述性横断面研究,研究时间为2018年11月1日至2020年6月31日。我们包括通过腹腔镜手术的患者。研究的参数包括年龄、性别、指征、手术时间、原因、转换率、术中困难、住院时间和术后并发症。结果:共手术83例。平均年龄33.3岁(范围11 ~ 74岁)。男性37例(44.5%),女性46例(55.5%)。手术包括阑尾切除术(49.3%)、胆囊切除术(18.1%)、不孕症探查(10.8%)、腹腔镜探查(7%)和经腹腹膜前(TAPP)腹股沟疝修补术(5.1%)。转化率为9.6% (n = 8),平均手术时间为81 min(范围20 ~ 210 min)。平均住院时间2.7天(范围1-8天)。死亡率为2.4% (n = 2)。结论:即使在资源匮乏的情况下,腹腔镜手术也有真正的好处。要发展微创外科,必须重视医疗队伍的培训和设备的改进。
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引用次数: 5
The effect of video game play on ophthalmic microsurgical simulator performance: a randomized controlled trial 视频游戏对眼科显微外科手术模拟器性能的影响:一项随机对照试验
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2021.0009
S. Dryden, R. Gabbard, Fabliha Anbar, Shane Marsili, James Fleming, Brian Fowler
Objective: To examine the impact of real-time video game play on anterior segment ophthalmic microsurgical performance using a cataract surgical simulator (Eyesi). Methods: Medical students and ophthalmology residents at the University of Tennessee Health Science Center in Memphis, Tennessee, completed a questionnaire and baseline microsurgical evaluation using the capsulorhexis module on the surgical simulator. Participants were excluded if they had any previous intraocular surgical experience or extensive surgical simulator practice. Participants were randomized to group A (intervention) or group B (control). Group A completed as many levels of Tiltmasters as possible over a 30-min period, and group B was only allowed to watch the capsulorhexis demonstration video without any additional practice. After the 30-min time period elapsed, all participants performed the capsulorhexis module. Results: Of the 41 participants, regular video game players had greater baseline scores than non-players (P=0.003) on the capsulorhexis module. There was no significant difference in the final surgical performance between the control and intervention groups. However, the intervention group showed significantly more improvement in surgical performance than the control group (P=0.04). All participants demonstrated improvement in the final surgical performance regardless of whether they were in the control group or the intervention group. Conclusions: Regular video game play enhanced baseline microsurgical simulator performance. Both the control and intervention groups demonstrated improvement in final surgical simulator performance, indicating a warm-up effect. Participants in the intervention arm demonstrated significantly higher improvement than the control group, indicating skills transfer of the video game to surgical simulator performance after 30 min of intervention.
目的:探讨实时视频游戏对白内障手术模拟器(Eyesi)眼科前节显微手术性能的影响。方法:田纳西州孟菲斯市田纳西大学健康科学中心的医学生和眼科住院医师使用手术模拟器上的撕囊模块完成问卷调查和基线显微外科评估。如果参与者之前有任何眼内手术经验或广泛的手术模拟器实践,则排除。参与者被随机分为A组(干预组)或B组(对照组)。A组在30分钟内完成尽可能多的倾斜大师关卡,B组只允许观看撕囊演示视频,没有任何额外的练习。30分钟时间过去后,所有参与者进行撕囊模块。结果:在41名参与者中,经常玩电子游戏的人在撕囊模块上的基线得分高于非玩家(P=0.003)。对照组和干预组的最终手术表现无显著差异。干预组在手术表现上的改善明显高于对照组(P=0.04)。无论是对照组还是干预组,所有参与者的最终手术表现都有所改善。结论:经常玩电子游戏可以提高显微外科模拟器的基本性能。对照组和干预组均表现出最终手术模拟器性能的改善,表明热身效果。干预组的参与者表现出明显高于对照组的改善,这表明在30分钟的干预后,视频游戏的技能转移到手术模拟器的表现上。
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引用次数: 0
Intraoperative albumin usage and free flap outcomes in UMMC UMMC术中白蛋白使用及游离皮瓣预后
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2021.a006
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引用次数: 0
Multi-disciplinary team-based simulation training in acute care settings: a systematic review of the impact on team performance 多学科团队模拟训练在急性护理设置:对团队绩效影响的系统回顾
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2022.0003
C. Agbo, Seilo Koshoedo, S. Sridharan, K. Spearpoint, Shivani Sharma, K. Ashaye
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引用次数: 0
A narrative review of non-technical skills simulations for junior surgical trainees in managing surgical on-call 对初级外科培训生管理外科随叫随到的非技术技能模拟的叙述回顾
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2021.0008
Rebecca Smith
Mastery of non-technical skills (NTS) training is an essential part of surgical training but is often overlooked in favour of technical skills training. Although NTS simulations exist for several clinical activities for surgeons at all levels of training, this article identifies that there are currently no NTS simulations for junior surgical trainees in managing the surgical on-call, which is a key role assumed by senior surgeons but neglected by formal training. Development of an NTS simulation in managing the on-call would teach trainees the social, cognitive and personal resource skills that are invaluable in everyday clinical practice, improving interprofessional working relationships and overall patient care. Important NTS simulation design aspects, including the establishment of psychological safety, the impact of high sociological and psychological fidelity, and appropriate simulation evaluation methods are discussed in depth. A ready-to-use template for a potential pilot study is included for further research into developing a low-cost, highimpact NTS simulation concept into future surgical training.
掌握非技术技能(NTS)培训是外科培训的重要组成部分,但往往被忽视,有利于技术技能培训。尽管NTS模拟存在于各级外科医生培训的几种临床活动中,但本文指出,目前还没有NTS模拟用于初级外科学员管理手术随叫随到,这是高级外科医生承担的关键角色,但被正式培训所忽视。在管理随叫随到的NTS模拟的发展将教会受训者在日常临床实践中非常宝贵的社会,认知和个人资源技能,改善跨专业工作关系和整体患者护理。深入讨论了NTS仿真设计的重要方面,包括心理安全的建立、高社会学和心理保真度的影响以及适当的仿真评估方法。为潜在的试点研究提供了一个现成的模板,用于进一步研究开发低成本,高影响的NTS模拟概念,以用于未来的外科培训。
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引用次数: 0
Virtual learning during COVID-19 pandemic amongst medical students in the UK 英国医学生在COVID-19大流行期间的虚拟学习
Pub Date : 1900-01-01 DOI: 10.1102/2051-7726.2021.a025
{"title":"Virtual learning during COVID-19 pandemic amongst medical students in the UK","authors":"","doi":"10.1102/2051-7726.2021.a025","DOIUrl":"https://doi.org/10.1102/2051-7726.2021.a025","url":null,"abstract":"","PeriodicalId":202461,"journal":{"name":"Journal of Surgical Simulation","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134183728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Surgical Simulation
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