High-stakes Technical Performance Assessments Across the Continuum of Surgical Training.

Objective: The aim of this article to outline proposals for the use of high stakes technical performance assessments, defined as assessments of technical skill that take place outside of the operating theatre, across the continuum of surgical training.

Summary Background Data: Technological advancements have allowed for the assessment of operative technical skill outside of the workplace environment, developed and evaluated in line with modern concepts of assessment validity. With the introduction of competency-based education principles across surgical training curricula, increasing scrutiny is being placed on the validity and reliability of assessments used to inform high-stakes training decisions regarding selection, progression through training, autonomy granting and end-of-training certification.

Management of patients with adrenal myelolipoma: experience from a tertiary referral centre.

Background: Adrenal myelolipomas are rare, benign, tumours of the adrenal cortex.

Aims: This study reports the experience of a tertiary adrenal surgery referral centre's approach to the management of patients with adrenal myelolipoma.

Methods: A retrospective observational cohort study was conducted on all adult patients (> 18 years age) diagnosed with adrenal myelolipoma from January 1, 2014, to December 30, 2022.

Development and validation of a simulation-based assessment of operative competence for higher specialist trainees in general surgery.

Background: Simulation is increasingly being explored as an assessment modality. This study sought to develop and collate validity evidence for a novel simulation-based assessment of operative competence. We describe the approach to assessment design, development, pilot testing, and validity investigation.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland.

Background: Handovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover.

Methods: After ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland.

Performance in Irish Selection and Future Performance in Surgical Training.

Importance: Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity.

Objective: To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments.

Design, Setting, And Participants: This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program.

Collating evidence to support the validation of a simulated laparotomy incision and closure-training model.

Background: It is essential to evaluate the functionality of surgical simulation models, in order to determine whether they perform as intended. In this study, we assessed the use of a simulated laparotomy incision and closure-training model by collating validity evidence to determine its utility as well as pre and post-test interval data.

Method: This was a quantitative study design, informed by Messick's unified validity framework.

Generating a Prioritized List of Operative Procedures for Simulation-based Assessment of General Surgery Trainees Through Consensus.

Objective: To develop appropriate content for high-stakes simulation-based assessments of operative competence in general surgery training through consensus.

Background: Valid methods of summative operative competence assessment are required by competency-based training programs in surgery.

Method: An online Delphi consensus study was conducted.

Assessing operative competence in core surgical training: A reliability analysis.

Background: This study quantifies the number of observations required to reliably assess the operative competence of Core Surgical Trainees (CSTs) in Ireland, using the Supervised Structured Assessment of Operative Performance (SSAOP) tool.

Methods: SSAOPs (April 2016-February 2021) were analysed across a mix of undifferentiated procedures, as well as for three commonly performed general surgery procedures in CST: appendicectomy, abdominal wall hernia repair, and skin/subcutaneous lesion excision. Generalizability and Decision studies determined the number of observations required to achieve dependability indices ≥0.

Perspectives on simulation-based assessment of operative skill in surgical training.

Introduction: The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to explore the factors associated with the acceptable use of SBA in surgical training, through the perceptions and experiences of a broad range of stakeholder representatives, building on findings from a review of the published literature.

Materials And Methods: Ten semi-structured interviews were conducted, using a sequential transformative qualitative methods approach, with representatives from identified key stakeholder groups; executive management, risk management, a practicing surgeon, an anaesthesiologist, a theatre-nursing representative, a representative from simulation industry, a patient, a medical student, a junior surgical trainee, and a senior surgical trainee.

Training and assessment using the LapSim laparoscopic simulator: a scoping review of validity evidence.

Introduction: The LapSim (Surgical Science, Sweden) laparoscopic simulator is a high-fidelity virtual reality simulator for use in endoscopic surgical training. This review critiques the current validity evidence for the LapSim laparoscopic simulator, specifically with respect to its potential use as a tool and method of training and assessment in surgery.

Methods: A scoping review of the MEDLINE (PubMed), EMBASE, Cochrane and Web of Science databases was conducted in accordance with PRISMA guidelines (2020)-scoping review extension.

Defining operative experience targets in surgical training: A systematic review.

Background: The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence.

Baseline Assessments of Psychomotor Aptitude Are Associated With the Future Operative Performance of Surgical Trainees: A Prospective Observational Cohort Study.

Objective: This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance.

Background: Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking.

Assessing Operative Skill in the Competency-based Education Era: Lessons From the UK and Ireland.

Introduction: Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods.

Methods: A review of the MEDLINE (Pubmed), EMBASE and Cochrane Library databases was undertaken in accordance with the Joanna Briggs Institute Protocol for Scoping Reviews (2020).

Training to proficiency in surgery using simulation: is there a moral obligation?

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The 'learning curve' in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients.

Outcomes of Acute Limb Ischaemia in Patients with Underlying Malignancy: A Systematic Review.

Objective: Previous studies have demonstrated amputation and mortality rates to be 14.3% - 30% and 11.4% - 28.

How do Trainers and Trainees use Formative Workplace-based Assessments of Operative Competence to Deliver and Receive Structured Feedback?

Objective: The aim of this study is to assess the quality of feedback provided to surgical trainees in the operating theatre, and to further investigate how trainees and trainers use workplace-based assessment in practice with regards to frequency and timing of assessments.

Design: A retrospective study of all submitted Supervised Structured Assessments of Operative Performance (SSAOPs) from April 25, 2016 to February 2, 2021 was conducted.

Setting: Surgical trainees in the Republic of Ireland across all national surgical training sites submitted SSAOPs through an online platform.

Perceptions and experiences of simulation-based assessment of technical skill in surgery: A scoping review.

Introduction: The introduction of simulation-based assessment raises questions as to its role in trainee selection, progression, certification and credentialing. This study sought to review and critique the available research regarding the perceptions and experiences of residents and their trainers towards simulation-based assessment of technical skills in surgery.

Methods: A comprehensive literature review of the Medline (PubMed), Embase, Cochrane and Web of Science databases was performed in accordance with the Joanna Briggs Institute 2020 protocol for scoping reviews in July 2020, for all original research articles, abstracts and conference proceedings assessing the attitudes, perceptions, opinions and experiences of residents and surgical trainers toward simulation-based assessment of technical or operative skill.

Open repair of a type II endoleak facilitated by temporary disconnection of graft components.

Endoleaks are a frequent indication for reintervention after endovascular repair of an abdominal aortic aneurysm. Here we present a method of open repair of a persistent type II endoleak involving graft component separation and reconstruction, in a patient with symptomatic interval aneurysmal sac enlargement despite endovascular coiling and embolization. This case report demonstrates an alternative open technique of endograft component separation and reconstruction that may be required in cases where open repair with sac exploration and vessel oversewing is hindered by the graft position.

Hybrid covered endovascular reconstruction of the aortic bifurcation (CERAB) procedure is preferable to aortobifemoral bypass for limb-threatening aortoiliac occlusive disease during the COVID-19 crisis.

The COVID-19 pandemic is disrupting the provision of acute vascular surgery across the globe. Limited evidence of the impact of nosocomial infection on patient outcomes as well as concerns about critical care capacity will likely have an impact on surgical decision-making. Endovascular therapy offers a way by which perioperative risk can be reduced for vascular patients while also reducing the impact of acute surgery on intensive care unit capacity.

Left atrial appendage clipping as an adjunctive therapy in lung cancer surgery for patients with atrial fibrillation: a case report.

The left atrial appendage (LAA) is thought to be responsible for the vast majority of embolic strokes, and has become an important target in the surgical management of atrial fibrillation (AF). Epicardial clipping of the LAA has emerged as a potentially safe, durable and effective method of surgical closure, and has been performed both as a stand-alone procedure (thoracoscopic LAA clipping) and as an adjunct in patients undergoing open cardiac surgery. To our knowledge, the use of epicardial clipping in the setting of non-cardiac thoracic surgery for patients with concurrent diagnosis of AF has not been previously reported.