Expert laparoscopist performance on virtual reality simulation tasks with and without haptic features.

Background: Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback's effect on skill development. Our objective is to compare expert laparoscopists' skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces.

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests.

Update on the Financial Well-Being of Surgical Residents in New England.

Background: Poor personal financial health has been linked to key components of health including burnout, substance abuse, and worsening personal relationships. Understanding the state of resident financial health is key to improving their overall well-being.

Study Design: A secondary analysis of a survey of New England general surgery residents was performed to understand their financial well-being.

Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review.

Background: Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a 6-item biannual survey querying potential stressors. We reviewed the initial 5-year experience to assess for trends and improve efforts in maintaining resident well-being.

Update on the Personal and Professional Well-Being of Surgical Residents in New England.

Background: Surgical culture has shifted to recognize the importance of resident well-being. This is the first study to longitudinally track regional surgical resident well-being over 5 years.

Study Design: An anonymous cross-sectional, multi-institutional survey of New England general surgery residents using novel and published instruments to create three domains: health maintenance, burnout, and work environment.

Overcoming Systems Factors in Case Logging with Artificial Intelligence Tools.

Introduction: Case logs are foundational data in surgical education, yet cases are consistently under-reported. Logging behavior is driven by multiple human and systems factors, including time constraints, ease of case data retrieval, access to data-entry tools, and procedural code decision tools.

Methods: We examined case logging trends at three mid-sized, general surgery training programs from September 2016-October 2020, January 2019-October 2020 and May 2019-October 2020, respectively.

Application of technology to educational needs in surgery.

Innovations in surgical education follow advancing clinical technology. New surgical methods have prompted demand for systematic methods to leverage computing power and internet tools to achieve proficiency-based training goals. Virtual reality, high-fidelity patient simulation, web-based resources to facilitate performance assessment, and telementoring have become mainstream practices, although patient outcomes benefits are not well studied.

Validation of a simple technique of volumetric analysis of complex incisional hernias without 3D CT scan reconstruction.

Purpose: Volumetric analysis is being increasingly utilized in the preoperative evaluation of complex incisional hernias. Three-dimensional (3D) reconstruction of abdominal computed tomography (CT) scan has been used to obtain surface area (SA) and volume (Vol.) measurements, while others have used simple mathematical formulas to obtain SA and Vol.

Use of a Secure Web-Based Data Management Platform to Track Resident Operative Performance and Program Educational Quality Over Time.

Objective: In surgery residency programs, Accreditation Council for Graduate Medical Education mandated performance assessment can include assessment in the operating room to demonstrate that necessary quality and autonomy goals are achieved by the conclusion of training. For the past 3 years, our institution has used The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) instrument to assess and track operative skills. Evaluation is accomplished in near real-time using a secure web-based platform for data management and analytics (Firefly).

Senior General Surgery Resident Confidence in Performing Abdominal Wall Hernia Repairs.

Background: It is expected that graduating general surgery residents be confident in performing common abdominal wall hernia repairs. The objective of our study was to assess the confidence of senior surgical residents in these procedures and to identify factors that correlate with confidence.

Methods: We performed a cross-sectional survey of PGY-4 and PGY-5 general surgery residents at ACGME-accredited programs in the United States in the spring of 2019.

Education Management Platform Enables Delivery and Comparison of Multiple Evaluation Types.

Objective: The purpose of this study was to determine whether an automated platform for evaluation selection and delivery would increase participation from surgical teaching faculty in submitting resident operative performance evaluations.

Design: We built a HIPAA-compliant, web-based platform to track resident operative assignments and to link embedded evaluation instruments to procedure type. The platform matched appropriate evaluations to surgeons' scheduled procedures, and delivered multiple evaluation types, including Ottawa Surgical Competency Operating Room Evaluation (O-Score) evaluations and Operative Performance Rating System (OPRS) evaluations.

Boot Camp in a Box: Initial Experience with Pretraining Skills Preparation for New Interns.

Purpose: In order to increase selected skills at onset of training, we provided newly matched PGY-1 trainees with materials and instructions to practice these skills, as well as the opportunity to share video-recorded performance and receive feedback based on these videos.

Methods: Knot tying and suturing kits, instruments and supplies, and video instructions for task performance were sent to newly matched trainees to our program (n = 10), with instructions to practice 4 tasks (1- and 2-handed knot tying, interrupted and running suturing) until self-assessed comfort with each task was achieved or the 8-week time point before start of training was reached. Each trainee returned a video of each task, which was graded by blinded reviewers for time and errors using an itemized evaluation instrument (12 items for suturing and five items for knot-tying).

Novel Educational Information Management Platform Improves the Surgical Skill Evaluation Process of Surgical Residents.

Objective: We sought to increase compliance and timeliness of surgery resident operative evaluation, by providing faculty and residents with a Platform-linking evaluation to analytics and machine-learning-facilitated case logging.

Design: We built a HIPAA-compliant web-based Platform for comprehensive management of resident education information, including resident operative performance evaluations. To assess evaluation timeliness, we compared the lag time for Platform-based evaluations to that of end-of-rotation evaluations.

Outlier experienced surgeon's performances impact on benchmark for technical surgical skills training.

Background: Training in medicine must move to an outcome-based approach. A proficiency-based progression outcome approach to training relies on a quantitative estimation of experienced operator performance. We aimed to develop a method for dealing with atypical expert performances in the quantitative definition of surgical proficiency.

Visual spatial ability for surgical trainees: implications for learning endoscopic, laparoscopic surgery and other image-guided procedures.

Background: In image-guided procedures, a high level of visual spatial ability may be an advantage for surgical trainees. We assessed the visual spatial ability of surgical trainees.

Methods: Two hundred and thirty-nine surgical trainees and 61 controls were tested on visual spatial ability using 3 standardised tests, the Card Rotation, Cube Comparison and Map-Planning Tests.

A case report of unexpected pathology within an incarcerated ventral hernia.

Introduction: Incidence of hernial appendicitis is 0.008%, most frequently within inguinal and femoral hernias. Up to 2.

A computerised test of perceptual ability for learning endoscopic and laparoscopic surgery and other image guided procedures: Score norms for PicSOr.

Background: The aptitude to infer the shape of 3-D structures, such as internal organs from 2-D monitor displays, in image guided endoscopic and laparoscopic procedures varies. We sought both to validate a computer-generated task Pictorial Surface Orientation (PicSOr), which assesses this aptitude, and to identify norm referenced scores.

Methods: 400 subjects (339 surgeons and 61 controls) completed the PicSOr test.

Putting the MeaT into TeaM Training: Development, Delivery, and Evaluation of a Surgical Team-Training Workshop.

Background: Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum.

Methods: Workshops were conducted at 3 national meetings.

Identifying Opportunities for Virtual Reality Simulation in Surgical Education: A Review of the Proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR Surgery.

Objectives: To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation.

Background Data: Simulation is an increasingly important part of surgical training. VR is a developing platform for using simulation to teach technical skills, behavioral skills, and entire procedures to trainees and practicing surgeons worldwide.

Evaluation of advanced laparoscopic skills tasks for validity evidence.

Background: Since fundamentals of laparoscopic surgery (FLS) represents a minimum proficiency standard for laparoscopic surgery, more advanced proficiency standards are required to address the needs of current surgical training. We wanted to evaluate the acceptance and discriminative ability of a novel set of skills building on the FLS model that could represent a more advanced proficiency standard-advanced laparoscopic surgery (ALS).

Methods: Qualitative and quantitative analyses were employed.

The effects of viewing axis on laparoscopic performance: a comparison of non-expert and expert laparoscopic surgeons.

Background: While the ideal relationship of telescope viewing axis and instrument working axis in laparoscopic surgery is co-axial, it is often necessary to deviate view of the surgical field from the direction of working instruments with potentially negative implications to performance. The objectives of this study are to (1) characterize performance effects of working progressively further off telescope viewing axis and (2) compare the ability of expert laparoscopic surgeons and non-expert surgeons to compensate for the psychomotor problems imposed by off-axis viewing.

Methods: Subjects included Baystate Medical Center surgical residents between PGY 1 and PGY 5 training years and attending surgeons.

Ramifications of single-port laparoscopic surgery: measuring differences in task performance using simulation.

Introduction: Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance.

Methods: Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience.

Best practices in interprofessional education and training in surgery: experiences from American College of Surgeons-Accredited Education Institutes.

Background: Interprofessional education (IPE) in health care describes a process for training that places health care learners from different professional disciplines into an environment or situation in which shared or linked educational goals are pursued. IPE represents a new way of thinking about education as a value proposition directed at high-quality interprofessional patient care and as such is an innovative strategy endorsed in statements by the Institute of Medicine and the World Health Organization. The requirements of the American College of Surgeons-accredited Education Institutes (ACS-AEIs) for Comprehensive (Level I) accreditation state that education and training activities at the accredited institutes (simulation centers) must be multidisciplinary in nature.

Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition.

Objectives: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation.