Background: How to optimally integrate simulation into a surgical training program is relatively unknown. We studied the effect of varying the practice schedule into either blocked or random patterns (termed contextual interference) on the long-term retention and transfer of surgical skills. Methods: 36 participants were randomized to practice 4 tasks from the Fundamental of Laparoscopic Surgery (FLS) program using one of three training schedules (blocked, random, no training). Skill was assessed using FLS scoring and hand-motion efficiency scores. Results: A positive benefit of training was seen over the controls for all 4 tasks (p<0.05). No difference was seen between the blocked and random groups in the amount of skill acquired, skill learned, or transfer of skill. Conclusion: The application of contextual interference was unable to differentiate between the blocked and random training groups. This could be due to the complexity of the tasks and/or the inexperience of the learners.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-31T12:08:04Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) MILTON - COLACAO DE GRAU.pdf: 6650065 bytes, checksum: 996dbdc7d9d5a860a4e5584e1429a777 (MD5) / Made available in DSpace on 2017-07-31T12:08:04Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) MILTON - COLACAO DE GRAU.pdf: 6650065 bytes, checksum: 996dbdc7d9d5a860a4e5584e1429a777 (MD5) Previous issue date: 2016-02-12 / CAPES / Objetivo: Aplicar uma metodologia construtivista fundamentada no uso de novos modelos cirúrgicos suínos no ensino-treinamento de procedimentos de emergências para capacitação de estudantes de medicina. Métodos: Estudo transversal, analítico, prospectivo, comparativo, controlado, divido em duas Fases. Primeira Fase: Ensino-Treinamento de Monitores; Segunda Fase: Ensino-Treinamento das Turmas de 2° e 8° Períodos. Amostra constituída de 332 estudantes divididos em 03 grupos: A, Monitores; B, 2° período e C, 8° período, 15 foram excluídos estudantes. Os grupos receberam aulas de cinco procedimentos de emergências aplicando didática diferenciada para cada grupo. Estes treinaram os procedimentos duas horas por semana durante um semestre. Aplicou-se o Protocolo de Avaliação de Ensinotreinamento de Procedimentos de Emergência (Pré e Pós-teste), prova objetivadiscursiva e a Escala de Avaliação Global de Desempenho Operativo (OSATS) para estimação de habilidades desenvolvidas. Resultados: Grupo A desenvolveu médias superiores aos grupos B e C em todas as variáveis. As diferencias entre os grupos B e C não foram significativas. O grupo C não demostrou um desempenho superior aos outros. Conclusões: Estudantes de medicina desenvolveram conhecimentos e habilidades clinico-cirúrgicas homogêneas mediante a aplicação da metodologia construtivista fundamentada no uso de modelos cirúrgicos suínos e anatômicos, sendo capazes de executar satisfatoriamente procedimentos invasivos de emergência. / Aims: Apply a constructivist methodology based on the use of new surgical swine models in the teaching and training of emergency procedures for training medical students. Methods: Cross-sectional, analytical, prospective, comparative, controlled, divided into two phases. First phase: Teaching and Training of Monitors; Stage Two: Teaching and Training of Classes 2 and 8th periods. Sample consisting of 332 students divided into 03 groups: A, Monitors; B, 2nd period and C, 8th period, 15 students were excluded. The five groups received emergency procedures applying different classes teaching for each group. These procedures have trained two hours per week for one semester. Applied the Protocol Assessment of Teaching and Training Emergency Procedures (pre and post-test), the objective is discursive event and the Global Assessment Scale Operating Performance (OSATS) pet developed skills. Results: Group A developed higher average than the B and C groups for all variables. The differences between groups B and C were not significant. Group C did not show superior performance to others. Conclusions: Medical students developed clinical and surgical skills homogeneously by applying the constructivist methodology based on the use of surgical pigs and anatomical models and performed invasive emergency procedures.

In surgical education, two of the current primary assessment tools for technical skills are the OSATS checklist and electromagnetic (EM) hand tracking. There are few bench models available for open procedures. The first two chapters of this thesis introduce these concepts further and provide detailed background knowledge. Chapter 3 explores interference that may from the concurrent use of EM tracking and cautery, finding that monopolar cautery interferes, while bipolar cautery does not. Chapter 4 discusses the validation of an assessment tool for open cholecystectomies (OCs) consisting of a porcine bench model and a Wii remote based infrared (IR) hand tracking system. The assessment tool is found to have construct validity and the face validity of the OC model is established. Chapter 5 concludes the thesis and presents several avenues of future research for the improvement of both the OC model and Wii remote based hand tracking system.

In surgical education, two of the current primary assessment tools for technical skills are the OSATS checklist and electromagnetic (EM) hand tracking. There are few bench models available for open procedures. The first two chapters of this thesis introduce these concepts further and provide detailed background knowledge. Chapter 3 explores interference that may from the concurrent use of EM tracking and cautery, finding that monopolar cautery interferes, while bipolar cautery does not. Chapter 4 discusses the validation of an assessment tool for open cholecystectomies (OCs) consisting of a porcine bench model and a Wii remote based infrared (IR) hand tracking system. The assessment tool is found to have construct validity and the face validity of the OC model is established. Chapter 5 concludes the thesis and presents several avenues of future research for the improvement of both the OC model and Wii remote based hand tracking system.

Laparoscopic bariatric procedures are complex minimally invasive operations with a potential for substantial morbidity and mortality along the early part of a surgeon’s learning curve. Simulation-enhanced training can improve a surgeon's technical and non-technical performance and lessen the learning curves in the operating room. Unfortunately, despite the convincing evidence supporting the use of simulation in surgical education, there is still a gap in translation of knowledge and technical skills from the research environment into clinically relevant training curricula. The objective of this thesis was to design and validate a comprehensive simulationenhanced training curriculum that addressed cognitive knowledge, technical and non-technical skill in laparoscopic bariatric surgery. This objective was achieved using three experimental studies. The first study employed a modified Delphi methodology and an international panel of experts in surgical and medical education to develop a consensus-based framework for design, validation and implementation of simulation-enahnced training curricula in surgery. The second study used a modified Delphi methodology and an international panel of experienced bariatric surgeons to develop an objective scale for assessment of operative skill in laparoscopic gastric bypass procedure. This scale was feasible to use and had high inter-rater and test-retest reliability, as well as evidence of construct and concurrent validity. The third study used the previously developed consensus-based framework to design a comprehensive simulation-enhanced training curriculum for laparoscopic bariatric surgery. A prospective, single-blinded randomized controlled trial was used to compare the effectiveness of this curriculum in comparison to conventional surgery training. Surgery residents who were trained in this curriculum demonstrated superior technical skills, superior non-technical skills and enhanced safety in the operating room.

Laparoscopic bariatric procedures are complex minimally invasive operations with a potential for substantial morbidity and mortality along the early part of a surgeon’s learning curve. Simulation-enhanced training can improve a surgeon's technical and non-technical performance and lessen the learning curves in the operating room. Unfortunately, despite the convincing evidence supporting the use of simulation in surgical education, there is still a gap in translation of knowledge and technical skills from the research environment into clinically relevant training curricula. The objective of this thesis was to design and validate a comprehensive simulationenhanced training curriculum that addressed cognitive knowledge, technical and non-technical skill in laparoscopic bariatric surgery. This objective was achieved using three experimental studies. The first study employed a modified Delphi methodology and an international panel of experts in surgical and medical education to develop a consensus-based framework for design, validation and implementation of simulation-enahnced training curricula in surgery. The second study used a modified Delphi methodology and an international panel of experienced bariatric surgeons to develop an objective scale for assessment of operative skill in laparoscopic gastric bypass procedure. This scale was feasible to use and had high inter-rater and test-retest reliability, as well as evidence of construct and concurrent validity. The third study used the previously developed consensus-based framework to design a comprehensive simulation-enhanced training curriculum for laparoscopic bariatric surgery. A prospective, single-blinded randomized controlled trial was used to compare the effectiveness of this curriculum in comparison to conventional surgery training. Surgery residents who were trained in this curriculum demonstrated superior technical skills, superior non-technical skills and enhanced safety in the operating room.

Since academic literature indicates that emotional intelligence (EI) is tied to work performance, there is increasing interest in understanding physician EI. We studied the EI of resident physicians in surgery, pediatric, and pathology residency programs at three academic centers to describe the EI profiles of residents in different specialties and determine whether gender differences in resident physician EI profiles mirror those in the general population. 325 residents were electronically invited to complete the validated Trait Emotional Intelligence Questionnaire (TEIQue), a tool comprised of 153 items that cluster to 15 independent facets, 4 composite factors, and 1 global EI score. The overall response rate was 42.8% (n=139, 84 women). Global EI of all residents (mean=101.0, SD=8.0) was comparable to the general population sample and was not statistically different between specialties or genders. EI profiling demonstrated distinct strengths and opportunities for development between specialty groups with an effect of specialty on sociability factor (p=0.005) and five TEIQue facets including optimism, stress management, emotion management, assertiveness, and social awareness (p=0.008-0.043). Women scored higher than men in emotionality factor (p=0.044) and the TEIQue facets impulse control, empathy, relationships, and self-motivation (p=0.004-0.049). Men scored higher than women in sociability factor (p=0.034) and 2 facets including stress management and emotion management (p=0.008-0.023). Linear regression demonstrated that age had a statistically significant predictive relationship with Global EI, though the effect was small (B=0.033, p=0.014). These findings suggest that similar to the general population, male and female residents may benefit from specific training of different EI domains to enhance well-rounded development. EI profiling may also inform future educational programming decisions for each specialty. Future research should focus on the functional relationship between educational interventions that promote targeted EI development and enhanced clinical performance.

This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. In the first study, we report a number of barriers that might prevent supervisors from providing constructive feedback to medical trainees, including a fear of being labeled as intimidating or harassing. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees including insufficient documentation, a perceived lack of support from program leadership, insufficient opportunities to observe performance, competing demands on time, fear of appeals or legal action, and fear of reciprocated poor staff evaluations. The second study examines the effectiveness of two new tools for assessing trainees’ performance and determines that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Participants reported that the new tools were helpful for improving learning in six ways: by sparking a dialogue regarding performance; by promoting a structured, procedure-specific framework which could be used as a mechanism for providing high quality feedback; by providing a framework for directing future learning; by facilitating a systematic tracking of progress over time; by promoting an increased motivation to learn; and by introducing a learning focus to the intraoperative environment. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessments and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care. / Thesis / Master of Science (MSc) / This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. We present two studies. In the first, we explore barriers that might prevent supervisors from providing constructive feedback to medical trainees. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees. The second study examines the effectiveness of two new tools for assessing trainees’ performance and demonstrates that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessment and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care.

Surgical education has the arduous task of providing effective and efficient methods of surgical skill acquisition and clinical judgment while staying abreast with the latest surgical technologies within an ever-changing field. Robotic surgery is one such technology. Many surgeons in practice today were either never taught or were not effectively taught robotic surgery during training, leaving them to navigate the robotic learning curve and reach mastery independently. This dissertation examines the impact of a video review guide on improving robotic surgical skills. Using Kolb’s Experiential Learning Theory as a framework, the literature review argues that video review can be used as a catalyst for reflection, which can deepen learning and improve self-assessment. Reflection, however, is not an innate skill but must be explicitly taught or guided. The researcher argues that a written video review guide can help novice surgeons develop reflective practice, resulting in improved surgical skills and a shorter robotic learning curve. A between-group quasi-random experiment was conducted to test this theory. The participants performed a pre-test technical simulation, conducted an independent video review, and then repeated the same simulation as a post-test. The intervention group received a surgical video review guide created by the researcher using Gibb’s Reflective Cycle and additional evidence-based strategies during the video review. The participants also completed an exit survey measuring the perceived usefulness of video review guides. Data analysis found that overall, both groups significantly improved their surgical skills; however, there was no statistical difference between the two groups. The participants perceived both the surgical video review guide and video review guides in general as useful. Implications for practice and recommendations for future research were discussed. This research underscores the potential of reflective guides as a low-cost and independent method to develop reflective practitioners further and improve surgical practice.

The fundamental of surgical training is the traditional apprenticeship method introduced by William Halsted which has been used for the last 100 years. It is based on learning in the operating room (OR) where the resident is guided by an experienced surgeon and gradually and methodically exposed to surgery. The continuous development of surgical methods together with the growing awareness of medical errors and ethical considerations have made the Halsted method outdated and there is an obvious need to be able to learn the skills of surgery without risking patient safety. New methods such as laparoscopy and endoscopy demand specific skills and abilities that may not be met by everyone. At the same time, the physical limitations of these new methods have made it possible to construct virtual reality (VR) simulators to practise and learn the skills necessary. This study is about the construction and evaluation of a VR-simulator for the training of transurethral resection of the prostate (TURP). It also concerns the specific abilities needed to become a good surgeon. A simulator for training TURP was developed after a face validity study where 17 experienced urologists gave their opinion of the specific content necessary for the training of this procedure. After a content validity study by nine experienced urologists and application of necessary improvements, a group of 11 medical students and nine experienced urologists performed a construct validity test where the urologists showed significantly higher levels of both skill and effectiveness compared to the inexperienced students when performing a simulated TURP procedure. The students showed a positive learning curve, but did not reach the levels of the urologists. The results of the experienced urologists were used as the minimal criterion level when 24 urology residents practised the procedure. Training took place while on a course on benign enlargement of the prostate and its treatment options, with emphasis on the “gold standard” treatment – TURP. During the course they performed three guided and video-taped TURP-procedures each on selected patients. Between two of the procedures they performed criterion-based training in the simulator. This VR-to-OR study showed improvement in operative skills with the same patient outcome as in the normal clinical situation. It also showed that simulator training improved their skills even more. During their time on the course their personality traits (TCI) and cognitive abilities (Rey complex figure and recognition trial, tower of London, WAIS-III) were tested. The results showed that a better learning curve in the OR was associated with a better simulator learning curve and a good visuospatial memory. The associated personality traits were high levels of goal directedness, impulse control, responsibility, anticipation of harmful events and a balanced attachment style. In conclusion, we have demonstrated that it was technically possible to construct a useful simulator for the training of TURP (PelvicVision®) which may now be considered clinically validated for this purpose. Novice training and performance in the simulator improves the learning curve and predicts the resident’s performance in the OR. The results support the implementation of validated simulation technology in a criterion-based training curriculum for residents. Furthermore, the results showed preliminary data on personality traits and visuospatial abilities that are important for learning a complex surgical procedure.