Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions

Higgins, Mark; Madan, Christopher R.; Patel, Rakesh

doi:10.1016/j.surge.2020.07.013

Cited by 39 publications

(25 citation statements)

References 24 publications

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“…Some abroad experiences or post-graduate surgical courses are still valid options, but recently, after the COVID-19 pandemic, international exchange programs have been dramatically reduced ( 6 , 7 ). Also, learning new surgical skills is different from perfecting them, which implies that they have to be repeated with constancy over time ( 15 ). The neurosurgical learning curve is still too long and dominated by conventional mentor–apprentice relationships ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

et al. 2022

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BackgroundIn the recent years, growing interest in simulation-based surgical education has led to various practical alternatives for medical training. More recently, courses based on virtual reality (VR) and three-dimensional (3D)-printed models are available. In this paper, a hybrid (virtual and physical) neurosurgical simulator has been validated, equipped with augmented reality (AR) capabilities that can be used repeatedly to increase familiarity and improve the technical skills in human brain anatomy and neurosurgical approaches.MethodsThe neurosurgical simulator used in this study (UpSurgeOn Box, UpSurgeOn Srl, Assago, Milan) combines a virtual component and a physical component with an intermediate step to provide a hybrid solution. A first reported and evaluated practical experience on the anatomical 3D-printed model has been conducted with a total of 30 residents in neurosurgery. The residents had the possibility to choose a specific approach, focus on the correct patient positioning, and go over the chosen approach step-by-step, interacting with the model through AR application. Next, each practical surgical step on the 3D model was timed and qualitatively evaluated by 3 senior neurosurgeons. Quality and usability-grade surveys were filled out by participants.ResultsMore than 89% of the residents assessed that the application and the AR simulator were very helpful in improving the orientation skills during neurosurgical approaches. Indeed, 89.3% of participants found brain and skull anatomy highly realistic during their tasks. Moreover, workshop exercises were considered useful in increasing the competency and technical skills required in the operating room by 85.8 and 84.7% of residents, respectively. Data collected confirmed that the anatomical model and its application were intuitive, well-integrated, and easy to use.ConclusionThe hybrid AR and 3D-printed neurosurgical simulator could be a valid tool for neurosurgical training, capable of enhancing personal technical skills and competence. In addition, it could be easy to imagine how patient safety would increase and healthcare costs would be reduced, even if more studies are needed to investigate these aspects. The integration of simulators for training in neurosurgery as preparatory steps for the operating room should be recommended and further investigated given their huge potential.

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Section: Discussionmentioning

confidence: 99%

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

et al. 2022

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“…Surgical skills including motor and cognitive skills decay when a surgeon goes through a long period of time without using the acquired skills (Perez et al, 2013). Simulationbased medical education may fill the gap in surgical practice and prevent the loss of surgical skills during a lockdown (Higgins et al, 2020). In addition, AI can be employed to interpret the data collected from simulations for surgeons' skill evaluation (Winkler-Schwartz et al, 2019).…”

Section: Tele-training Of Surgeonsmentioning

confidence: 99%

Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision

et al. 2021

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The unprecedented shock caused by the COVID-19 pandemic has severely influenced the delivery of regular healthcare services. Most non-urgent medical activities, including elective surgeries, have been paused to mitigate the risk of infection and to dedicate medical resources to managing the pandemic. In this regard, not only surgeries are substantially influenced, but also pre- and post-operative assessment of patients and training for surgical procedures have been significantly impacted due to the pandemic. Many countries are planning a phased reopening, which includes the resumption of some surgical procedures. However, it is not clear how the reopening safe-practice guidelines will impact the quality of healthcare delivery. This perspective article evaluates the use of robotics and AI in 1) robotics-assisted surgery, 2) tele-examination of patients for pre- and post-surgery, and 3) tele-training for surgical procedures. Surgeons interact with a large number of staff and patients on a daily basis. Thus, the risk of infection transmission between them raises concerns. In addition, pre- and post-operative assessment also raises concerns about increasing the risk of disease transmission, in particular, since many patients may have other underlying conditions, which can increase their chances of mortality due to the virus. The pandemic has also limited the time and access that trainee surgeons have for training in the OR and/or in the presence of an expert. In this article, we describe existing challenges and possible solutions and suggest future research directions that may be relevant for robotics and AI in addressing the three tasks mentioned above.

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“…For design, it is essential to ensure that CS, both open and closed, are developed and transferred to real-life clinical practice but also that skill decay over time can be minimised. The review and the wider evidence base, that also includes sport psychology and clinical skills training, highlights the importance of guided deliberate practice, goal setting, spaced learning (short and repeated sessions), repeated assessment of skill with feedback and opportunities for practice across a wide variety of situations, both simulated and real-life (Cecilio-Fernandes et al 2018;McGinn et al 2018;Higgins et al 2021). For delivery, the review and sports psychology evidence-base also highlight the importance of groupbased (Greenspan and Feltz 1989) and multimodal approaches that target several PMS in combination (Sharp et al 2013), with PMST guided by a trainer with sport psychology expertise, including a focus on coaching to enable personalised adaptation of PMS to different challenging situations (Mageau and Vallerand 2003;Hanin and Hanina 2009).…”

Section: Recommendationsmentioning

confidence: 99%

Applying sport psychology in health professions education: A systematic review of performance mental skills training

et al. 2021

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Introduction: Health professionals are expected to consistently perform to a high standard during a variety of challenging clinical situations, which can provoke stress and impair their performance. There is increasing interest in applying sport psychology training using performance mental skills (PMS) immediately before and during performance. Methods: A systematic review of the main relevant databases was conducted with the aim to identify how PMS training (PMST) has been applied in health professions education and its outcomes. Results: The 20 selected studies noted the potential for PMST to improve performance, especially for simulated situations. The key implementation components were a multimodal approach that targeted several PMS in combination and delivered face-to-face delivery in a group by a trainer with expertise in PMS. The average number of sessions was 5 and of 57 min duration, with structured learner guidance, an opportunity for practice of the PMS and a focus on application for transfer to another context. Conclusion: Future PMST can be informed by the key implementation components identified in the review but further design and development research is essential to close the gap in current understanding of the effectiveness of PMST and its key implementation components, especially in real-life situations.

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Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions

Cited by 39 publications

References 24 publications

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

Robotics and AI for Teleoperation, Tele-Assessment, and Tele-Training for Surgery in the Era of COVID-19: Existing Challenges, and Future Vision

Applying sport psychology in health professions education: A systematic review of performance mental skills training

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