Preoperative warm-up the key to improved resident technique: a randomized study

Moran-Atkin, Erin; Abdalla, Gamal; Chen, Grace; Magnuson, Thomas; Lidor, Anne O.; Schweitzer, Michael; Steele, Kimberley E.

doi:10.1007/s00464-014-3778-1

Cited by 20 publications

(32 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, researchers have been investigating whether these simulators might yield shorter-term gains for trainees and experts alike, through the implementation of preoperative Òwarm-upsÓ [12,13]. The idea of warming up for surgery has largely been borrowed from sports medicine: there is a long history of elite athletes performing warm-up routines.…”

Section: Introductionmentioning

confidence: 99%

A systematic examination of preoperative surgery warm-up routines

et al. 2016

View full text Add to dashboard Cite

Background: Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented? Methods:In order to address these issues, we adopted a two-pronged approach: (i) we conducted a systematic review of the literature to identify existing studies utilizing preoperative simulation techniques; (ii) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised crossover trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation.Results: Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. Whilst the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies. Conclusions:There is an urgent need for a more rigorous approach to the development of Ôwarm-upÕ routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance.

show abstract

Section: Introductionmentioning

confidence: 99%

A systematic examination of preoperative surgery warm-up routines

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Moran-Atkin et al studied the effect of a pre-operative ex-vivo warm-up by residents before entering the operating theater to perform laparoscopic surgery. 27 Significant improvements in depth perception and dexterity were found in residents who performed laparoscopic cases, including laparoscopic sleeve resection and LRYGB. Due to the small RCT the results cannot be specified for the bariatric procedures, but the overall effect is noted.…”

Section: Discussionmentioning

confidence: 98%

“…23,26 The Global Ratings Scales, Objective Structured Assessment of Technical Skills (OSATS), Bariatric OSATS (BOSATS) and error counts were used for evaluation of the effects of various interventions. 20,26,27 The resident and fellow education remarks are summarized in Table B.…”

Section: Training Level and Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review

Kaijser

Ramshorst

Wagensveld

et al. 2018

Journal of Surgical Education

View full text Add to dashboard Cite

show abstract

“…8 If tracheal intubation has failed and arterial haemoglobin oxygen concentration starts to decrease, ventilation via a facemask will be required, but cricoid pressure may also prevent mask ventilation. 8 If both tracheal intubation and mask ventilation have failed, major guidelines for difficult airway management unanimously recommend to insert a supraglottic airway (such as the laryngeal mask airway), and if that also fails, to gain invasive access to the infraglottic airway (such as percutaneous cricothyrotomy) as the last resort. [9][10][11] Nevertheless, cricoid pressure may hamper insertion of these devices.…”

Section: Mental Imagery: the Mind's Eyementioning

confidence: 99%

Improving procedural performance through warm-up and mental imagery

Weller

2016

British Journal of Anaesthesia

View full text Add to dashboard Cite

Anaesthetists are expected to develop and maintain expertise in procedural skills with low or zero tolerance for error. The more complex technical skills, as required for advanced airway management or ultrasound-guided procedures, require expertise in navigation, hand-eye coordination, and visualizing distant structures. Furthermore, learning and maintaining skills on patients is no longer acceptable when alternatives exist. Reduced working hours further limit opportunities for the traditional experiential learning of advanced procedural skills.Our surgical colleagues, faced with similar issues, have responded over the last few decades with extensive research and innovation aimed at optimising procedural performance and reducing error. Simulation and skills laboratories are now required by the Accreditation Council for Graduate Medical Education American (ACGME) and the research questions have moved from does simulation work to defining the elements of skills training and pre-procedure preparation that work best in different contexts. 1 However, even our surgical colleagues have struggled to integrate simulation-based skills programs into the regular training environment. The pre-procedural warm-up, by bringing simulators into the theatre suite, may help to embed simulation practice into the standard preparation for surgery. A further approach, also the subject of recent intense research activity, is mental imagery, a structured process of mental rehearsal prior to the procedure. Warm-up and mental imagery are well established in sports and the arts prior to a performance, and increasing evidence supports their value in surgery in improving performance and reducing procedural error.In this issue, Samuelson and colleagues 2 describe a warm-up for fibre-optic intubation (FOI) for anaesthesia trainees. They randomised subjects to a control group with no warm-up and an intervention group who undertook a 5-minute warm-up using a series of cases of varying difficulty on a virtual reality bronchoscopy simulator. Subsequent performance of asleep FOI in healthy patients with no anticipated airway difficulties showed significantly better performance in the warm-up group. I could find no other studies reporting pre-procedural warm-up in anaesthesia and only one on mental imagery. 3 Of relevance, Wright and colleagues 4 reported that the rates of errors, such as administering the wrong medication or blood, inadequate depth of anaesthesia, and oesophageal intubation, decrease after the first operations of the day, suggesting that anaesthetists' performance may improve after a period of warm-up.I undertook a Medline search of the literature on warm-up and mental imagery for procedural skills and provide here a narrative review with reference to potential application in anaesthesia. Pre-procedural warm-upWarming up prior to a race or a musical performance is established practice and supported by a wealth of evidence. The similarities between athletic or artistic performance and the performance of a surgeon embarking on a comple...

show abstract

Preoperative warm-up the key to improved resident technique: a randomized study

Cited by 20 publications

References 18 publications

A systematic examination of preoperative surgery warm-up routines

A systematic examination of preoperative surgery warm-up routines

Current Techniques of Teaching and Learning in Bariatric Surgical Procedures: A Systematic Review

Improving procedural performance through warm-up and mental imagery

Contact Info

Product

Resources

About