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PubMedDate not supplied

Benefits of surgical experience in a third-world country during residency.

PURPOSE: Completion of a United States surgical residency enables the graduate to provide service in most populated areas. Graduates are technically well trained and efficient in performing most surgeries. United States-based teaching facilities are generally furnished with technically advanced supplies and equipment. Access to financial reserve is also available. Surgery in third-world countries, however, can be challenging. These countries, particularly in the outskirts, lack supplies and innovation, such as advanced equipment, medication, and personnel. Compounding the problem, patients tend to have advanced pathology and diminished financial means. METHODS: The United States-based surgical team annually collaborated with a medical mission to provide service to a rural community of the Dominican Republic. A senior-level surgery resident accompanied the surgeon. Surgical supplies were donated and brought with the team. The average number of cases performed was approximately 37 per week. All procedures were performed for symptomatic pathology. All patients were preoperatively screened and evaluated for comorbidities. RESULTS: No immediate complications occurred. Local physicians provide long-term follow-up. Pediatric procedures were not performed secondary to lack of postoperative resources. CONCLUSIONS: Surgical experience is beneficial to the recipient community and the resident surgeon. The extent of pathology and lack of resources enforces efficiency and broadens skills. This opportunity can potentially prepare surgeons for the growing need of rural surgery.

Journal Article↗
PubMed2002

Virtual reality training improves operating room performance: results of a randomized, double-blinded study.

OBJECTIVE: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. SUMMARY BACKGROUND DATA: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. METHODS: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). RESULTS: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). CONCLUSIONS: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Cholecystectomy, Laparoscopic↗
PubMed2006

Simulation of surgery for craniosynostosis: a training model in a fresh cadaveric sheep cranium. Technical note.

The authors present a training model in sheep crania that allows residents in neurosurgery and plastic surgery to practice the frontoorbital remodeling procedure used in the surgical correction of simple craniosynostoses such as plagiocephaly, trigonocephaly, and brachiocephaly. The model comprises a three-step approach: subperiosteal and subperiorbital dissection; elevation of the bifrontal bone flap and the supraorbital bar; and finally, frontoorbital remodeling. The authors conclude that this training model, based on the use of cadaveric sheep crania, represents a fairly useful method to accustom trainees to the required surgical techniques and simulates well the steps of standard pediatric and adult craniofacial surgery for simple craniosynostosis.

Animals↗
PubMed1999

Assessment of technical skills transfer from the bench training model to the human model.

BACKGROUND: This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. METHODS: Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. RESULTS: Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F(2,44) = 3.49, P <0.05) and global scores (F(2,44) = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. CONCLUSIONS: Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.

Cadaver↗
PubMed1992

Priorities of undergraduate dental education: what do students think?

In recent years there has been an increasing interest in the teaching of behavioural sciences to dental undergraduates, but psychologists and sociologists can meet with resistance to their teaching from both staff and students. In an attempt to understand this resistance further, this paper provides the results of a cross-sectional survey conducted with undergraduate students at two UK dental schools. The results indicate that students believe that training in technical aspects of care (e.g. practice in manual skills, knowledge about anatomy) should assume a substantially higher priority than training in social aspects (e.g. practice in communication skills, knowledge about psychology). The students felt that they were increasingly prepared for both aspects of practice as they progressed through the course, and senior students were more likely to believe that their dental schools should give a higher priority to history-taking and psychological methods to control pain and anxiety than junior students. These results present a considerable challenge for psychologists and sociologists teaching at dental schools and suggest that appropriate curriculum design and integrated teaching may be the way forward.

Attitude of Health Personnel↗
PubMed2005

Changing clinical practice, helping people quit: the Wisconsin Cessation Outreach model.

Six University of Wisconsin-Center for Tobacco Research and Intervention (UW-CTRI) Regional Outreach Specialists, based in 5 regions across the state, provide training and technical assistance on evidence-based tobacco cessation interventions to clinics, hospitals, health systems, insurers, community organizations and worksites through academic detailing methods. The core of this approach involves individualized training on the U.S. Public Health Service Clinical Practice Guideline, "Treating Tobacco Use and Dependence" as well as follow-up technical assistance to achieve sustainable system changes and a reduction in barriers to tobacco cessation services. The program's scope includes health systems, managed care organizations, hospitals, worksites, and community organizations. The program also links organizations and the communities they serve to the Wisconsin Tobacco Quit Line and related cessation services. Since 2001, over 10,000 health care providers in over 500 clinics and 26 health systems and managed care organizations have received Guideline-based cessation training through the Outreach program. This paper examines research supporting this Cessation Outreach Model, describes its operation, discusses key outcomes, and reviews future directions and applications.

Community Health Services↗
PubMed2004

Library involvement in the implementation of a course management system.

Course management system software has much to offer the faculty and students in universities that adopt this technology. Libraries have used this technology to provide links to library resources, but they can also have a role in implementing the adoption of the course management software. The Penn State College of Medicine successfully implemented the ANGEL course management system under the guidance of a medical librarian. Tasks specific to the librarian included communication and promotion of ANGEL, in addition to providing training and technical support.

Computer-Assisted Instruction↗
PubMed2000

Recent developments and present status of telepathology.

Telepathology which is the diagnostic work of a pathologist at a distance has been developed to routine application within the last ten years. It can be classified in relation to application, technical solutions, or performance conditions. Diagnostic pathology performance distinguishes primary diagnosis (for example, frozen section statement) from secondary diagnosis (for example, expert consultation) and quality assurance (diagnostic accuracy, continuous education and training). Applications comprise (a) frozen section service; (b) expert consultations; (c) remote control measurements; and (d) education and training. The technical solutions distinguish active (remote control, live imaging) systems from passive (conventional microscope handling, static imaging), and the performance systems with interactive (on-line, live imaging) use from those with passive (offline, static imaging) practice. Intra-operative frozen section service is mainly performed with remote control systems; whereas expert consultations and education/training are commonly based upon Internet connections with static imaging in an off-line mode. The image quality, transfer rates, and screen resolution of active and passive telepathology systems are sufficient for an additional or primary judgment of histological slides and cytological smears. From the technical point of view, remote control telepathology requires a fast transfer and at least near on-line judgement of images, i.e., image acquisition, transfer and presentation can be considered one performance function. Thus, image size, line transfer rate and screen resolution define the practicability of the system. In expert consultation, the pixel resolution of images and natural color presentation are the main factors for diagnostic support, whereas the line transfer rate is of minor importance. These conditions define the technical compartments, especially size and resolution of camera and screen. The performance of commercially available systems has reached a high quality standard. Pathologists can be trained in a short time and use the systems in a routine manner. Several telepathology systems have been implemented in large Institutes of Pathology which serve for frozen section diagnosis in small hospitals located in the local area. In contrast, expert consultation is mainly performed with international connections. There is a remarkable increase of expert consultations by telepathology according to the experiences of the Armed Forces Institute of Pathology or the Department of Pathology, Thoraxklinik, Heidelberg. In expansion of these experiences, a "globalization" of telepathology can be expected. Telepathology can be used to shrink the period necessary for final diagnosis by request for diagnostic assistance to colleagues working in appropriate related time zones. Telepathology is, therefore, not a substitute of conventional diagnostic procedures but a real improvement in the world of pathology.

Europe↗
PubMed1997

The effect of drinking and driving interventions on alcohol-involved traffic crashes within a comprehensive community trial.

The Drinking and Driving Component, one of five elements of the Community Trials Project, involved the implementation of a special drink driving countermeasure in the three experimental communities, one in Northern California, one in Southern California and another in South Carolina. This intensified enforcement of driving under the influence (DUI) was designed to deter potential drinking drivers by increasing their perception of the risk of being arrested leading to a reduction in the consumption of alcohol before driving. See component detailed description in Voas (1997, this issue). The evaluation found that media advocacy training and technical assistance resulted in increased DUI news coverage and that additional police officer hours for DUI enforcement, greater use of breathalyzer equipment, increased officer training and more checkpoints produced increased DUI enforcement. The combined effects of increased DUI news coverage and DUI enforcement yielded increased public perceived risk of arrest and subsequently less drinking and driving. Overall the evaluation found that alcohol-involved traffic crashes were reduced as a result of this component in the experimental communities as contrasted with the matched comparison communities.

Accidents, Traffic↗
PubMed2006

Building Native Hawaiian capacity in cancer research and programming. A legacy of 'Imi Hale.

In 2000, cancer health indicators for Native Hawaiians were worse than those of other ethnic groups in Hawai'i, and Native Hawaiians were under-represented in research endeavors. To build capacity to reduce cancer health disparities, 'Imi Hale applied principles of community-based participatory research (CBPR) and empowerment theory. Strategies included: 1) engaging Native Hawaiians in defining cancer priorities; 2) developing culturally appropriate processes and products; 3) supplementing primary and secondary cancer prevention activities; 4) offering skills training and technical assistance; and 5) providing an infrastructure to support culturally appropriate research. Between 2000 and 2005, 'Imi Hale involved more than 8000 Native Hawaiians in education, training, and primary and secondary prevention activities; developed 24 culturally tailored educational products (brochures, curricula, and self-help kits); secured $1.1 million in additional program and research funds; trained 98 indigenous researchers, 79 of whom worked on research projects; and engaged more than 3000 other Native Hawaiians as research participants and advisors. Evidence of empowerment was seen in increased individual competence, enhanced community capacity and participation, reduced barriers, and improved supports to address cancer in Hawaiian communities. Operationalizing CBPR and empowerment requires a commitment to involving as many people as possible, addressing community priorities, following cultural protocol, developing and transferring skills, and supporting an infrastructure to reduce barriers and build supports to sustain change. This approach is time consuming, but necessary for building competence and capacity, especially in indigenous and minority communities. Cancer 2006. (c) 2006 American Cancer Society.

Biomedical Research↗
PubMed2006

Technical skills continue to improve beyond surgical training.

BACKGROUND: There is growing focus on surgical technical competence and the means by which we are able to measure it. Ongoing studies have shown a plateau effect with increasing experience of the operator. The aim of this study was to assess the technical competence of five groups of surgeons with increasing experience and validate a new rating tool for use in surgical assessment. METHODS: Fifty surgeons performed a saphenofemoral junction ligation on a synthetic groin model. The procedure was videotaped, blinded, and reviewed independently by three assessors. Performance was assessed using a previously validated global rating scale of generic surgical skill. In addition, each procedure was rated with the procedure-specific Imperial College Evaluation of Procedure-Specific Skill (ICEPS) rating scale to establish the construct validity (ability to differentiate on the basis of skill) and inter-observer reliability. RESULTS: Both rating scales showed improved scores with ascending grades (P < .001) and demonstrated a high inter-observer reliability both for generic and procedure-specific skill (alpha = 0.97 and alpha = 0.96, respectively). Total operative scores demonstrated significant differences between surgeons in postgraduate years 1 and 2 and surgeons in years 3 and 4 and also between newly appointed and experienced consultants (P < .041). Procedure-specific performance showed a plateau effect at the registrar level. Generic skill continued to improve, and significant differences were seen between newly appointed and senior consultants (P < .026). CONCLUSION: This study shows that surgical performance continues to improve significantly beyond consultancy, and the data suggest that generic and procedural performance continue to improve, with significant improvement in the former with increasing experience. The ICEPS rating scale demonstrates construct validity and a high inter-observer reliability supporting its use in formative and summative assessment.

Clinical Competence↗
PubMed1994

Electrosurgical injuries during laparoscopy: prevention and management.

Despite the fact that electrophysics and its application to surgery, in particular endoscopic surgery, is a discreet science, there is little attention paid to the applied principles of the physics involved when surgeons receive their formal training in the technical aspects of surgery. Most training programs consider the discipline of electrosurgery as a skill that is left to the 'hands on' exposure of the student, and that the skills and knowledge of the average professor have been awarded through a 'grandfather' process of credentials. As a result, many myths have been perpetuated over the past decades since William Bovie introduced the first electrosurgical diathermy machine using high frequency radio waves instead of heated instruments (cautery) to destroy human tissue. Electrogenerators, today, have become finely tuned instruments that offer many versatile variables for the contemporary surgeon to harness and deliver, in either a discreet or broad manner, to tissue to obtain a desired effect and outcome.

Electric Injuries↗
PubMed2000

How organizational factors contribute to innovations in service delivery.

Twelve staff members from three community centers providing services to people with mental retardation were interviewed about the implementation of a new approach to service delivery that utilized Essential Lifestyle Planning. Findings indicate that although the innovation proposed and the technical assistance provided were quite similar, the outcomes varied greatly across the three sites. By highlighting the importance of organizational factors, such as timing and agency supports, these findings provide direction for future training and technical assistance activities of those who promote change in service-delivery philosophy and methods.

Adult↗