Striving for Better Medical Education: the Simulation Approach.

Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties. Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used. Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators. The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

Minimally Invasive Supraumbilical Approach for Pyloromyotomy.

BACKGROUND: The three major approaches for Ramstedt pyloromyotomy - right upper quadrant incision, supraumbilical incision and laparoscopic method, are often compared, with some preference given to the supraumbilical approach. It becomes widely adopted in many centers around the world. AIM: To analyse the early results of the supraumbilical incision in treatment of hypertrophic pyloric stenosis and to test a hypothesis that this technique may be valuable in our clinical conditions. MATERIALS AND METHODS: Within a ten-month period five children with hypertrophic pyloric stenosis were selected (using single random sample) for pyloromyotomy via supraumbilical incision and another five children - via Robertson incision. This technique consists of semi lunar cutting in the upper half of umbilicus, extended cranially in the midline. After a Ramstedt pyloromyotomy, linea alba is sutured and the reshaped skin is sutured in semilunar manner around the umbilicus. The scar was estimated with Patient and Observer Scar Assessment Scale. RESULTS: The operations were performed by pediatric surgeons with different experience and with basic equipment. The operative time was 5-10 min longer for the supraumbilical incision. The pyloromyotomy led to a definitive healing, with timely feeding and discharging, without any complication. The quality of the scar was significantly better after the supraumbilical incision. CONCLUSION: Supraumbilical incision is reliable and related to low complication rates. It leaves better scar than the Robertson incision and is an excellent alternative in search for less invasive techniques.