The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training.

PURPOSE: The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills. METHODS: The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data. RESULTS: The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training. CONCLUSION: The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed. TRIAL REGISTRATION: This trial was retrospectively registered on clinicaltrials.gov (NCT06301230).

Long-term quality of life after hybrid robot-assisted and open Ivor Lewis esophagectomy for esophageal cancer in a single center: a comparative analysis.

PURPOSE: Due to improved survival of esophageal cancer patients, long-term quality of life (QoL) is increasingly gaining importance. The aim of this study is to compare QoL outcomes between open Ivor Lewis esophagectomy (Open-E) and a hybrid approach including laparotomy and a robot-assisted thoracic phase (hRob-E). Additionally, a standard group of healthy individuals serves as reference. METHODS: With a median follow-up of 36 months after hRob-E (n = 28) and 40 months after Open-E (n = 43), patients' QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30 (QLQ-C30) and the EORTC Esophagus specific QoL questionnaire 18 (QLQ-OES18). RESULTS: Patients showed similar clinical-pathological characteristics, but hRob-E patients had significantly higher ASA scores at surgery (p < 0.001). Patients and healthy controls reported similar global health status and emotional and cognitive functions. However, physical functioning of Open-E patients was significantly reduced compared to healthy controls (p = 0.019). Operated patients reported reduced role and social functioning, fatigue, nausea and vomiting, dyspnea, and diarrhea. A trend towards a better pain score after hRob-E compared to Open-E emerged (p = 0.063). Regarding QLQ-OES18, hRob-E- and Open-E-treated patients similarly reported eating problems, reflux, and troubles swallowing saliva. CONCLUSIONS: The global health status is not impaired after esophagectomy. Despite higher ASA scores, QoL of hRob-E patients is similar to that of patients operated with Open-E. Moreover, patients after hRob-E appear to have a better score regarding physical functioning and a better pain profile than patients after Open-E, indicating a benefit of minimally invasive surgery.

Breaking the Silence: A Workshop for Medical Students on Dealing With Failure in Medicine.

PROBLEM: Failure is a powerful teacher but an emotionally stressful experience. Before residency, when failure in clinical training is inevitable, medical students should learn to talk about and cope with failure. However, medical school curricula rarely include this topic, and physicians seldom share their mistakes and failures with trainees. This report describes and evaluates a workshop on dealing with failure in medicine. APPROACH: Two attending surgical consultants and a life coach facilitated the workshop between February 2021 and February 2022, which consisted of different educational approaches, such as presentations, small group discussions, and journal clubs. The sessions aimed to enable medical learners to identify and analyze actual and potential failure events in everyday clinical practice and learn from them, disclose and communicate medical failures and "speak up," reflect on failure and develop coping strategies, and understand the moderating role of fear of failure. OUTCOMES: Thirty medical students participated in the workshop. Dealing with failure in a productive manner was the medical learners' key learning objective and anticipated takeaway from the workshop. After the workshop, 19 of the 30 participants anonymously completed the standard university evaluation form. The medical students gave the workshop a mean (SD) rating of 8.59 (0.98) on a Likert scale ranging from 1 to 10. They felt better prepared to approach future challenges in a constructive manner after being equipped with strategies to deal with failure. Listening to the failure experiences of faculty and peers in a safe environment helped them accept that failure is inevitable. NEXT STEPS: The findings suggest that medical students appreciated a safe environment to discuss failure. By promoting a safe learning environment early in the medical career, medical schools could make an important contribution to reducing the stigma of failure and eliminating the shame and blame culture, thus contributing to students' well-being.

Prevalence of medically induced psychological trauma and its influence on women's health.

OBJECTIVE: The aim of the present study was three-fold. One, to assess the prevalence of medical traumatization in outpatients of a gynecologic department; two, to analyze the relationship of medical traumatization with adverse childhood events; and three, to investigate the extent to which medical traumatization affects the health outcomes of woman. METHODS: Between January and September 2022, a prospective cross-sectional study recruited patients of a gynecologic outpatient clinic at St. Gallen Cantonal Hospital in Switzerland. Medical trauma was a self-reported item. The presence of adverse childhood events was assessed using the Childhood Trauma Questionnaire. The severity of post-traumatic stress was evaluated using the Impact of Event Scale Revised questionnaire. RESULTS: In total, 227 patients were recruited. Medical trauma was reported by 20% of the interviewees and it was strongly associated with obesity (A = 0.005). Undergoing surgery was most commonly the source of psychological distress (5.7%) followed by delivery (4.8%), pregnancy loss (4.8%), and cancer diagnosis (4.0%). Yet, fewer than 1% of the patients reached the threshold suggesting post-traumatic stress disorder. CONCLUSIONS: We found no relationship between the medical trauma, adverse childhood events, cardiovascular disease, or substance abuse. The presence of medical trauma was associated with the patient's body mass index (calculated as weight in kilograms divided by the square of height in meters).