What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. METHODS: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. RESULTS: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. CONCLUSIONS: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

The entrustable professional activities of laparoscopic surgery: moving toward an integrated training model.

BACKGROUND: Entrustable Professional Activities (EPAs) provide the opportunity to integrate multiple competencies into meaningful units that facilitate curriculum development and assessment design. As part of the process of reviewing and enhancing the Fundamentals of Laparoscopic of Surgery (FLS) program, we used the concept of EPAs to create a framework of reference that articulates a contemporary definition of Laparoscopic Surgery (LS). METHODS: The framework of reference of LS was created with data gathered from a literature review and during series of educational retreats with subject matter experts (SMEs). Various activities were implemented during these retreats to develop the LS EPAs, their constitutive competencies, and related observable behaviors. RESULTS: Ten EPAs and associated competency descriptors (articulated as observable behaviors) specific to LS were identified. In addition, knowledge areas were associated to each EPA. DISCUSSION: A comprehensive list of EPAs for LS were identified. These EPAs will be used in the development and update of the FLS program. Further, they can be used to guide the development of curriculum, clinical teaching, and assessment in any surgical program with a laparoscopic training component. They are applicable to any level of training by defining the expected observable behaviors associated with a given level of expertise. These fundamental aspects of LS provide a common framework of reference across different surgical specialties.

An argument-based validation study of the fundamentals of laparoscopic surgery (FLS) program.

BACKGROUND: The Fundamentals of Laparoscopy Surgery (FLS) program was launched over 15 years ago. Since then, there has been an exponential rise in advancements of laparoscopy and its uses. In response, we conducted an argument-based validation study of FLS. The purpose of this paper is to exemplify this approach to validation for surgical education researchers using FLS as an illustrative case. METHODS: The argument-based approach to validation involves three key actions: (1) developing interpretation and use arguments; (2) research; and (3) building a validity argument. Drawing from the validation study of FLS each step is exemplified. RESULTS: Qualitative and quantitative data sources from the FLS validity examination study provided evidence that both supported claims, but also generated backing for rebuttals. Some of the key findings were synthesized in a validity argument to illustrate its structure. DISCUSSION: The argument-based validation approach described numerous advantages over other validation approaches: (1) it is endorsed by the foundational documents in assessment and evaluation research; (2) its specific language of claims, inferences, warrants, assumptions and rebuttals provides a systematic and unified way to communicate both the processes and outcomes of validation; and (3) the use of logic reasoning in building the validity document clearly delineates the relationship between evidence and the inferences made to support desired uses and interpretations from assessments.

Development of a formative feedback tool for transanal total mesorectal excision.

INTRODUCTION: Transanal total mesorectal excision (TaTME) is a novel procedure in the treatment of rectal cancer. Current training models for TaTME suggest a period of proctored cases, but no structured feedback tool exists to guide operators during the learning phase. The objective of this study therefore was to develop a formative feedback tool for the critical steps of the transanal portion of TaTME. METHODS: A two-round Delphi study by TaTME experts was conducted to determine the items to be included in the formative feedback tool. Participants rated each step from a prepared list using a Likert scale from 1 (Not relevant) to 5 (Very relevant) with the option to suggest additional steps. Responses to the first round were presented in the second round, where participants rated the revised list of steps. Consensus was defined as > 80% of participants rating the step as 4 or 5 (out of 5). Items were combined when appropriate to avoid redundancy. Rating anchors describing performance (on a 5-point scale) were then developed for each step. The final tool was recirculated and participants rated the finished product on its feasibility and usefulness. RESULTS: Twenty-six TaTME experts were contacted for participation. Fifteen experts (58%) participated in the first round of the study, and eleven (42%) participated in the second round. The majority (14, 93%) had completed fellowship training in colorectal surgery. The first round of the Delphi study contained 34 items, and 32 items met inclusion criteria after the second round. Redundant items were combined into 15 items that comprised the final tool. Out of eight respondents to the feasibility survey, all believed the feedback tool enhances the feedback of learners and would use it for training purposes if available. CONCLUSION: This work describes the development of a novel consensus-based formative feedback tool specific to TaTME.

Children's spirituality: Exploring spirituality in the lives of cancer survivors and a healthy comparison group.

This study found that children with a history of cancer had higher scores on certain measures of spirituality compared to their healthy peers. Health history was found to significantly moderate the relations among spirituality and outcome variables, such as depression and anxiety. Furthermore, parent-child dyadscancer had more highly correlated scores than parent-child dyadshealthy on both the Depression subscale and the Existential Well-Being subscale, whereas parent-child dyadshealthy had more highly correlated scores than parent-child dyadscancer on the Duality factor. Limitations and future directions are discussed.

Agresión relacional en preescolar: variables cognoscitivas y emocionales asociadas / Relational Aggression in Preschool: cognitive and emotional variables associated

Cuando una persona usa la agresión relacional busca dañar las relaciones de otros a través de manipulaciones y exclusión de grupo. Existe muy poca investigación sobre este tipo de agresión en el preescolar. De igual forma, tampoco se han establecido con claridad qué variables psicológicas se asocian con esta. La presente investigación se centró en la agresión relacional y la agresión física en una muestra de 77 niños y niñas de preescolar. Se midieron variables cognoscitivas (creencias favorables hacia la agresión y teoría de la mente) y variables emocionales (control de la ira) en los niños. No se encontraron diferencias significativas entre niños y niñas en los niveles de agresión física o de agresión relacional. Sin embargo, cuando se incluyó agresión física como covariada, se encontró más agresión relacional en niñas que en niños y cuando agresión relacional fue usada como covariada, se encontró más agresión física en niños que en niñas. El control de la ira apareció como un importante factor en la predicción de la agresión relacional.

When somebody uses relational aggression seeks damage relations of others through manipulation and exclusion group. There is little research on this aggression type in preschool. Similarly, not been established clearly what psychological variables are associated with this. This research focused both relational and physical aggressions in a sample of 77 preschool children. Were measured cognitive variables (beliefs favorable toward aggression and theory of mind) and emotional variables (anger) in children. Do not significant differences between boys and girls were found in levels physical aggression or relational aggression. However, when included physical aggression as a covariate, more relational aggression was found in girls than children, and when relational aggression was used as a covariate, was found more physical aggression in boys than in girls. The anger came as an important factor in predicting relational aggression.