Colorectal endoscopic submucosal dissection in the USA: The current state and future perspectives.

Endoscopic submucosal dissection (ESD) is a transformative advancement in the endoscopic management of superficial gastrointestinal lesions. Initially conceived for the treatment of early gastric cancer, ESD has demonstrated proficiency in achieving en-bloc resection of superficial gastrointestinal lesions. ESD has experienced widespread acceptance in Japan and East Asia; however, its adoption in the USA remains delayed. This initial hesitancy could be attributed to procedural complexity and training demands; nonetheless, recently, ESD has been gaining popularity in the USA. This is due to the advancements in endoscopic technology, tailored training programs, and cumulative evidence regarding the efficacy and safety of ESDs. This review aimed to deliberate the historical progress, current implementation, and prospective trajectory of ESDs in the USA. With ongoing clinical research, technological integration, and educational efforts, ESD is likely to become the gold standard for managing large gastrointesitinal lesions. This progress marks an imperative step toward less invasive, more precise, and patient-centric approaches regarding advanced therapeutic endoscopy in the USA.

Development of the European Laparoscopic Intermediate Urological Skills LUSs2 Curriculum: A Delphi Consensus from the European School of Urology.

Background and objective: While programmes such as the European Basic Laparoscopic Urological Skills have made strides in foundational training, a significant gap exists for intermediate and advanced laparoscopy education. Our objective is to develop and validate the European laparoscopic intermediate urological skills (LUSs2) curriculum, which will establish uniformity in the training of urological laparoscopic procedures and facilitate proficiency among practitioners. Methods: The study combines a literature review, cognitive task analysis development by a steering group, and a two-round Delphi survey involving international experts in urological laparoscopy. Consensus was defined as agreement of ≥70% among experts. The survey included statements on various laparoscopic procedures, assessed on a Likert scale from 1 (strongly disagree) to 9 (strongly agree). Key findings and limitations: The Delphi process achieved consensus on 85% (235/275) of statements, indicating a strong agreement on the curriculum's content. Areas covered include renal hilum dissection, major vessel injury management, enucleation and renorrhaphy, vesicourethral anastomosis, and pyeloplasty. Limitations include the nonsystematic nature of the literature review and potential biases inherent in expert-based consensus methods. Conclusions and clinical implications: The LUSs2 curriculum significantly advances the standardised training of laparoscopic urological skills. It offers a detailed, consensus-validated framework that addresses the need for uniformity in surgical education and aims to enhance surgical proficiency and patient care. Patient summary: This study presents the development of a new standardised training curriculum for urological laparoscopic surgery. We intend this curriculum to improve the quality of surgical training and ensure high-quality patient care.

High-intensity interval training alleviates liver inflammation by regulating the TLR4/NF-κB signaling pathway and M1/M2 macrophage balance in female rats with cisplatin hepatotoxicity.

Cisplatin (CDDP) is an antineoplastic drug whose adverse effects include hepatotoxicity. The inflammatory process is crucial in the progression of liver injuries. Exercise is known for its anti-inflammatory effects, but the influence of different training modalities on hepatoprotection is still unclear. This study aims to compare the impacts between preconditioning with high-intensity interval training (HIIT) and traditional continuous training of low (LT) and moderate (MT) intensities on inflammatory markers in Wistar female rats with CDDP-induced hepatotoxicity. Thirty-five rats were divided into five groups: control and sedentary (C + Sed), treated with CDDP and sedentary (CDDP + Sed), treated with CDDP and subjected to LT (CDDP + LT), treated with CDDP and subjected to MT (CDDP + MT), and treated with CDDP and subjected to HIIT (CDDP + HIIT). The training protocols consisted of treadmill running for 8 weeks before CDDP treatment. The rats were euthanized 7 days after the treatment. Liver samples were collected to evaluate the expression of various inflammatory markers and types of macrophages. Our results indicated that HIIT was the only protocol to prevent the increase in all analyzed pro-inflammatory cytokines and reduce the number of ED-1-positive cells, attenuating the TLR4/NF-κB signaling pathway in the liver. Additionally, HIIT increased the anti-inflammatory cytokine IL-10 and regulated M1/M2 macrophage polarization. Thus, this study suggests that preconditioning with HIIT is more effective in promoting hepatoprotective effects than LT and MT, regulating inflammatory markers through modulation of the TLR4/NF-κB signaling pathway and M2 macrophage polarization in the hepatic tissue of female rats treated with CDDP.

How well does the academic performance of Ethiopian anaesthetists predict their National Licensing Examination scores: a cross-sectional study.

OBJECTIVES: This study assessed the relationship between academic performance and National Licensing Examination (NLE) scores of Ethiopian anaesthetists and proposed academic performance thresholds that predict failing the NLE. DESIGN: A retrospective cross-sectional study. SETTING: Academic performance measures were collected from eight universities and matched to total and subdomain NLE scores for anaesthetists. Four universities were first generation (oldest), three were second generation and one was third generation (newest). PARTICIPANTS: 524 anaesthetists. MEASURES: Selected course grades, yearly (Y1-Y4) and cumulative grade point averages (GPAs) and in-school exit exam status were correlated with NLE scores. Linear regression was used to identify predictors of NLE score. Receiver operating characteristic curves were plotted to estimate GPA thresholds that predict failing the NLE. RESULTS: Total and general surgery anaesthesia subdomain NLE scores showed moderate to strong linear relationships with most academic performance indicators. However, correlations between the rest of the subdomain NLE scores and composite course scores were either small or negligible (r<0.5). For every 1-point increase in a 4-point cumulative GPA and composite senior year practicum course score, the first-attempt NLE score increased by 12.61 (95% CI 10.03 to 15.19; p<0.0001) and 3.98 (95% CI 1.77 to 6.19; p=0.001) percentage points, respectively. Those entering university directly from high school and those attending a third-generation university would, on average, score 2.79 (95% CI 0.23 to 5.35; p=0.033) and 4.34 (95% CI 1.42 to 7.26; p=0.004) higher NLE scores compared with nurse entrants and first-generation university graduates, respectively. On a 4-point grading system, the thresholds for failing the NLE were below 2.68 for year-1 GPA, 2.62 for year-2 GPA, 2.72 for year-3 GPA, 3.04 for year-4 GPA and 2.87 for cumulative GPA. CONCLUSIONS: The Ethiopian anaesthetist's NLE score modestly correlated with most academic performance indicators. Based on pass/fail thresholds, the NLE could assist training programmes in improving NLE pass rates.

Education and Training in Peritoneal Surface Oncology.

Peritoneal surface oncology (PSO) is a novel field dealing with the knowledge of peritoneal neoplasms, primary or secondary, and their clinical management. As a specific treatment with curative intent for peritoneal neoplasms developed over the years, there is a growing need to comprehensively educate and train surgical oncologists worldwide in this discipline, a recognized unmet need. The European School of Peritoneal Surface Oncology (ESPSO) emerged in 2014 to provide an answer to this need.

The Effect of Simulation-Based Training on the Hand Hygiene Knowledge and Practices of Palliative Caregivers: A Double-Blind, Randomized, Controlled Single-Center Study.

This study aimed to investigate the effect of simulation-based training on hand hygiene knowledge and practices among palliative caregivers. The study was conducted with 60 caregivers in a palliative care clinic between December 2022 and September 2023. The participants were divided into two groups by simple randomization. The intervention and control groups received the same hand hygiene theoretical education and demonstration. The intervention group also received additional simulation-based hand hygiene practices recommended by the World Health Organization. A pretest-posttest design was used to assess hand hygiene knowledge and practices. Data were collected with personal information, hand hygiene knowledge, and hand hygiene practice forms. Analysis of covariance was performed to compare posttest scores between the groups. Simulation-based hand hygiene training programs offer an effective and feasible strategy to improve the hand hygiene knowledge and practices of caregivers. It should be integrated into clinical areas to increase palliative caregivers' hand hygiene knowledge and practices. Evidence-based practices can be improved by increasing randomized controlled studies on the effectiveness of simulation-based hand hygiene training for caregivers. Trial Registration: The study was registered at ClinicalTrials.gov with registration number NCT05848596.

Interleukin-15 and high-intensity exercise: relationship with inflammation, body composition and fitness in cancer survivors.

Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth. These anti-oncogenic effects of exercise were associated with the exercise-mediated release of myokines such as interleukin (IL)-15. However, no study has quantified the acute IL-15 response in human cancer survivors, and whether physiological adaptations to exercise training (i.e. body composition and cardiorespiratory fitness) influence this response. In the present study breast, prostate and colorectal cancer survivors (n = 14) completed a single bout of high-intensity interval exercise (HIIE) [4×4 min at 85-95% heart rate (HR) peak, 3 min at 50-70% HR peak] before and after 7 months of three times weekly high-intensity interval training (HIIT) on a cycle ergometer. At each time point venous blood was sampled before and immediately after HIIE to assess the acute myokine (IL-15, IL-6, IL-10, IL-1ra) responses. Markers of inflammation, cardiorespiratory fitness and measures of body composition were obtained at baseline and 7 months. An acute bout of HIIE resulted in a significant increase in IL-15 concentrations (pre-intervention: 113%; P = 0.013, post-intervention: 102%; P = 0.005). Post-exercise IL-15 concentrations were associated with all other post-exercise myokine concentrations, lean mass (P = 0.031), visceral adipose tissue (P = 0.039) and absolute V ̇ O 2 ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}}}$ peak (P = 0.032). There was no significant effect of 7 months of HIIT on pre- or post-HIIE IL-15 concentrations (P > 0.05). This study demonstrates HIIE is a sufficient stimulus to increase circulating IL-15 and other myokines including IL-6, IL-10 and IL-1ra which may be clinically relevant in the anti-oncogenic effect of exercise and repetitive exposure to these effects may contribute to the positive relationship between exercise and cancer recurrence. KEY POINTS: Exercise has been demonstrated to reduce the risk of cancer recurrence. Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth, mediated by exercise-induced myokines (IL-6 and IL-15). High-intensity interval exercise significantly increased myokines associated with the anti-oncogenic effect of exercise and the magnitude of response was associated with lean mass, but training did not appear to influence this response. Given IL-15 has been implicated in the anti-oncogenic effect of exercise and is being explored as an immunotherapy agent, high-intensity interval exercise may improve outcomes for people living beyond cancer through IL-15-mediated pathways. Interventions that increase lean mass may also enhance this response.

The impact of minimally invasive gynecologic surgery subspecialty training on outcomes of benign laparoscopic hysterectomy- a retrospective cohort study.

STUDY OBJECTIVE: To compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GO), or general obstetrician/gynecologists (OB/GYN). DESIGN: Retrospective cohort study. SETTING: Quaternary care academic hospital. PATIENTS OR PARTICIPANTS: Patients undergoing MIH for benign indications from 3/2015 to 3/2020 were included. INTERVENTIONS: MIH. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons' group. A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs. Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (OR 2.25, 95%CI 1.36-3.71) and 25.9% of the OB/GYN group (OR 2.65, 95%CI 1.70-4.12). Major intra- or postoperative complications were associated with surgeons' groups (OR 7.02 95%CI 2.67-18.47, and 6.84 95%CI 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%, OR 7.21 95%CI 2.52-20.60) and OB/GYNs (9.7%, OR 7.82 95%CI 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs compared with MIGS (18.5% vs. 10.9%, OR 1.86 95%CI 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared to GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs compared with MIGS surgeons (OR 2.12 95%CI 1.07-4.22; OR 2.48 95%CI 1.49-4.12, respectively). CONCLUSION: Fellowship trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

Expiratory Muscle Strength Training Reduces Oxidative Stress and Systemic Inflammation in Men with Obstructive Sleep Apnea Syndrome: A Double-Blinded, Randomized Parallel Trial.

STUDY OBJECTIVES: This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS). METHODS: Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apne Hipopne Index-AHI) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated. RESULTS: The percentage of AHI change in the High-EMST group(50.8%) was significantly higher than in the Low-EMST group(6.3%) (p=0.002, d=1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b=-0.149; CR=-3.065; p=0.002), and as AHI increased by one unit, ODI increased by 0.746 points (b=0.746; CR=10.604; p<0.001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups. CONCLUSION: EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than Low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

BACKGROUND: Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. METHODS: This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. RESULTS: One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. CONCLUSION: Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Blood Harmonisation of Endoscopic Transsphenoidal Surgical Video Frames on Phantom Models.

Physical phantom models have been integral to surgical training, yet they lack realism and are unable to replicate the presence of blood resulting from surgical actions. Existing domain transfer methods aim to enhance realism, but none facilitate blood simulation. This study investigates the overlay of blood on images acquired during endoscopic transsphenoidal pituitary surgery on phantom models. The process involves employing manual techniques using the GIMP image manipulation application and automated methods using pythons Blend Modes module. We then approach this as an image harmonisation task to assess its practicality and feasibility. Our evaluation uses Structural Similarity Index Measure and Laplacian metrics. The results we obtained emphasize the significance of image harmonisation, offering substantial insights within the surgical field. Our work is a step towards investigating data-driven models that can simulate blood for increased realism during surgical training on phantom models.

The associations of muscle-strengthening exercise with recurrence and mortality among breast cancer survivors: a systematic review.

BACKGROUND: Our systematic review aimed to critically evaluate empirical literature describing the association of muscle-strengthening exercise (MSE) with recurrence and/or mortality among breast cancer survivors. METHODS: We included English-language empirical research studies examining the association between MSE and recurrence and/or mortality among females diagnosed with breast cancer. Seven databases (MEDLINE, PsycINFO, Embase, Scopus, Web of Science, Cochrane CENTRAL, and CINAHL) were searched in September 2023. Quality was appraised using the Mixed Methods Appraisal Tool. Results are summarized descriptively. RESULTS: Five sources were identified. MSE measurement differed in relation to the description of the MSE (i.e., muscle-strengthening vs. strength training), examples of activities (e.g., sit-ups or push-ups vs. calisthenics vs. circuit training), and exercise frequency (i.e., days vs. times/week). Findings offer provisional evidence that some MSE may lower the hazards of recurrence and mortality. This association may vary by race, weight status, and menopausal status. CONCLUSIONS: In summary, limited available evidence suggests that MSE may lower the hazards of recurrence and mortality. More consistent measurement and analyses would help generate findings that are more readily comparable and applicable to inform clinical practice. Further research is needed to improve understanding of the strength and differences of these associations among underserved and underrepresented women.

Assessment of the Effects of the COVID-19 Pandemic on Orthopaedic Surgery Training Among Orthopaedic Residents in Southern Nigeria.

Background: Surgical training is hands-on, with residents requiring optimal exposure to patients for optimal training and adequate experience. Thus, despite the increased usage of virtual, non-physical resources for medical education during the pandemic, orthopaedic surgical training still suffered adversely. Objectives: To explore the overall impact of the COVID-19 pandemic on Orthopaedic surgery training, teaching and practice amongst residents in southern Nigeria. Materials and Methods: This was a cross-sectional prospective study involving 54 senior orthopaedic surgery residents in southern Nigeria. Data were collected using a semi-structured online-based questionnaire created on the Google Forms and sent via online platforms (e.g., WhatsApp and Telegram). Descriptive and inferential analysis was done using Statistical Package for Social Sciences (SPSS). Consent was also obtained from all respondents. Results: A total of 54 orthopaedic surgery residents responded to our questionnaire. About 71.7% of the residents surveyed reported reduced exposure to surgical cases in general, and 70.3% reported reduced operative teaching exposure. About 68.5% of the respondents reported reduced opportunities for surgical skills acquisition training. More than half of respondents (63%) reported no changes in morbidity/mortality of orthopaedic cases witnessed and performed. The majority of the respondents agreed to a slight decrease in the availability of implants and courses (40.7%) whereas 44.4% affirmed an increase in the cost of training. Overall, 70.4% believed that the impact of COVID-19 on orthopaedic surgical training has been slightly negative. The average rating for experience on alternative learning methods - virtual video conferences, pre-recorded lectures, in-person small group meetings and surgical simulation activities was 2.26 on a scale of 1-4 (decreasing order of satisfaction). Conclusion: The COVID-19 pandemic caused significant changes in orthopaedic surgery training, with low cases exposure and reduction in operative teaching being the most significant changes and the resultant increase in alternative forms of training and skill acquisition.

Protein expression changes in Tibetan middle-to-long distance runners after the transition from high altitude to low altitude: Implications for enhancing endurance training.

The study aims to investigate the differences in protein expressions in Xizang's (Tibetan) middle-to-long distance runners after the transition from high altitude to low altitude and reveal the molecular mechanisms underlying their enhanced middle-to-long distance running performance. In the study, eleven subjects were selected from native Tibetan middle-to-long distance runners to participate in an 8-week pre-competition exercise training program consisting of a 6-week training stage in Kangding City at an altitude of 2 560 meters (m) and a subsequent 2-week training stage in Leshan City at an altitude of 360 â€‹m. Blood samples were collected twice from the runners before beginning altitude exercise training in Kangding and after going to sea level - Leshan City. Using a label-free quantitative method, peptides in the samples were analyzed by mass spectrometry. Proteomic analysis was performed to identify differentially expressed proteins and predict their biological functions. A total of 846 proteins were identified in the 21 samples, including 719 quantified proteins. In total, 49 significantly differentially expressed proteins (p â€‹< â€‹0.05) were identified, including twenty-eight 0.2-fold up-regulated proteins or twenty-one 0.17-fold down-regulated proteins. The up-regulated proteins, including cystic fibrosis transmembrane conductance regulator (CFTR) and carbonic anhydrase I (CAI), were of particular interest due to their role in regulating the oxygen saturation in deep tissues. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis indicated that these proteins were mainly involved in regulating actin cytoskeleton, local adhesion, biotin absorption and metabolism, immune system, cancer, and membrane transport processes. In conclusion, Tibetan middle-to-long distance runners who resided in high-altitude areas benefited from repeated plateau-plain alternate training mode during the pre-competition period. The training mode induced positive changes in peripheral blood plasma proteins (CFTR and CAI), the biomarkers associated with aerobic capacity. Among the 11 runners, one female athlete won the gold medal in the 3 000-m running event in this competition, demonstrating that the plateau-plain alternate training mode could enhance the aerobic capacity of athletes.

Development and Videographic Evaluation of a Vascular Access Simulation-Based Curriculum for Surgical and Medical Trainees.

Background: There is a paucity of data evaluating femoral arterial access training, despite significant morbidity/mortality associated with incorrect femoral arterial access. The aim of this study was to develop and evaluate a novel 2-component simulation-based curriculum to address a lack of standardized access training and identify the most frequent errors in access. Methods: The femoral arterial access curriculum was developed through a multi-disciplinary collaboration and utilized in-person simulation sessions in conjunction with online and in-person didactic training. Access errors and curriculum efficacy were assessed using mixed-methodology evaluation of video recordings of trainee arterial access pre- and postcurriculum. All recordings were reviewed and scored by 2 blinded, independent investigators. Results: Twenty-six participants completed the curriculum with pre- and postcurriculum recordings. Sixteen participants (62%) were in their first year of residency training. Fifteen participants (58%) belonged to general surgery residency, 9 (35%) to emergency medicine, 1 to vascular surgery, and 1 to interventional radiology residency programs. The global rating for the overall ability to obtain femoral arterial access under ultrasound guidance (0 = fail, 4 = excellent) improved following the curriculum (0.87 ± 0.15, 2.79 ± 1.26, P < 0.0001). Fourteen participants (54%) were unable to independently complete the procedure before training, compared to only 2 participants (8%) following the curriculum. Procedural completion time decreased from 7.14 ± 4.26 to 3.81 ± 2.53 minutes (P < 0.001). Most frequent errors, determined through qualitative analysis, included difficulty using the ultrasound and unsafe maneuvers. Conclusions: Before the curriculum, there were significant frequent errors in junior resident femoral arterial access with major patient safety concerns. A novel simulation-based femoral arterial access curriculum resulted in improved procedural skills across all metrics.

Surgical skill simulation training to proficiency reduces procedural errors among novice cardiac device implanters: a randomized study.

AIMS: In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across institutions; suboptimal approaches may increase complications. We investigated how novel proficiency-based progression (PBP) simulation training impacts the surgical quality of implantations, compared to traditional simulation (SIM) training. METHODS AND RESULTS: In this international prospective study, novice implanters were randomized (blinded) 1:1 to participate in a simulation-based procedure training curriculum, with proficiency demonstration requirements for advancing (PBP approach) or without (SIM). Ultimately, trainees performed the surgical tasks of an implant on a porcine tissue that was video-recorded and then scored by two independent assessors (blinded to group), using previously validated performance metrics. Primary outcomes were the number of procedural Steps Completed, Critical Errors, Errors (non-critical), and All Errors Combined. Thirty novice implanters from 10 countries participated. Baseline experiences were similar between groups. Compared to SIM-trained, the PBP-trained group completed on average 11% more procedural Steps (P < 0.001) and made 61.2% fewer Critical Errors (P < 0.001), 57.1% fewer Errors (P = 0.140), and 60.7% fewer All Errors Combined (P = 0.001); 11/15 (73%) PBP trainees demonstrated the predefined target performance level vs. 3/15 SIM trainees (20%) in the video-recorded performance. CONCLUSION: Proficiency-based progression training produces superior objectively assessed novice operators' surgical performance in device implantation compared with traditional (simulation) training. Systematic PBP incorporation into formal academic surgical skills training is recommended before in vivo device practice. Future studies will quantify PBP training's effect on surgery-related device complications.

A four year follow-up survey on the teledidactic TELUS ultrasound course: long-term benefits and implications.

BACKGROUND: The COVID-19 pandemic disrupted traditional medical education, prompting innovative teaching methods for practical skills training. The teledidactic TELUS ultrasound course, launched in 2020-2021, aimed to provide remote instruction in ultrasound techniques. OBJECTIVE: This study assesses the long-term impact of the teledidactic ultrasound course conducted during the study years on current clinical practice. METHODS: In 2024, a follow-up survey was conducted with former TELUS course students now practicing as physicians across various specialities. Participants rated their confidence in ultrasound examinations and its frequency in practice. RESULTS: 21 out of 30 participants (70%) completed the survey. 71.4% rated the course experience as excellent (5/5 points). Most reported significant learning gains, especially in the FAST module. While all agreed the course enhanced their ultrasound skills, its impact on patient care received mixed reviews. Frequency of ultrasound use varied widely among specialities, with high use in surgery and internal medicine but less in psychiatry, neurology, and ophthalmology. Notably, 42,9% had not pursued further ultrasound training post-course. CONCLUSION: The teledidactic ultrasound course effectively provided remote education, integrating skills into practice. Mixed reviews on patient care impact and speciality-specific ultrasound use suggest sustained integration depends on relevance and ongoing education. Self-assessment results support online ultrasound courses, indicating potential use in resource-limited or geographically constrained settings.

IMRA/SRS Delphi consensus on international standards for common core components of robotic surgical training design.

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include-training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended.

Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea.

Background/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement. Methods: All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings. Results: The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved. Conclusions: This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

Systematic review of subjective validation methods for computerized colonoscopy simulators.

Introduction: In recent years, different approaches have been used to conduct a subjective assessment of colonoscopy simulators. The purpose of this paper is to review these different approaches, specifically the ones used for computerized simulators, as the first step for the design of a standard validation procedure for this type of simulators. Methods: A systematic review was conducted by searching papers after 2010 in PubMed, Google Scholar, ScienceDirect, and IEEE Xplore databases. Papers were screened and reviewed for procedures regarding the subjective validation of computerized simulators for traditional colonoscopy with an endoscope. Results: An initial search in the databases identified 2094 papers, of which 7 remained after exhaustive review and application of exclusion criteria. All studies used questionnaires for subjective validation, with "face" being the most common validity type tested, while "content" validity and "usability" were less prominent. Conclusions: A classification of subscales for testing face validity was derived from the studies. The Colonoscopy Simulator Realism Questionnaire (CSRQ) was selected as the guide to follow for the development of future questionnaires related to subjective validation. Mislabeling of the validity tested in the studies due to ambiguous interpretations of the validity types was a common occurrence observed in the reviewed studies.