The evolution of surgical virtual education and telementoring: One surgeon's journey.

The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation.

Elaboración de un simulador de trauma torácico a partir de un torso cadavérico utilizando tecnología de imágenes digitales e impresión 3D / Elaboration of a thoracic trauma surgery simulation model from a cadaveric human torso incorporating digital image technology and 3D printing

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Simulation for Foregut and Bariatric Surgery: Current Status and Future Directions.

Simulation offers the opportunity to practice in a safe, controlled, and standardized environment. Surgical simulation, in particular, is very attractive because it avoids learning and practicing surgical skills in the operating room. Many simulators are currently available such as box-lap trainers, virtual-reality platforms, cadavers, live animals, animal-based tissue blocks, and synthetic/artificial models. Endoscopic interventions can be practiced with high-fidelity virtual simulators. Box-lap trainers help practicing basic laparoscopic skills. Cadavers and live animals offer realism to train entire foregut and bariatric procedures. However, limited availability and high expenses often restrict their use. Ex vivo simulators with animal tissue blocks have been recently developed and appear to be a realistic and cost-effective alternative. Three-dimensional printing and real-time navigation systems have also emerged as promising training tools. Overall, further efforts are needed to develop a formal simulation curriculum with validated simulators for foregut and bariatric surgery.

Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods.

While robotic surgery has grown in popularity and scope over the past decade, there is a persistent need for simulation-based training as surgeons adapt from the working at the bedside to the immersive and multisensory tasks at the console. From dry laboratory to virtual reality (VR) environments, simulation can be used to train surgeons in basic tasks, complex operative steps, and coordination of whole operations with members of the entire operating room (OR) staff. By integrating simulation into mentored training programs, surgeons can reduce the number of cases required to master a complex operation. Future VR based simulation will become essential to the adaptation of the surgical workforce to new technologies and adoption of emerging robotic platforms. Ultimately, robotic simulation will set standards for credentialing of new surgeons.

Simulation in Hernia Surgery: Where Do We Stand?

Simulation seems to be the best method of improving medical attitude, technical skills, and operating times. A literature review of the available data in simulation for hernia surgery was performed. Surgical simulation has been included as a main requirement in residency programs and endorsed by several surgical societies. However, evaluating how simulation affects patient's outcomes is challenging. In addition, simulation training represents an institutional economic burden that could undermine its implementation and development. Published data support that simulation-based training is a highly efficient tool, thus, its implementation should be strongly encouraged.

What Is Your Reality? Virtual, Augmented, and Mixed Reality in Plastic Surgery Training, Education, and Practice.

SUMMARY: Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical technique and finesse in delicate procedures have become ever more important, and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending. This application of technology and simulation has been demonstrated in other fields such as in the airline industry with flight simulation. The ability to learn, synthesize, and incorporate learned materials and ideas through virtual, augmented, and mixed reality tools offers a great opportunity to put our field at the forefront of a paradigm shift in surgical education. The critical utility of digital education could not be further emphasized any more than in the unfortunate and infrequent situation of a worldwide pandemic. This article reviews some of the important recent technologies that have developed and their applications in plastic surgery education and offers a look into what we can expect in the future.

Robotic Surgery: The Impact of Simulation and Other Innovative Platforms on Performance and Training.

OBJECTIVE: To review the current status of robotic training and the impact of various training platforms on the performance of robotic surgical trainees. DATA SOURCES: Literature review of Google Scholar and PubMed. The search terms included a combination of the following: "robotic training," "simulation," "robotic curriculum," "obgyn residency robotic training," "virtual reality robotic training," "DaVinci training," "surgical simulation," "gyn surgical training." The sources considered for inclusion included peer-reviewed articles, literature reviews, textbook chapters, and statements from various institutions involved in resident training. METHODS OF STUDY SELECTION: A literature search of Google Scholar and PubMed using terms related to robotic surgery and robotics training, as mentioned in the "Data Sources" section. RESULTS: Multiple novel platforms that use machine learning and real-time video feedback to teach and evaluate robotic surgical skills have been developed over recent years. Various training curricula, virtual reality simulators, and other robotic training tools have been shown to enhance robotic surgical education and improve surgical skills. The integration of didactic learning, simulation, and intraoperative teaching into more comprehensive training curricula shows positive effects on robotic skills proficiency. Few robotic surgery training curricula have been validated through peer-reviewed study, and there is more work to be completed in this area. In addition, there is a lack of information about how the skills obtained through robotics curricula and simulation translate into operating room performance and patient outcomes. CONCLUSION: Data collected to date show promising advances in the training of robotic surgeons. A diverse array of curricula for training robotic surgeons continue to emerge, and existing teaching modalities are evolving to keep up with the rapidly growing demand for proficient robotic surgeons. Futures areas of growth include establishing competency benchmarks for existing training tools, validating existing curricula, and determining how to translate the acquired skills in simulation into performance in the operating room and patient outcomes. Many surgical training platforms are beginning to expand beyond discrete robotic skills training to procedure-specific and team training. There is still a wealth of research to be done to understand how to create an effective training experience for gynecologic surgical trainees and robotics teams.

Innovative Educational Pathways in Spine Surgery: Advanced Virtual Reality-Based Training.

BACKGROUND: Over the past few years, a reorganization of the educational pathways has been promoted with the purpose of optimizing the acquisition of competences and their assessment, so as to reduce the risks to both health care professionals and end users. Virtual reality (VR) has been repeatedly tested, initially as a positive reinforcement for more traditional educational pathways and, more recently, as their potential substitute. The aim of this study was to demonstrate the potentiality of VR simulation training in spine surgery. METHODS: The VR simulator reproduced the lateral lumbar access to the spine. The simulation included a tutorial, the preoperative settings, and the surgical session with different levels of procedural complexity. A total of 10 users were recruited for this study: 3 senior surgeons (group A) and 7 orthopedic residents or junior orthopedic surgeons (group B). Each user completed the simulation twice. RESULTS: The user's age or previous experience with VR technology did not show any relevance. On average, the entire simulation was completed in 24'36'. Group B showed an improvement between the 2 attempts in both sessions, the preoperative settings and the surgical simulation. The number of major errors dropped from an average of 5.2 to 1.8 and from an average of 4 (maximum 6-minimum 1) to 1.4, respectively. The simulation was never interrupted because of technical bugs or adverse effects related to the technology. CONCLUSIONS: VR-based training pathways might promote a high standard of care. Our preliminary experience suggests an effective implementation of the traditional coaching process.

Cadaverless anatomy: Darkness in the times of pandemic Covid-19.

The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.

Effects of a Simulation With Team-Based Learning on Knowledge, Team Performance, and Teamwork for Nursing Students.

Simulation and team-based learning are reported as useful strategies in nursing education. However, empirical evidence on the effects of participating in an integrated course of team-based learning and simulation is limited. The aim of this study was to identify the effects of a nursing simulation program with team-based learning on knowledge, team performance, and teamwork among Korean nursing students. A one-group pretest-posttest design was used. Fourth-year students (N = 229) participated in a 32-hour nursing simulation program with team-based learning. Each of the three sessions of the program involved a 3-hour task training with video-assisted learning and skills performance assessment, 1-hour team-based learning, and 4-hour simulation session with a high-fidelity simulator. In addition to the knowledge test and performance assessment, participants completed a self-administered questionnaire on teamwork. Participants achieved higher scores in the Group Readiness Assurance Test than they did in the Individual Readiness Assurance Test. The posttest scores on team performance and teamwork were significantly higher than their pretest scores. The simulation with team-based learning induced favorable effects on participants' knowledge, performance, and teamwork. A curricular integration of simulation program with team-based learning is consistent with achieving outcomes-based learning in nursing education.

Advances in Surgical Training Using Simulation.

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.

Clinical simulation in nursing education in intensive therapy: an integrative review / Simulación clínica en la educación en enfermería en terapia intensiva: revisión integradora / Simulação clínica na educação de enfermagem em terapia intensiva: revisão integrativa

ABSTRACT Objective: to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care. Method: an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017. Results: 29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years. Conclusion: variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

RESUMEN Objetivo: analizar las publicaciones sobre prácticas de simulación clínica para la educación en Enfermería en Terapia Intensiva. Método: revisión integradora realizada en la biblioteca LILACS, PubMed, Cochrane Library, CINAHL y SciELO, de artículos publicados de 2008 a 2017. Resultados: se seleccionaron 29 artículos. 76% abordaran el uso de la simulación en la educación continuada de profesionales de enfermería, mientras que los demás describen su uso para la educación de estudiantes. Hay una prevalencia más grande de estudios con nivel de evidencia 6 (17), siendo 28 publicaciones a nivel internacional. Se verificó una creciente en la producción científica, siendo 16 artículos publicados en los tres últimos años. Conclusión: las variables, después del uso de la simulación, como confianza, habilidad de comunicación, eficiencia en la identificación del empeoramiento clínico de pacientes, desarrollo de competencias técnicas, trabajo en equipo y toma de decisión clínica presentaron un perfeccionamiento significativo, demostrando que esa herramienta es efectiva en la calificación de la asistencia a pacientes críticos.

RESUMO Objetivo: analisar as publicações sobre práticas de simulação clínica para a educação em Enfermagem em Terapia Intensiva. Método: revisão integrativa realizada através da biblioteca LILACS, PubMed, The Cochrane Library, CINAHL e SciELO, de artigos publicados de 2008 a 2017. Resultados: foram selecionados 29 artigos. 76% abordaram o uso da simulação na educação continuada de profissionais de enfermagem, enquanto os outros descrevem seu uso para a educação de estudantes. Há uma maior prevalência de estudos com nível de evidência 6 (17), sendo 28 publicações em âmbito internacional. Verificou-se uma crescente na produção científica, sendo 16 artigos publicados nos três últimos anos. Conclusão: as variáveis, após o uso da simulação, como confiança, habilidade de comunicação, eficiência na identificação da piora clínica de pacientes, desenvolvimento de competências técnicas, trabalho em equipe e tomada de decisão clínica, apresentaram um aperfeiçoamento significativo, demonstrando que essa ferramenta é efetiva na qualificação da assistência a pacientes críticos.

[Virtual arthroscopy : Gaming or training concept of the future]. / Virtuelle Arthroskopie : Computerspiel oder Weiterbildungskonzept der Zukunft?

Arthroscopy is a technically challenging surgical procedure with a relatively shallow learning curve compared to open procedures. To become an expert special cognitive and manual abilities have to be acquired and trained. The current situation in further medical education combined with the increasing economic pressure in the medical field does not leave enough room for a time-consuming training in arthroscopic techniques. A structured simulation training could be an alternative solution to this problem. The benefits of arthroscopic simulation training are meanwhile well documented. The complex tasks that an expert carries out during arthroscopy can be fragmented into more simple and elementary exercises and can be trained in a stress-free environment outside the operation room. An essential advantage of simulation training is the assessment of objective measurement parameters during the individual exercises. These parameters can be used to evaluate the learning process and performance of arthroscopic tasks. The aim of this review is to reflect the current state of simulation technology in arthroscopy and to show how simulator training can be meaningfully and effectively integrated into arthroscopic further training, exemplified by a modern medical further education concept.

Healthcare students' perceptions and experiences of making errors in simulation: An integrative review.

BACKGROUND: Research literature suggests that learning from mistakes facilitates news insights and leads to professional development. The significant growth in the use of simulation-based learning is premised on the understanding that in this context learners can make and learn from their errors without negatively impacting real patients. However, studies also suggest that making errors can be emotionally detrimental to learners. Given these contradictory findings, this literature review explores learners' views about this phenomenon. OBJECTIVE: The objective of this integrated review was to explore healthcare students' perceptions of making errors during simulation-based learning experiences. DESIGN: Whittemore and Knafl's framework for integrated reviews was used to structure this review. DATA SOURCES: Five electronic databases MEDLINE, CINAHL, PsycINFO, ProQuest, and SCOPUS and the search engine Google Scholar were searched. The initial terms used were nursing students, medical students, health professionals, error*, mistake*, and simulation. METHODS: The original search resulted in 2317 potential records. After screening against the inclusion/exclusion criteria, 11 articles were critically appraised using The Critical Appraisal Skills Program (CASP) checklist and were included in the review. RESULTS: The two overarching themes to emerge from the analysis were the impact of errors on learners and the impact of errors on learning. CONCLUSION: Despite the negative feelings experienced by some students regarding making mistakes in simulation, there were key factors that moderated the impact of these feelings and transformed the errors into learning opportunities. These included: the provision of a safe learning environment where constructive feedback was provided by skilled educators, and where students were supported to take responsibility for their mistakes. Although the findings suggest that making mistakes in simulation-based learning can be beneficial, optimising learning from mistakes requires a deliberate and thoughtful approach in which educators plan for and support learners to recognise, acknowledge and respond effectively to errors.