Generating a Prioritized List of Operative Procedures for Simulation-based Assessment of General Surgery Trainees Through Consensus.

OBJECTIVE: To develop appropriate content for high-stakes simulation-based assessments of operative competence in general surgery training through consensus. BACKGROUND: Valid methods of summative operative competence assessment are required by competency-based training programs in surgery. METHOD: An online Delphi consensus study was conducted. Procedures were derived from the competency expectations outlined by the Joint Committee on Surgical Training Curriculum 2021, and subsequent brainstorming. Procedures were rated according to their perceived importance, perceived procedural risk, how frequently they are performed, and simualtion feasibility by a purposive sample of 30 surgical trainers and a 5-person steering group. A modified Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula was applied to the generated data to produce ranked procedural lists, which were returned to participants for re-prioritization. RESULTS: Prioritized lists were generated for simulation-based operative competence assessments at 2 key stages of training; the end of 'phase 2' prior to the development of a sub-specialty interest, and the end of 'phase 3', that is, end-of-training certification. A total of 21 and 16 procedures were deemed suitable for assessments at each of these stages, respectively. CONCLUSIONS: This study describes a national needs assessment approach to content generation for simulation-based assessments of operative competence in general surgery using Delphi consensus methodology. The prioritized procedural lists generated by this study can be used to further develop operative skill assessments for use in high-stakes scenarios, such as trainee progression, entrustment, and end-of-training certification, before subsequent validity testing.

A view from the top: A qualitative exploration of top-level health care leaders' perceptions on the implementation of simulation-based education in postgraduate medical education.

INTRODUCTION: Although there is substantial evidence supporting the benefits of simulation-based education (SBE), its widespread and effective implementation remains challenging. The aim of this study was to explore the perceptions of top-level health care leaders regarding SBE and the barriers and facilitators that influence its wide implementation as part of the postgraduate surgical curricula in Denmark. METHODS: We conducted semi-structured interviews with top-level health care leaders who were chosen based on their roles in ensuring high-quality patient care delivery and developing strategies to achieve the goals of the entire health care system. The interview transcripts were translated into English, and a thematic approach was used to code and inductively analyse the data. We used the Consolidated Framework for Implementation Research to identify and understand the determinants to a successful implementation of SBE. RESULTS: We interviewed 13 participants from different political and administrative levels. We found that the participants had limited knowledge about SBE, which highlighted a disconnection between these leaders and the educational environment. This was further compounded by a lack of effective communication and inadequate information dissemination between simulation centres and higher-level organisations. While participants recognised the benefits of SBE for doctors in training, they expressed concerns about the implementation given the already strained health care system and limited resources. The need for evidence, particularly in the context of patient safety, was emphasised to facilitate SBE implementation. Although participants supported the implementation of SBE, it was unclear who should initiate action. DISCUSSION: This study highlighted the perspectives of top-level health care leaders regarding SBE and identified the determinant factors for a successful implementation. Effective communication channels are crucial to enhance collaborations and reduce the disconnection between the different health care organisational levels. Strategic implementation processes, including the roles and responsibilities, should be defined and established. These will inform decisions regarding the implementation strategies to effectively integrate SBE into the residency training curricula.

Simulation-based education in ultrasound - diagnostic and interventional abdominal focus. / Simulationsbasierte Ausbildung im Ultraschall ­ Fokus auf der diagnostischen und interventionellen Abdomen-Sonografie.

Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.

Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe.

OBJECTIVE: This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery. METHODS: A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs). Three online survey rounds explored demographics, SBE availability, and facilitators and barriers to SBE implementation. RESULTS: Overall, 147 KOLs (target population 338) accepted invitation to round 1, representing 30 European countries. The dropout rates for rounds 2 and 3 were 29% and 40%, respectively. Most respondents (88%) were senior, consultant level or higher. No mandatory SBE training was required in their department before training on patients, according to 84% of the KOLs. There was high consensus on the need for structured SBE (87%) and mandatory SBE (81%). SBE is available for the top three prioritised procedures in GNA-2019 (basic open skills, basic endovascular skills, and vascular imaging interpretation) in 24, 23, and 20 of the 30 represented European countries, respectively. The highest ranking facilitators were structured SBE programmes, availability of simulation equipment locally and regionally, good quality simulators, and having a dedicated person running the SBE. The highest ranked barriers were lack of structured SBE curriculum, equipment costs, lack of SBE culture, no or limited dedicated time for faculty to teach in SBE, and clinical work overload. CONCLUSION: Based largely on the opinions of KOLs in vascular surgery in Europe, this study revealed that SBE is needed in vascular surgery training and that systematic and structured programmes are required to ensure successful implementation.

Exploring training needs of newly graduated medical doctors to inform the undergraduate simulation-based curriculum: a national Delphi consensus study.

PURPOSE: Mastering technical procedures is a key component in succeeding as a newly graduated medical doctor and is of critical importance to ensure patient safety. The efficacy of simulation-based education has been demonstrated but medical schools have different requirements for undergraduate curricula. We aimed to identify and prioritize the technical procedures needed by newly graduated medical doctors. METHODS: We conducted a national needs assessment survey using the Delphi technique to gather consensus from key opinion leaders in the field. In the first round, a brainstorm was conducted to identify all potential technical procedures. In the second round, respondents rated the need for simulation-based training of each procedure using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF). The third round was a final elimination and prioritization of the procedures. RESULTS: In total, 107 experts from 21 specialties answered the first round: 123 unique technical procedures were suggested. Response rates were 58% and 64% in the second and the third round, respectively. In the third round, 104 procedures were eliminated based on the consensus criterion, and the remaining 19 procedures were included and prioritized. The top five procedures were: (i) insert peripheral intravenous catheter, (ii) put on personal protection equipment, (iii) perform basic airway maneuvers, (iv) perform basic life support, and (v) perform radial artery puncture. CONCLUSION: Based on the Delphi process a final list of 19 technical procedures reached expert consensus to be included in the undergraduate curriculum for simulation-based education.

Using a novel virtual-reality simulator to assess performance in lumbar puncture: a validation study.

BACKGROUND: A lumbar puncture procedure's success depends on a competent physician minimizing the risk of failing to get a sample and avoiding complications such as post-dural headache. A new virtual-reality simulator might be helpful in deciding when a physician is competent to perform lumbar puncture. We aimed to investigate validity evidence for a simulator-based test in lumbar puncture and establish a pass/fail standard to allow a mastery learning training program. METHODS: Validity evidence was investigated using Messick's framework by including participants who were novices, intermediates, or experienced in lumbar puncture. Each participant performed two lumbar puncture procedures on the simulator, and fifty-nine predefined simulator metrics were automatically recorded. Cronbach's alpha was used to explore internal consistency reliability. Intergroup comparisons were made using independent sample t-tests with Tukey's correction for multiple comparisons. The learning effect was explored using paired sample t-test analysis, and a pass/fail standard was established using the contrasting groups' method. RESULTS: 73 novices, 18 intermediates, and 19 physicians performed the test resulting in a total of 220 procedures. 25 metrics (42.4%) had good discriminatory ability, and the reliability of these metrics was good, Cronbach's α = 0.81. The experienced physicians were significantly better than the novices (18.3 vs. 13.3, p < 0.001), and the pass/fail standard was established at 16 points. This standard resulted in 22 (30.1%) novices passing (i.e., false positives) and 5 (26.3%) physicians failing (i.e., false negatives). CONCLUSION: This study provides validity evidence for a simulator-based test of lumbar puncture competence. The test can help ensure basic competence at the end of a simulation-based training program for trainees, i.e., a mastery learning training program.

Assessment of Technical Competence in Distal Radius Fracture Fixation by a Volar Locking Plate: A Global Delphi Consensus Study.

PURPOSE: Volar locking plate fixation of distal radius fractures is a common orthopedic procedure and should be mastered by graduating orthopedic residents. Surgical education is transitioning from a traditional time-based approach to competency-based medical education. Valid and objective assessment is essential for successful transition. The purpose of this study was to develop a comprehensive, procedure-specific assessment tool to evaluate technical competence in volar locking plate osteosynthesis of a distal radius fracture. METHODS: International orthopedic/trauma experts involved in resident education participated as panelists in a four-round online Delphi process to reach consensus on the content of the assessment tool. Round 1 was an item-generating round, in which the panelists identified potential assessment parameters. In round 2, the panelists rated the importance of each suggested assessment parameter and reached consensus on which to include in the assessment tool. Round 3 yielded specific assessment score intervals for specific bone and fracture models and is not reported in this study. In round 4, the panelists assigned weights to the assessment parameters on a 1-10 scale to determine how each parameter should have an impact on the overall results. RESULTS: Eighty-seven surgeons, representing 42 countries, participated in the study. Round 1 resulted in 45 assessment parameters, grouped into five procedural steps. After round 2, the number of parameters was reduced to 39. After the final round, an additional parameter was removed and weights were assigned to the remaining parameters. CONCLUSIONS: Using a systematic methodology, a preliminary assessment tool to evaluate technical competence in distal radius fracture fixation was developed. A consensus of international experts supports the content validity of the assessment tool. CLINICAL RELEVANCE: This assessment tool represents the first step in the evidence-based assessment essential for competency-based medical education. Before implementation, further studies exploring validity of variations of the assessment tool in different educational contexts are required.

Ensuring competence in ultrasound-guided procedures-a validity study of a newly developed assessment tool.

OBJECTIVES: To investigate the validity of the Interventional Ultrasound Skills Evaluation (IUSE) tool for assessment of procedural competence in ultrasound-guided procedures in a clinical environment, including a pass/fail score. METHODS: Novices and experienced radiologists were recruited from four hospitals and were observed and assessed while performing ultrasound-guided procedures. Performances were assessed using the IUSE tool by two independent raters. Validity evidence was gathered in accordance with Messick's framework: response process was ensured by standardisation of written rater instructions. Internal structure was explored using Cronbach's alpha for internal consistency reliability; inter-rater reliability was calculated as Pearson's r independently across all ratings, and test-retest reliability was reported using Cronbach's alpha. Relationship to other variables was investigated by comparing performances of the participants in each group. Consequences evidence was explored by calculating a pass/fail standard using the contrasting groups method. RESULTS: Six novices and twelve experienced radiologists were enrolled. The IUSE tool had high internal consistency (Cronbach's alpha = 0.96, high inter-rater reliability (Pearson's r = 0.95), and high test-retest reliability (Cronbach's alpha = 0.98), and the mean score was 33.28 for novices and 59.25 for experienced with a highly significant difference (p value < 0.001). The pass/fail score was set at 55 resulting in no false positives or false negatives. CONCLUSIONS: Validity evidence from multiple sources supports the use of the IUSE tool for assessment of competence in ultrasound-guided procedures in a clinical environment and its use in high-stakes assessment such as certification. A credible pass/fail criterion was established to inform decision-making. KEY POINTS: • A multi-site validity investigation established that the Interventional Ultrasound Skills Evaluation (IUSE) tool can be used to assess procedural competence in ultrasound-guided procedures. • Validity evidence was gathered according to Messick's framework validity from the following sources: response process, internal structure, relationship to other variables, and consequences evidence. • The IUSE tool can be used for both formative and summative assessment, and a credible pass/fail score was established to help inform decision-making such as certification.

Consensus on communication curriculum content in Danish undergraduate medical education: A Delphi study.

BACKGROUND: The acquisition of skills in patient-centered communication is a critical aspect of medical education which demands both resource-intensive instruction and longitudinal opportunities for learning. Significant variation currently exists in the content and timing of communication education. The aim of this study was to establish consensus regarding communication curriculum content for undergraduate medical education (UME) within the country of Denmark. METHODS: This study employed a Delphi process which is a widely accepted method for establishing consensus among experts and can be utilized to guide planning and decision-making in education. For this study, consensus was based on greater than 60% agreement between participants. Diverse stakeholders, representing all four universities with medical schools in Denmark, participated in an iterative three-round Delphi process which involved: (1) identifying key curricular elements for medical student education, (2) rating the importance of each item, and (3) prioritizing items relative to one another and rating each item based on the level of mastery that was expected for each skill (i.e. knowledge, performance with supervision, or performance independently). RESULTS: A national sample of 149 stakeholders participated with a 70% response rate for round 1, 81% for round 2, and 86% for round 3. The completed Delphi process yielded 56 content items which were prioritized in rank order lists within five categories: (1) establishing rapport, engaging patient perspectives and responding to needs; (2) basic communication skills and techniques; (3) phases and structure of the encounter; (4) personal characteristics and skills of the student; (5) specific challenging patient groups and context-dependent situations. DISCUSSION: Using a Delphi process, it was possible to achieve consensus regarding communication curriculum content for UME. These findings provide an important foundation for ensuring greater uniformity in UME, as well as supporting the important longitudinal goals of communication skill development across medical training.

Consensus on technical procedures in radiology to include in simulation-based training for residents: a European-wide needs assessment.

OBJECTIVES: To identify and prioritize technical procedures for simulation-based training that should be part of the education of residents in radiology. METHODS: This European-wide needs assessment study used a modified Delphi technique to gather consensus from different key education stakeholders in the field. The first round was a brainstorming phase to identify all procedures that a newly specialized radiologist should potentially be able to do. In the second round, each procedure was explored for the need for simulation training; the participants determined frequency, number of radiologists performing the procedure, impact on patient comfort and safety, and feasibility of simulation. The result of this round was sent back to the participants for final evaluation and prioritization. RESULTS: Seventy-one key education stakeholders from 27 European countries agreed to participate and were actively involved in the Delphi process: response rates were 72% and 82% in the second and third round, respectively. From 831 suggested procedures in the first round, these were grouped and categorized into 34 procedures that were pre-prioritized in the second round according to the need for simulation-based training. In the third round, 8 procedures were eliminated resulting in final inclusion of 26 procedures. Ultrasound procedures were highly ranked including basic skills such as probe handling; abdominal ultrasound; and ultrasound of kidneys, retroperitoneum, intestines, and scrotum. CONCLUSION: The prioritized list of procedures represents a consensus document decided upon by educational stakeholders in radiology across Europe. These procedures are suitable for simulation and should be an integral part of the education of radiologists. KEY POINTS: • The 26 identified procedures are listed according to priority and should be included as an integral part of simulation-based training curricula of radiologists across Europe. • This needs assessment is only the first step towards developing standardized simulation-based training programs that support the harmonization of education and training across Europe.

Evaluation of competence in ultrasound-guided procedures-a generic assessment tool developed through the Delphi method.

OBJECTIVES: To develop a generic and objective tool for assessing competence in percutaneous ultrasound-guided procedures. METHODS: Interventional ultrasound experts from the Nordic countries were invited to participate in a three-round Delphi process. A steering committee was formed to manage the process. In round 1, the experts were asked to suggest all aspects to consider when assessing competence in US-guided procedures. Suggestions were analyzed and condensed into assessment items. In round 2, the expert panel rated these items on a 1-5 scale and suggested new items. Items with a mean rating of ≤ 3.5 were excluded. In round 3, the expert panel rated the list items and suggested changes to the items. RESULTS: Twenty-five experts were invited, and response rates in the three rounds were 68% (17 out of 25), 100% (17 out of 17), and 100% (17 out of 17). The three-round Delphi process resulted in a 12-item assessment tool, using a five-point rating scale. The final assessment tool evaluates pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. CONCLUSIONS: Expert consensus was achieved on a generic tool for assessment of competence in percutaneous ultrasound-guided procedures-the Interventional Ultrasound Skills Evaluation (IUSE). This is the initial step in ensuring a valid and reliable method for assessment of interventional US skill. KEY POINTS: • Through a Delphi process, expert consensus was achieved on the content of an assessment tool for percutaneous ultrasound-guided procedures-the Interventional Ultrasound Skills Evaluation (IUSE) tool. • The IUSE tool is comprehensive and covers pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. • This is an important step in ensuring valid and reliable assessment of interventional US skills.

Learning Curves and Competences of Vascular Trainees Performing Open Aortic Repair in a Simulation-Based Environment.

BACKGROUND: The aim of this study was to analyze learning curves and competency gains of novice vascular trainees when performing open aortic repair in a simulation-based environment. METHODS: This was a prospective study of 16 vascular trainees performing infrarenal open aortic repair on an inanimate abdominal aortic aneurysm simulator with pulsatile pressure and flow. Each participant performed 4 procedures as a primary surgeon while getting structured feedback by a supervising experienced vascular surgeon. All sessions were video recorded and were anonymously and independently assessed by 3 rater-trained experts on an online platform using the newly validated open abdominal aortic aneurysm repair of technical expertise assessment tool. All supervisor interferences and procedure time was noted. RESULTS: Reliability between raters was excellent (intraclass correlation coefficient = 0.92). Participants' mean scores almost doubled during the course between the first (13.4, 95% confidence interval [CI], 6.8-20) and fourth session (29.8, 95% CI, 26.3-33.3) with a mean difference of 14.6 (P < 0.001). Supervisor interference also decreased significantly from mean 3.0 (95% CI, 1.5-3.6) in the first to 0.7 (95% CI, 0.4-1.0) in the fourth session (P = 0.004). Procedure time decreased with a mean of 24 minutes: from 81 min (95% CI, 71.8-90.3) to 57 min (95% CI, 51.1-63.2, P < 0.001). There was a significant negative correlation between procedure time and the Open Abdominal Aortic Aneurysm Repair of Technical Expertise score (Pearson's r = -0.72, P < 0.01). Only half of the participants passed the pass/fail score of 27.7 points during the course. CONCLUSIONS: Novice vascular trainees achieve skills and competencies in open aortic repair in a simulated setting with dedicated supervision and feedback and can become ready for supervised surgery on real patients. Learning rates are individual, and it is important to construct training programs with emphasis on proficiency and not merely attending a course.

Automatic and Objective Assessment of Motor Skills Performance in Flexible Bronchoscopy.

BACKGROUND: Motor skills have been identified as a useful measure to evaluate competency in bronchoscopy. However, no automatic assessment system of motor skills with a clear pass/fail criterion in flexible bronchoscopy exists. OBJECTIVES: The objective of the study was to develop an objective and automatic measure of motor skills in bronchoscopy and set a pass/fail criterion. METHODS: Participants conducted 3 bronchoscopies each in a simulated setting. They were equipped with a Myo Armband that measured lower arm movements through an inertial measurement unit, and hand and finger motions through electromyography sensors. These measures were composed into an objective and automatic composite score of motor skills, the motor bronchoscopy skills score (MoBSS). RESULTS: Twelve novices, eleven intermediates, and ten expert bronchoscopy operators participated, resulting in 99 procedures available for assessment. MoBSS was correlated with a higher diagnostic completeness (Pearson's correlation, r = 0.43, p < 0.001) and a lower procedure time (Pearson's correlation, r = -0.90, p < 0.001). MoBSS was able to differentiate operator performance based on the experience level (one-way ANOVA, p < 0.001). Using the contrasting groups' method, a passing score of -0.08 MoBSS was defined that failed 30/36 (83%) novice, 5/33 (15%) intermediate, and 1/30 (3%) expert procedures. CONCLUSIONS: MoBSS can be used as an automatic and unbiased assessment tool for motor skills performance in flexible bronchoscopy. MoBSS has the potential to generate automatic feedback to help guide trainees toward expert performance.

A Nationwide Needs Assessment to Identify and Prioritize Technical Procedures for Simulation in Obstetrics and Gynaecology: A Delphi Study.

OBJECTIVE: The aims of the study were to identify and prioritize technical procedures that should be developed and integrated in a simulation-based curriculum for obstetrics and gynaecology residents. METHODS: The Delphi method was used, consisting of three rounds of survey questionnaires. Key leaders across Denmark were invited to participate. In Delphi round 1, the participants individually identified technical procedures that newly authorized specialists should be able to perform. These procedures were sent to round 2 to be explored for need for simulation-based training by estimating frequency of procedures, number of doctors, potential patient risk and/or discomfort, and feasibility of simulation. Round 3 consisted of elimination and prioritization of remaining procedures (Canadian Task Force Classification III). RESULTS: A total of 165 key leaders were invited. Response rates were 61%, 50%, and 53%, respectively. Identified procedures in Round 1 were as follows: gynaecology (n = 51), obstetrics (n = 40), and general procedures (n = 10). A needs assessment formula was used to calculate needs for training on the basis of the answers in round 2 and produce a preliminary prioritized list that was sent to round 3 for final exploration. Round 3 consisted of elimination and final prioritization, where gynaecology (n = 17) prioritized basic laparoscopy, vaginal ultrasound, and laparoscopy with salpingostomy and salpingectomy; obstetrics procedures (n = 16) prioritized basic resuscitation of newborn, vacuum extraction, and management of shoulder dystocia; and one general procedure (basic adult resuscitation) was included. CONCLUSION: A needs assessment using the Delphi method produced a prioritized list of technical procedures suitable for simulation. This can guide the development of simulation-based training programs.

Point-of-care ultrasound for general practitioners: a systematic needs assessment.

Objective: The aim of the study was to achieve consensus among a group of ultrasound proficient general practitioners (GPs) from Denmark, Norway, Sweden and Finland on which ultrasound scanning modalities and ultrasound-guided procedures are essential to GPs in their daily work for the purpose of including them in a basic ultrasound curriculum.Design: The Delphi methodology was used to obtain consensus.Subjects: Sixty Scandinavian GPs with more than two years of point-of-care ultrasound (POCUS) experience were invited to join the Delphi expert panel.Main outcome measures: In the first Delphi round each member of the panel was asked to produce a list of scanning modalities and procedures which they found relevant to include in a basic ultrasound curriculum. In Delphi round two, these suggestions were presented to the entire panel who assessed whether they found them essential in their daily work. Items not reaching consensus in round two, were presented to the panel in a third and final round. Items reaching more than 67% agreement were included.Results: Forty-five GPs were included in the study and 41 GPs completed all rounds. Agreement was obtained on 30 scanning modalities and procedures primarily within the musculoskeletal (8), abdominal (5), obstetric (5) and soft tissue (3) diagnostic areas. Four ultrasound-guided procedures were also agreed upon.Conclusion: A prioritized list of 30 scanning modalities and procedures was agreed upon by a group of ultrasound proficient GPs. This list could serve as a guideline when planning future POCUS educational activities for GPs.Key pointsPoint-of-care ultrasound (POCUS) is increasingly being used by general practitioners (GPs), but little is known about which ultrasound applications are most used.We performed a systematic needs assessment among a group of ultrasound proficient GPs using the Delphi methodology for the purpose of establishing a basic POCUS curriculum.The process resulted in a prioritized list of 30 scanning modalities and ultrasound guided procedures.Our study provides the basis for an evidence-based basic POCUS curriculum for GPs.

Learn EVAR sizing from scratch: The results of a one-day intensive course in EVAR sizing and stent graft selection for vascular trainees.

BACKGROUND AND AIM: Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. METHODS: Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. RESULTS: All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30-48:20) min (median and range). The participants' overall test scores (lower is better) were in median 17.9 (11.9-28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7-25.2) (<200 EVAR's) (p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 -18.7) (≥200 EVAR's) (p = .01). The sub-score for anatomical measurements was 10.6 (3.9-18.8) and comparable with the experienced group 9.7 (8.1-12.8) (p = .83) but inferior to the expert operators 6.5 (5.2-10.2) (p = .04). The sub-score for stent graft selection was 7.5 (4.9-14.1) and comparable with experienced operators scoring 4.5 (3.6-12.3) (p = .09) but inferior to the expert operators score of 5.0 (3.6-8.4) (p = .01). CONCLUSION: This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.

A national needs assessment study to determine procedures for simulation-based training in cardiology in Denmark.

OBJECTIVES: New training methods such as simulation have been introduced in cardiology as in other specialties; however, the development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The objective of this study was to perform a nationwide general needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum for cardiology residency in Denmark. DESIGN: We completed a needs assessment using the Delphi method among key opinion leaders in cardiology. Brainstorming in round 1 identified technical procedures that future cardiologists should learn. Round 2 was a survey to examine frequency of procedure, number of cardiologists performing the procedure, operator-related risk and/or discomfort for patients and feasibility for simulation. Round 3 was final elimination and prioritization of procedures. RESULTS: Ninety-four key opinion leaders were included, and the response rates were 77% (round 1), 62% (Round 2), and 68% (Round 3). Twenty-four technical procedures were identified in Round 1 and pre-prioritized in Round 2. In round 3, 13 procedures were included in the final prioritized list. The five highly prioritized procedures eligible for simulation-based training were advanced life support, pleurocentesis, transesophageal echocardiography, coronary angiography, and pericardiocentesis. CONCLUSION: The general needs assessment following the Delphi process identified and prioritized 13 technical procedures in cardiology that should be integrated in a simulation-based curriculum. The final list provides educators a guide when developing simulation-based training programmes for cardiology residents.

Consensus on technical procedures for simulation-based training in anaesthesiology: A Delphi-based general needs assessment.

BACKGROUND: Anaesthesiologists are expected to master an increasing number of technical procedures. Simulation-based procedural training can supplement and, in some areas, replace the classical apprenticeship approach during patient care. However, simulation-based training is very resource-intensive and must be prioritised and optimised. Developing a curriculum for simulation-based procedural training should follow a systematic approach, eg the Six-Step Approach developed by Kern. The aim of this study was to conduct a national general needs assessment to identify and prioritise technical procedures for simulation-based training in anaesthesiology. METHODS: A three-round Delphi process was completed with anaesthesiology key opinion leaders. In the first round, the participants suggested technical procedures relevant to simulation-based training. In the second round, a needs assessment formula was used to explore the procedures and produce a preliminary prioritised list. In the third round, participants evaluated the preliminary list by eliminating and re-prioritising the procedures. RESULTS: All teaching departments in Denmark were represented with high response rates in all three rounds: 79%, 77%, and 75%, respectively. The Delphi process produced a prioritised list of 30 procedure groups suitable for simulation-based training from the initial 138 suggestions. Top-5 on the final list was cardiopulmonary resuscitation, direct- and video laryngoscopy, defibrillation, emergency cricothyrotomy, and fibreoptic intubation. The needs assessment formula predicted the final prioritisation to a great extent. CONCLUSION: The Delphi process produced a prioritised list of 30 procedure groups that could serve as a guide in future curriculum development for the simulation-based training of technical procedures in anaesthesiology.

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion.

BACKGROUND: Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. OBJECTIVES: The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. METHODS: Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. RESULTS: Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being "too busy." CONCLUSION: Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.

Identifying and prioritizing technical procedures in otorhinolaryngology for simulation-based training: a national needs assessment in Denmark.

PURPOSE: To conduct a national needs assessment using a structured approach to identify and prioritize technical skills and procedures in otorhinolaryngology (ORL) for simulation-based training. METHODS: The study was designed as a national Danish survey of key educational stakeholders in ORL. A Delphi methodology with three rounds was used: the first round constituted a brainstorming phase to identify relevant procedures; the second round was a survey of importance, frequency, number of physicians needed to train, and patient safety/discomfort of the procedures, and feasibility of simulation-based training; and a final third round for prioritization. RESULTS: A total of 62 key opinion leaders were identified and 50 responded in the first round, constituting our panel. Fifty technical skills and procedures were identified in the brainstorming phase and were sent out for assessment, with responses from 56.5% of still eligible panellists. Thirty-six procedures were found important in ORL residency training by the panel. After final prioritization by the panel (response rate 43.4%), there was broad consensus (> 75%) on the need for simulation-based training of 13 technical skills and procedures, with the most highly ranking procedures being emergency cricothyroidotomy, flexible fibre pharyngo-laryngoscopy, and basic surgical skills. CONCLUSIONS: As educational decisions are increasingly required to be evidence-based, this study represents a structured approach to identifying procedures for simulation-based training in ORL. This information can be valuable in the development and implementation of simulation-based training programmes in the ORL residency training curriculum.