Taking advantage of asynchronous digital feedback: development of an at-home basic suture skills training program for undergraduate medical students that facilitates skills retention.

Purpose: To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods: Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsupervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results: Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07). Conclusion: It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.

Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM).

The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .

Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM) / Inovações no treinamento cirúrgico: explorando o papel da inteligência artificial e dos grandes modelos de linguagem (LLM)

ABSTRACT The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .

RESUMO O cenário do treinamento cirúrgico está evoluindo rapidamente com o surgimento da inteligência artificial (IA) e sua integração na educação e simulação. Este artigo explora as aplicações e benefícios potenciais do treinamento cirúrgico assistido por IA, em particular o uso de modelos de linguagem avançados (MLAs), para aprimorar a comunicação, personalizar o feedback e promover o desenvolvimento de habilidades. Discutimos os avanços no treinamento baseado em simulação, ferramentas de avaliação impulsionadas por IA, sistemas de avaliação baseados em vídeo, plataformas de realidade virtual (RV) e realidade aumentada (RA), e o papel potencial dos MLAs na transcrição, tradução e resumo do feedback. Apesar das oportunidades promissoras apresentadas pela integração da IA, vários desafios devem ser abordados, incluindo precisão e confiabilidade, preocupações éticas e de privacidade, viés nos modelos de IA, integração com os sistemas de treinamento existentes, e treinamento e adoção de ferramentas assistidas por IA. Ao abordar proativamente esses desafios e aproveitar o potencial da IA, o futuro do treinamento cirúrgico pode ser remodelado para proporcionar uma experiência de aprendizado mais abrangente, segura e eficaz para os aprendizes, resultando em melhores resultados para os pacientes.

Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience.

PURPOSE: This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS: Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS: LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.

DEVELOPMENT AND VALIDATION OF A NEW LAPAROSCOPIC ENDOTRAINER FOR NEONATAL SURGERY AND REDUCED SPACES.

BACKGROUND: Pediatric laparoscopy box with sliding tray. Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. AIM: To develop and validate a new neonatal/reduced-space endotrainer. METHODS: The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the performance of each subject on nine exercises. RESULTS: A 10.5 x 10 x 18 cm acrylic simulator was created, with an internal working surface of 9 x 9 cm. An HD camera was incorporated, with a 0-180° range of movement. All exercises of a Basic Laparoscopic Training Program were adapted on a scale of 1:0.5 to fit in. From 49 participants, 42 (85.71%) answered the survey; 80.5% considered that the simulator reproduces similar conditions to procedures performed in children under one year of age; 61.1% thought that the simulator represents a difficulty identical to procedures performed in newborns; 73.7% considered that the neonatal simulator is more complicated than the adult simulator. Experts showed significantly better performance in all proposed exercises. CONCLUSION: The simulator has a high-quality image and design that allows training with basic tasks. The endotrainer permitted to discriminate between these different skill levels and was well evaluated by users with diverse surgical experience.

Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay.

Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA; p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes; p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days; p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.

Video-Based Guided Simulation without Peer or Expert Feedback is Not Enough: A Randomized Controlled Trial of Simulation-Based Training for Medical Students.

BACKGROUND: Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective. METHODS: A prospective randomized controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores. RESULTS: No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores [(19.8 (18.5-21); 16.6 (15.5-17.5)) and (20.3 (19.88-21); 16.8 (16-17.5)) vs (15.7 (15-16); 13.3 (12.5-14)) (p < 0.05)], respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS [7 (4.5-9) and 7.4 (4.88-10) vs 3.5 (1.5-6) (p < 0.05)] and SRS scores [5.4 (3.5-7) and 6.3 (4-8.5) vs 3.1 (1.13-4.88) (p < 0.05)], respectively. CONCLUSION: The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.

Minimally invasive tele-mentoring opportunity-the mito project.

BACKGROUND: Simulation training is a validated method for acquiring laparoscopic skills. Training sessions may be sporadic or lack continuity in oversight by instructors since traditional programs mandate in-person teaching and evaluation. This study presents the development, implementation, and results of a novel smartphone application that enables remote teacher-student interaction. This interface is used to complete a validated program that provides learner-specific feedback. Outcomes of training via Lapp were compared to outcomes of traditional in-person training. METHODS: A web-based and mobile iOS and Android application (Lapp) was developed to enable a remote student-teacher interaction. Instructors use Lapp to assess video recorded training sessions of students at distant locations and guide them through the laparoscopic skill course with specific and personalized feedback. Surgical trainees at two remote training centers were taught using Lapp. A control group was assessed during traditional simulation training at the training facility, with in-person feedback. Pre- and post-training performances were video recorded for each trainee and blindly evaluated by two experts using a global rating scale (GRS) and a specific rating scale (SRS). RESULTS: A total of 30 trainees were trained via Lapp and compared with 25 locally taught. Performance in the Lapp group improved significantly after the course in both GRS and SRS scores, from 15 [6-17] to 23 [20-25], and from 12 [11-15] to 18 [15-20], respectively. The results between both groups were comparable. CONCLUSION: Laparoscopic simulation training using a mobile app is as effective as in-person instruction in teaching advanced laparoscopic surgical skills. Lapp provides an effective method of teaching through simulation remotely and may allow expansion of robust simulation training curriculums.

Development and validation of a new laparoscopic endotrainer for neonatal surgery and reduced spaces / Desenvolvimento e validação de um novo endotrainer laparoscópico para cirurgia neonatal e espaços reduzido

ABSTRACT Background: Pediatric procedures have the difficulty of being performed in reduced spaces. Training in reduced spaces has proven to be different in complexity compared to adult laparoscopic endotrainers. Aim: To develop and validate a new neonatal/reduced-space endotrainer. Methods: The simulator was tested and assessed by users with different skill levels and experience in laparoscopic pediatric surgery through an 8-item questionnaire. Construct validity was determined by evaluating the performance of each subject on nine exercises. Results: A 10.5 x 10 x 18 cm acrylic simulator was created, with an internal working surface of 9 x 9 cm. An HD camera was incorporated, with a 0-180° range of movement. All exercises of a Basic Laparoscopic Training Program were adapted on a scale of 1:0.5 to fit in. From 49 participants, 42 (85.71%) answered the survey; 80.5% considered that the simulator reproduces similar conditions to procedures performed in children under one year of age; 61.1% thought that the simulator represents a difficulty identical to procedures performed in newborns; 73.7% considered that the neonatal simulator is more complicated than the adult simulator. Experts showed significantly better performance in all proposed exercises. Conclusion: The simulator has a high-quality image and design that allows training with basic tasks. The endotrainer permitted to discriminate between these different skill levels and was well evaluated by users with diverse surgical experience.

RESUMO Racional: Os procedimentos pediátricos têm dificuldade de serem realizados em espaços reduzidos. O treinamento nesses espaços provou ser diferente em dificuldade em comparação aos endotrainers laparoscópicos adultos. Objetivo: Desenvolver e validar um novo endotrainer neonatal com espaço reduzido. Métodos: O simulador foi criado, testado e avaliado por usuários com diferentes níveis de habilidade e experiência em cirurgia pediátrica laparoscópica por meio de um questionário de oito itens. A validação do método foi determinada pela avaliação do desempenho de cada participante em nove exercícios. Resultados: Foi criado um simulador acrílico de 10,5 x 10 x 18 cm, com uma superfície de trabalho interna de 9 x 9 cm. Uma câmera HD foi incorporada com faixa de movimento de 0-180°. Todos os exercícios do Programa de Treinamento Laparoscópico Básico foram adaptados em escala de 1:0,5 para se ajustarem. Dos 49 participantes, 42 (85,71%) responderam à pesquisa; 80,5% consideraram que o simulador reproduz condições semelhantes às de procedimentos realizados em crianças menores de um ano; 61,1% consideraram que o simulador representa dificuldade semelhante aos procedimentos realizados em recém-nascidos; 73,7% consideraram que o simulador neonatal é mais difícil que o simulador adulto. Especialistas apresentaram desempenho significativamente melhor em todos os exercícios propostos. Conclusão: O simulador possui imagem de alta qualidade e design que permitem o treinamento com exercícios básicos. O aparelho permitiu discriminar entre os diferentes níveis de habilidade e foi bem avaliado por usuários com experiência cirúrgica diversificada.