A systematic review of methodological principles and delivery of surgical simulation bootcamps.

BACKGROUND: The growth of "bootcamp style" simulation training in surgical practice has been exponential over the last decade. Developing and delivering a surgical bootcamp requires a significant investment. This systematic review aims to identify the key components that allow for a successful and rewarding surgical bootcamp course to be implemented that can be applied to all surgical specialities. METHODS: To understand the surgical bootcamp principles and delivery mechanisms, we searched peer-reviewed, English language studies published between 2000 and 21. RESULTS: From 137 articles, 14 studies with a Medical Education Research Quality Instrument Score of >11.5 were included. Most studies followed the core components; delivery at transition (12), mapping syllabus (13), multimodality delivery (14), and deliberate practice with formative feedback (12) apart from 1:1 training by only 2 studies. CONCLUSIONS: Our review suggests that Surgical bootcamp can be an extremely useful education tool for trainees if 5 pillars of a boot camp are respected.

A Practice Platform for Systematic Development of Microsurgical Instrument Technique.

Many surgical disciplines, particularly those specializing in the pediatric age group, use microsurgical instruments with the assistance of either optical loupe or microscope magnification to perform high precision surgical procedures. We developed a course consisting of two parts: Part 1 consists of low fidelity, inanimate exercises or training and practice platform, and part 2 employed a rat model. In this report, we describe and provide templates for the first part of the course, namely the practice platform as an integral set of six low-fidelity exercises, each focusing on a specific aspect of instrument handling required to master the later use of the instruments during actual microsurgery. This platform is made to systematically and efficiently improve the microsurgical skills of junior as well as advanced surgical trainees.

Implementing and Evaluating a National Certification Technical Skills Examination: The Colorectal Objective Structured Assessment of Technical Skill.

OBJECTIVE: To implement the Colorectal Objective Structured Assessment of Technical skill (COSATS) into American Board of Colon and Rectal Surgery (ABCRS) certification and build evidence of validity for the interpretation of the scores of this high stakes assessment tool. BACKGROUND DATA: Currently, technical skill assessment is not a formal component of board certification. With the technical demands of surgical specialties, documenting competence in technical skill at the time of certification with a valid tool is ideal. METHODS: In September 2014, the COSATS was a mandatory component of ABCRS certification. Seventy candidates took the examination, with their performance evaluated by expert colorectal surgeons using a task-specific checklist, global rating scale, and overall performance scale. Passing scores were set and compared using 2 standard setting methodologies, using a compensatory and conjunctive model. Inter-rater reliability and the reliability of the pass/fail decision were calculated using Cronbach alpha and Subkoviak methodology, respectively. Overall COSATS scores and pass/fail status were compared with results on the ABCRS oral examination. RESULTS: The pass rate ranged from 85.7% to 90%. Inter-rater reliability (0.85) and reliability of the pass/fail decision (0.87 and 0.84) were high. A low positive correlation (r= 0.25) was seen between the COSATS and oral examination. All individuals who failed the COSATS passed the ABCRS oral examination. CONCLUSIONS: COSATS is the first technical skill examination used in national surgical board certification. This study suggests that the current certification process may be failing to identify individuals who have demonstrated technical deficiencies on this standardized assessment tool.

A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the Colorectal Objective Structured Assessment of Technical Skill (COSATS).

OBJECTIVE: To develop and evaluate an objective method of technical skills assessment for graduating subspecialists in colorectal (CR) surgery-the Colorectal Objective Structured Assessment of Technical Skill (COSATS). BACKGROUND: It may be reasonable for the public to assume that surgeons certified as competent have had their technical skills assessed. However, technical skill, despite being the hallmark of a surgeon, is not directly assessed at the time of certification by surgical boards. METHODS: A procedure-based, multistation technical skills examination was developed to reflect a sample of the range of skills necessary for CR surgical practice. These consisted of bench, virtual reality, and cadaveric models. Reliability and construct validity were evaluated by comparing 10 graduating CR residents with 10 graduating general surgery (GS) residents from across North America. Expert CR surgeons, blinded to level of training, evaluated performance using a task-specific checklist and a global rating scale. The mean global rating score was used as the overall examination score and a passing score was set at "borderline competent for CR practice." RESULTS: The global rating scale demonstrated acceptable interstation reliability (0.69) for a homogeneous group of examinees. Both the overall checklist and global rating scores effectively discriminated between CR and GS residents (P < 0.01), with 27% of the variance attributed to level of training. Nine CR residents but only 3 GS residents were deemed competent. CONCLUSIONS: The Colorectal Objective Structured Assessment of Technical Skill effectively discriminated between CR and GS residents. With further validation, the Colorectal Objective Structured Assessment of Technical Skill could be incorporated into the colorectal board examination where it would be the first attempt of a surgical specialty to formally assess technical skill at the time of certification.

Do not teach me while I am working!

BACKGROUND: The aim of this study was to determine if technical surgical experience enhances the learning of new cognitive information under multitasking conditions. METHODS: Junior (years 1-3) and experienced (years 4 and 5) general surgery residents performed a Nissen fundoplication on a synthetic model (the primary task). While performing the primary task, they listened to and memorized information describing the steps of a computer-assisted hip replacement surgery (the secondary task). Performance on the primary and secondary tasks was assessed using performance metrics and multiple-choice questions. RESULTS: The primary task was performed better by the senior than the junior trainees (P = .001, P = .007). The senior trainees also scored higher on the secondary task than the junior trainees (P = .001). CONCLUSIONS: Senior trainees have superior capacity to multitask. This may have direct implications on both clinical and simulation-based education, such that educators need to adjust the amount of information presented in accordance to trainees' levels of training.

Addressing the severe shortage of health care providers in Ethiopia: bench model teaching of technical skills.

CONTEXT: There is a severe shortage of health care workers in Ethiopia. This situation must be addressed by the efficient training of mass cohorts of students. OBJECTIVES: This study aimed to demonstrate that bench model training is a feasible approach to teaching surgical skills in Ethiopia. METHODS: A pre-test, simulation-based training intervention and post-test design was used. Two objective structured assessments of technical skills (OSATS) and a bench-top simulation training session were administered at the Black Lion Hospital, Addis Ababa, Ethiopia. Participants included 19 surgical residents who volunteered as trainees. Five surgical faculty members and one senior resident from the Black Lion Hospital, as well as two faculty members from the University of Toronto, participated as trainers and evaluators. The intervention consisted of OSATS tests comprising four stations, covering knot tying, closure of skin laceration, elliptical excision and bowel anastomosis. Tests were separated by 2-hour practice sessions. Main outcome measures included previously validated instruments comprising global rating scales (GRS) and skill-specific checklists (SSC). RESULTS: The measures showed no improvement on knot tying (GRS: P = 0.14; SSC: P = 0.7), marginal improvement on closure of laceration (GRS: P = 0.48; SSC: P = 0.003), and improvements on excision (GRS: P = 0.012; SSC: P = 0.003) and bowel anastomosis (GRS: P < 0.001; SSC: P < 0.001). CONCLUSIONS: The bench models and scoring schemes developed in Toronto, Canada were directly applicable in Addis Ababa, Ethiopia. This approach may prove a feasible, safe and cost-effective method for training a multitude of health care professionals in technical skills and may help to address the human resources deficit in Africa.

Developing criteria for proficiency-based training of surgical technical skills using simulation: changes in performances as a function of training year.

BACKGROUND: Proficiency-based residency training programs can be more efficient than the current duration-based formats. For their successful implementation, appropriate proficiency criteria must be developed. The objective of this study was to investigate the relationship between technical skill performances assessed using computer- and expert-based methods and training year. An assumption was that asymptotes in performance as a function of training year can be used to set the proficiency level for a technical skill, so the value at which the asymptote occurs can be labeled as the proficiency criteria. STUDY DESIGN: Thirty-eight general surgery residents performed one-handed knot tying on bench-top simulators at two levels of difficulty: superficial and deep. Motion-efficiency measures and expert-based measures were used to evaluate performance. Total number of operations (ie, surgical volume) that each trainee participated in during residency was also acquired. RESULTS: On the superficial model, asymptotes were observed at year 1 for motion-efficiency and year 3 for expert-based measures. On the deep model, asymptotes were observed at year 2 for motion-efficiency and year 4 for expert-based measures. CONCLUSIONS: The data demonstrate the challenges associated with defining technical skills proficiency criteria. Different asymptotes were observed for the two assessment methods and neither covaried substantially with surgical volume. These data suggest that this asymptote approach in defining proficiency criteria can be suitable for development of proficiency-based residency training programs. The sensitivity of this approach to the type of assessment method and to the functional difficulty of the simulators used for assessment must be considered.

Setting up a surgical skills center.

With the increasing use of simulation in medicine, many departments of surgery are considering the development of a surgical skills center. This article focuses on practical issues that must be considered when setting up a surgical skills center. The importance of developing a mission statement and including relevant stakeholders is discussed. The types of curricula that can be developed as well as the appropriate equipment purchased to support different curricula are considerations. Space requirements, funding sources, and staffing are also covered. Setting up a surgical skills center requires institutional buy-in and planning from the outset. Various models of skills centers, depending on local politics, are discussed.