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1.
Ann Vasc Surg ; 62: 92-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31220589

RESUMO

BACKGROUND: Sexual harassment is any unwelcome behavior or obscene remark that affects an individual's work performance or creates an intimidating, hostile, or offensive environment. We sought to examine its presence in vascular surgery training programs, identify factors associated with occurrence, and determine reporting barriers. METHODS: An anonymous survey consisting of questions on frequency of sexual harassment including type/perpetrators/locations; why/how the practice occurs; reporting mechanisms/barriers to reporting; and demographic information was emailed to all vascular surgery trainees in the United States. Descriptive and univariate analysis was performed. RESULTS: Of 498 invitations sent, 133 (27%) completed the survey. Fifty of 133 (38%) thought harassment occurred more commonly in surgical specialties with hierarchy/power dynamics, historical male dominance in field, and ignoring of behavior, being the most common reasons cited that it still occurs. Of 133, 81 (61%) respondents have either experienced (63/133, 47%) or witnessed (18/133, 14%) other trainees being harassed, with calling a sexist slur/intimate nickname being the most common behavior. Those affected were more commonly women (P = 0.0006), with the most common perpetrator being a surgical attending and the most common area of occurrence being the operating room. Reasons for not reporting included believing the behavior was harmless in intent (33/63, 52%) and feeling nothing would come of it if reported (28/63, 44%), but 15/63 (24%) feared repercussions and 15/63 (24%) feeling uncomfortable are identified as a target of sexual harassment. Of 133, 46 respondents were not aware of institutional mechanisms for reporting harassment, with only 70/133 (53%) feeling comfortable reporting to their departmental leadership. CONCLUSIONS: A significant number of vascular surgery trainees have experienced sexual harassment during their training. Over a third of respondents do not know institutional mechanisms for reporting, and almost half do not feel comfortable reporting to departmental leadership. Increasing education on harassment and reporting mechanisms may be necessary in vascular surgery training programs.


Assuntos
Educação de Pós-Graduação em Medicina , Médicas , Assédio Sexual/prevenção & controle , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Atitude do Pessoal de Saúde , Currículo , Feminino , Humanos , Masculino , Médicas/psicologia , Assédio Sexual/psicologia , Cirurgiões/psicologia , Inquéritos e Questionários , Estados Unidos , Local de Trabalho/psicologia
4.
Semin Vasc Surg ; 32(1-2): 14-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540649

RESUMO

The recognition of vascular surgery as an independent surgical specialty is inevitable, but the pathway to full autonomy remains uncertain. Vascular surgery emerged from general surgery in the mid-1950s with the advent of synthetic grafts and microvascular techniques. By the early 1980s, Accreditation Council for Graduate Medical Education-approved fellowships were established in most large academic medical centers. The American Board of Surgery recognized this additional specialty training by awarding vascular graduates a Certificate of Special Qualifications distinguishing them from general surgeons. The emergence of endovascular surgery radically changed the face of vascular surgery from a general surgery subspecialty to a unique surgical specialty with a growing array of minimally invasive tools. With the establishment of a primary Certificate in Vascular Surgery and the subsequent development of integrated residencies, vascular surgery moved ever closer to recognition as an independent surgical specialty. Despite the remarkable progress that has been observed over the past 50 years, there is a desire in the vascular community for formal recognition of the unique body of knowledge and surgical skills that serve as the foundation of contemporary vascular care.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Autonomia Profissional , Conselhos de Especialidade Profissional , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Previsões , História do Século XX , História do Século XXI , Humanos , Conselhos de Especialidade Profissional/história , Conselhos de Especialidade Profissional/normas , Conselhos de Especialidade Profissional/tendências , Cirurgiões/história , Cirurgiões/normas , Cirurgiões/tendências , Estados Unidos , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/normas , Procedimentos Cirúrgicos Vasculares/tendências
5.
Semin Vasc Surg ; 32(1-2): 21-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540651

RESUMO

The development of the 0+5 integrated vascular training program allows training to begin after medical school and is a "new" paradigm in specialty surgery training. Whether community and academic surgeons in practice will accept this training program remains an unanswered question. My perspectives as an integrated vascular resident trainee who recently entered clinical practice provide insight on the adequacy of my training and the lessons I have learned as a vascular surgery specialist.


Assuntos
Escolha da Profissão , Certificação , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Fatores Etários , Atitude do Pessoal de Saúde , Competência Clínica , Currículo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interpessoais , Descrição de Cargo , Avaliação de Programas e Projetos de Saúde , Cirurgiões/psicologia , Local de Trabalho/psicologia
6.
Semin Vasc Surg ; 32(1-2): 23-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540652

RESUMO

Burnout among vascular surgery trainees is a significant problem and needs to be addressed at the level of the individual, training program duties, and at each institution. The clinical challenges and patient-oriented care required of a vascular surgeon generate a level of stress that requires its recognition and development of coping methods to promote well-being and personal happiness. There are ways to minimize burnout during surgical training, including acknowledgment of its symptoms, mentorship, self-care, and access to resources for stress reduction. Crucial factors in maintaining a positive outlook and a sense of meaningful work are faculty entrustability, receptive leadership, celebrating small victories, and recognition that resiliency is a skill that can be learned. Successful vascular surgeon training is a mission that requires everyone involved to actively promote well-being behavior and a supportive work environment. With appropriate implementation of these practices, our training programs can cultivate surgeons who are competent, compassionate, and committed to advancing vascular care.


Assuntos
Adaptação Psicológica , Esgotamento Profissional/prevenção & controle , Educação de Pós-Graduação em Medicina/métodos , Saúde Mental , Cirurgiões/educação , Cirurgiões/psicologia , Procedimentos Cirúrgicos Vasculares/educação , Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Currículo , Humanos , Relações Interpessoais , Liderança , Mentores , Resiliência Psicológica , Local de Trabalho/psicologia
7.
Semin Vasc Surg ; 32(1-2): 27-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540653

RESUMO

The development of two training paradigms for the training of vascular surgeons has naturally resulted in concerns regarding competence equivalency. Comparison of the traditional 5+2 year and the integrated 0-5 year training programs has confirmed clear differences in trainee experience. To date, the overall vascular procedure case-log experience is equivalent except in the areas of open abdominal procedures that separate traditional vascular fellows from integrated vascular surgery residents. The integrated vascular surgery trainee has the advantage of increased time spent on vascular services, and this results in a significantly increased major vascular case volume. Finally, while there is a difference in the types of jobs attained by these two groups, with vascular residents trending toward a more academic scope of practice, both groups report very similar training and job attainment satisfaction, including salary compensation.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Carga de Trabalho , Escolha da Profissão , Currículo , Humanos , Satisfação no Emprego , Modelos Educacionais
8.
Semin Vasc Surg ; 32(1-2): 30-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540654

RESUMO

Vascular surgery is a specialty discipline highlighted by a lifelong learning process from which new endovascular devices and techniques will continue to emerge. Industry partnerships can provide a safe learning environment for trainees, with a focus on maximizing learning opportunities during fellowship or residency. Unlike other surgical specialties, vascular surgery empowers its trainees to become competent in both open and image-guided endovascular interventions, requiring two unique skill sets to become a contemporary vascular surgeon. Due to the rapid growth of technology and innovations, industry partnerships enhance and maximize the learning experience of the trainee by often providing the products, education, research support, and financial assistance. This can come in the form of innovative and educational activities, including simulation, exposure to thought leaders, attendance at conferences and workshops, and one-on-one assistance with cases. In this article, we review the role that industry can serve in vascular education to support budding vascular surgeons through exposure and repetition as they lay down the fundamentals of their careers.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Setor de Assistência à Saúde , Relações Interinstitucionais , Parcerias Público-Privadas , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Comportamento Cooperativo , Currículo , Educação de Pós-Graduação em Medicina/economia , Setor de Assistência à Saúde/economia , Humanos , Parcerias Público-Privadas/economia , Apoio à Pesquisa como Assunto , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/economia
9.
Semin Vasc Surg ; 32(1-2): 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540655

RESUMO

Vascular ultrasound has proven to be a cornerstone for the management of patients with vascular disease, and is utilized by vascular surgeons in the outpatient clinic, the operating room, and for follow-up after revascularisation. Today vascular surgeons are among the most frequent users of ultrasound apart from radiologists. Mastering the skills of vascular ultrasound and interpretation is best acquired under supervision and is more easily learned as part of the daily practice of vascular surgery. Separating vascular ultrasound into basic and advanced procedures is useful, and basic vascular ultrasound skills should be a part of a vascular surgical training program curriculum. In Europe, certification of vascular surgeons in basic vascular ultrasound via a pass-fail test is in its infancy, preceded by local and national initiatives. In the area of clinical vascular research, duplex ultrasound is superior to most other diagnostic modalities due to its availability and noninvasive nature and ultrasound-based research will in addition to improving patient care generate physicians highly experienced in vascular ultrasound.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Aprendizagem , Cirurgiões/educação , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Humanos
10.
Semin Vasc Surg ; 32(1-2): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540656

RESUMO

Diagnostic testing performed in the noninvasive vascular laboratory is a cornerstone of care for patients with suspected or known vascular disease. The Society for Vascular Surgery has mandated that vascular surgery resident training include mentored experience in performing vascular laboratory testing and interpreting its results. The trainee should be experienced with vascular laboratory instrumentation and testing protocols, be knowledgeable in ultrasound imaging of vascular anatomy, and be competent to classify disease severity relevant to the study indication. The scope of test interpretation should include peripheral arterial, peripheral venous, cerebrovascular, and visceral abdominal testing using duplex ultrasound supplemented by indirect physiologic testing for peripheral arterial and venous disease. The emergence of endovascular therapy has expanded duplex ultrasound applications in the areas of screening, procedural imaging, and surveillance following intervention. Pre-procedure testing to assess disease location and severity, and vein mapping for dialysis access or extremity bypass grafting provide important patient-specific information that can reduce the need for more invasive vascular imaging. It is recommended that trainees acquire the hand-on skills to perform duplex testing in vascular clinic and inpatient sites, such as the emergency department and operating room. Training programs should have a structured vascular laboratory curriculum that documents annual educational milestones that encompass both test interpretation aptitude and hands-on duplex scanning skills. Before completion of training, the resident should acquire documented experience in test interpretation sufficient to take the Physician Vascular Interpretation examination, which is required for American Board of Surgery certification as a vascular surgeon.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/cirurgia , Técnicas de Diagnóstico Cardiovascular , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Tomada de Decisão Clínica , Currículo , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
11.
Semin Vasc Surg ; 32(1-2): 48-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540657

RESUMO

The evolving demands of surgical training have led to the successful implementation of skills examinations in the areas of laparoscopic and endoscopic surgery. Currently, there is no similar formal skills assessment in vascular surgery, despite endovascular intervention replacing open surgery in treatment of many vascular conditions. The adoption of less invasive techniques to treat aneurysm and occlusive disease has resulted in new training paradigms and technical challenges for trainees. The duty hour restriction for trainees and declining numbers of complex open vascular interventions have added to the challenges of vascular surgery training. Simulation is a promising avenue for both skills training and assessment. The ability to evaluate the fundamental skills of trainees would be an important step to ensure a degree of uniformity in trainees' technical abilities. The role of simulation-based training in acquiring, testing, and refining these skills is still in its infancy in the vascular surgery training paradigm. This article aims to impart a deeper understanding of the conditions for developing and implementing the fundamentals of vascular and endovascular surgery, and to provide guidance regarding the role of simulation-based training in a rapidly evolving specialty. There are various forms of simulation available, including benchtop models, high-fidelity simulators, and virtual-reality simulators, and each requires a different method of proficiency assessment. Both open surgery and endovascular skills can be assessed and the application of successful implementation in academic vascular surgery training program is presented.


Assuntos
Certificação , Instrução por Computador/métodos , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Treinamento por Simulação/métodos , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Certificação/normas , Competência Clínica , Instrução por Computador/normas , Currículo , Educação de Pós-Graduação em Medicina/normas , Humanos , Curva de Aprendizado , Treinamento por Simulação/normas , Cirurgiões/normas , Procedimentos Cirúrgicos Vasculares/normas
12.
Semin Vasc Surg ; 32(1-2): 5-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540658

RESUMO

The American Board of Surgery (ABS) has more than 80 years of both direct and indirect involvement in US surgical education, with its primary role being certification of graduates of Accreditation Council for Graduate Medical Education-approved surgical training programs. The ABS's impact on education has been at multiple levels, including the development of the content and administration of qualifying and certifying examinations; original education research based on the Board's unique data sets; and surgical training and education-related initiatives in partnership with multiple regulatory bodies and surgical societies. Within these efforts, by incremental steps, the specialty of vascular surgery attained recognition as a primary specialty of the ABS, and the Vascular Surgery Board of the ABS was established 20 years ago, in 1998. The 2 decades that followed have witnessed significant transformations in the evaluation and treatment of vascular disease, the paradigms for training vascular and endovascular surgeons, and the Vascular Surgery Board has partnered with stakeholder organizations to continually ensure quality education for the evolving vascular surgical workforce. Looking forward, while surgical education remains outside of its primary mission, the ABS and Vascular Surgery Board will continue as key stakeholders and leaders in the complex network of professional societies and training institutions that will guide the evolution of vascular surgery training.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Conselhos de Especialidade Profissional , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/normas , História do Século XX , História do Século XXI , Humanos , Conselhos de Especialidade Profissional/história , Conselhos de Especialidade Profissional/normas , Cirurgiões/história , Cirurgiões/normas , Estados Unidos , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/normas
13.
Iowa Orthop J ; 39(1): 15-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413669

RESUMO

Background: There is a wide array of indications for lower extremity amputation (LEA) and inherent variability in operative experiences between surgical residents. Significant variation in resident surgical experience performing LEAs is possible. Objective: To identify inter- and intra-specialty trends and variability in LEA experience in graduating orthopedic surgery, general surgery, and vascular surgery residents from 2007-2017. Methods: Publicly available ACGME case log data for above knee amputation, below knee amputation, and transmetatarsal/ digital amputation procedures from accredited orthopaedic surgery, general surgery, traditional (5+2) vascular surgery and integrated (0+5) vascular surgery residencies was reviewed from 2007-2017. Linear regression analysis was used to identify temporal trends, with statistical significance set at p<0.05. Results: From 2007-2017, the mean number of total LEA, AKA, and BKA performed by graduating orthopaedic surgery residents did not change significantly. The mean number of total LEAs logged by graduating general surgery and integrated (0+5) vascular surgery residents did not change significantly over time (p=0.98, p=0.23, respectively). The mean number of total LEAs logged by traditional (5+2) vascular surgery residents increased from 16.0 to 32.6 (p<0.01). As study year increased, graduating integrated (0+5) and traditional (5+2) vascular surgery residents logged more LEAs relative to graduating orthopaedic surgery and general surgery residents (p<0.01). Conclusions: There is significant variation in resident experience in LEAs between surgical specialties. Integrated vascular surgery residents logged the most LEAs, followed by traditional vascular surgery residents, orthopaedic surgery residents, and general surgery residents. Experience of orthopaedic surgery residents in LEAs has been relatively stable over time.Level of Evidence: IV.


Assuntos
Amputação/educação , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Extremidade Inferior/cirurgia , Amputação/métodos , Bases de Dados Factuais , Feminino , Cirurgia Geral/educação , Humanos , Modelos Lineares , Masculino , Procedimentos Ortopédicos/educação , Estudos Retrospectivos , Análise e Desempenho de Tarefas , Estados Unidos , Procedimentos Cirúrgicos Vasculares/educação
15.
J Cardiovasc Surg (Torino) ; 60(5): 582-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256581

RESUMO

BACKGROUND: A geometrical understanding of the individual patient's disease morphology is crucial in aortic surgery. The aim of our study was to validate a questionnaire addressing understanding of aortic disease and use this questionnaire to investigate the value of 3D printing as a teaching tool for surgical trainees. METHODS: Anonymized CT-angiography images of six different patients were selected as didactic cases of aortic disease and made into 3D models of transparent rigid resin with the Vat-photopolymerization technique. The 3D aortic models, which could be disassembled and reassembled, were displayed to 37 surgical trainees, immediately after a seminar on aortic disease. A questionnaire was developed to compare the trainees' understanding before (T0) and after (T1) demonstration of the 3D printed models. RESULTS: A panel of 15 experts participated in evaluating face and content validity of the questionnaire. The questionnaire validity was established and therefore the information investigated by the questionnaire could be synthetized using the mean of the items to indicate the understanding. The participants (mean age 28 years, range 26-34, male 59%) showed a significant improvement in understanding from T0 (median=7.25; IQR=1.50) to T1 (median=8.00; IQR=1.50; P=0.002). CONCLUSIONS: Preliminary data suggest that the use of 3D-printed aortic models as a teaching tool was feasible and improved the understanding of aortic disease among surgical trainees.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Educação de Pós-Graduação em Medicina/métodos , Impressão Tridimensional , Cirurgiões/educação , Inquéritos e Questionários , Procedimentos Cirúrgicos Vasculares/educação , Adulto , Aorta/cirurgia , Doenças da Aorta/cirurgia , Compreensão , Escolaridade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Modelos Anatômicos , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Dados Preliminares , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes
16.
Semin Thorac Cardiovasc Surg ; 31(4): 635-637, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31279913

RESUMO

The first concept of Artificial Intelligence (AI) came into attention during 1920s and currently it is rapidly being integrated in our daily clinical practice. The use of AI has evolved from basic image-based analysis into complex decisions related to different surgical procedure. AI has been very widely used in the cardiology field, however the use of such machine-led decisions has been limited and explored at slower pace in surgical practice. The use of AI in cardiac surgery is still at its infancy but growing dramatically to reflect the changes in the clinical decision making process for better patient outcomes. The machine-led but human controlled algorithms will soon be taking over most of the decision making processes in cardiac surgery. This review article focuses on the practice of AI in aortic surgery and the future of such technology-led decision making pathways on patient outcomes, surgeon's learning skills and adaptability.


Assuntos
Doenças da Aorta/cirurgia , Inteligência Artificial/tendências , Cirurgiões/tendências , Cirurgia Assistida por Computador/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Doenças da Aorta/diagnóstico por imagem , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Big Data , Competência Clínica , Difusão de Inovações , Previsões , Humanos , Curva de Aprendizado , Cirurgiões/educação , Cirurgiões/psicologia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/educação , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/educação
17.
Surgery ; 166(5): 835-843, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31353081

RESUMO

BACKGROUND: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. METHODS: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. RESULTS: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. CONCLUSION: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Internato e Residência/organização & administração , Erros Médicos/prevenção & controle , Ferimentos e Lesões/cirurgia , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Benchmarking/métodos , Benchmarking/estatística & dados numéricos , Artéria Braquial/lesões , Artéria Braquial/cirurgia , Cadáver , Competência Clínica/estatística & dados numéricos , Avaliação Educacional/métodos , Fasciotomia/efeitos adversos , Fasciotomia/estatística & dados numéricos , Artéria Femoral/lesões , Artéria Femoral/cirurgia , Humanos , Internato e Residência/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Estudos Prospectivos , Cirurgiões/educação , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/educação , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
18.
Br J Oral Maxillofac Surg ; 57(7): 616-619, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31239227

RESUMO

As training in microvascular surgery often involves the use of live animals, it is important that such a practice is regularly revisited and justified, particularly in the context of emerging training strategies such as virtual simulation. This systematic review was therefore designed to assess the ongoing need for their use over other methods. A search of PubMed and MEDLINE using the major MeSH terms: anastomosis, surgical vascular procedures, microsurgery, and training, yielded 1386 titles from which 153 abstracts were read, 70 papers analysed, and 17 included. Nine of these papers were randomised studies that compared different methods of training. Other publications were included if the use of live animals was assessed or commented upon, or both (8 publications). Only one study randomised trainees to a non-living animal model or a living model, with detailed assessment that included clinical transfer to live surgery. It showed no significant difference in the quality of training, and excellent techniques of assessment. There was much discussion on the advantage of regular training and opportunities to practise without tuition, but there was no clear advantage for the use of live animals. Our review emphasises the lack of evidence regarding the need for live animals in the training of microsurgical or microvascular skills. Although the assumption remains that the use of live rats is essential, there is a clear need for a high-quality, comparative study to justify the continued use of such models given the quality of the alternatives now available.


Assuntos
Competência Clínica , Microcirurgia/educação , Procedimentos Cirúrgicos Vasculares/educação , Anastomose Cirúrgica , Animais , Modelos Animais , Ratos
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