Mastering instruments before operating on a patient: the role of simulation training in tool use skills.

BACKGROUND: We examined the impact of tool complexity on surgeons' performance and evaluated the value of using a simulation-based program for reducing training cost. METHODS: Three pairs of surgical graspers with increasing mechanical complexity, which were designed for open, laparoscopic, and endoscopic procedures, were used in performing a simple object transportation task. Task times and mental workload of 17 surgeons were compared using all 3 variations of the graspers to test the impact of tool complexity on surgical performance. Subsequently, 4 of these surgeons decided to enter a 3-week training phase and practiced with these 3 surgical instruments on a daily basis. Learning curves were plotted to examine the value of using simulation for proficiency training with these tools. RESULTS: Task time was significantly prolonged as tool complexity increased. Practice in a simulated environment shortened the task time significantly and moderately reduced mental workloads. However, the difference in task time varied among the 3 types of tools. Between days 1 and 9, task times for each types of grasper were reduced by 55% (endoscopic), 42% (open), and 22% (laparoscopic). CONCLUSIONS: Tool complexity may degrade a surgeon's performance. Extensive simulation training programs are important for surgeons to gain proficiency in handling a tool before they practice on patients.

Role of platelet activating factor in cardiac dysfunction, apoptosis and nitric oxide synthase mRNA expression in the ischemic-reperfused rabbit heart.

BACKGROUND: The role of platelet activating factor (PAF) and nitric oxide in myocardial ischemia-reperfusion (MIR) injury and the interrelationship of the two mediators is poorly understood. The contribution of PAF to apoptosis during MIR has not been studied. OBJECTIVES: To determine the contribution of PAF to ex vivo cardiac dysfunction during the initial 5 h of postischemia reperfusion, to determine the contribution of PAF to inducible nitric oxide synthase (NOS) and endothelial NOS mRNA expression during MIR, and to determine whether PAF contributes to apoptosis during MIR. METHODS: Isolated blood-perfused rabbit hearts underwent 30 min of global ischemia and 5 h reperfusion. Animals were divided into four groups, which received either PAF antagonist TCV-309 or vehicle before ischemia, or were sham operated (heart perfusion only), or were control (no heart perfusion). RESULTS: Administration of the PAF antagonist significantly improved myocardial contractility (614 mmHg/s versus 308 mmHg/s, positive dP/dt, P<0.0001) and coronary vascular flow rate (5.5 mL/min versus 3.9 mL/min, P<0.01) during reperfusion compared with untreated animals (values at 5 h reperfusion). Treatment with PAF antagonist significantly increased mRNA expression of endothelial NOS (2.8 versus 1.3 ratio, P<0.05) compared with the untreated group. PAF antagonist reduced procaspase-3 cleavage (66 versus 108 ratio, P<0.05) and DNA fragmentation (8.2 versus 11.0 positive cells per field) compared with untreated animals. CONCLUSIONS: PAF antagonism with TCV-309 protected against myocardial contractile depression and coronary vasoconstriction during the initial 5 h reperfusion. PAF may play a role in the regulation of endothelial NOS mRNA expression and contribute to apoptosis during ischemia-reperfusion in the heart.

Academic performance and comparative effectiveness of computer- and textbook-based self-instruction.

We intended to clarify the influence of student academic ability on the effectiveness of CAI, using data of a study to assess the effectiveness of a new type of CAI software, cyberPatient (CP), at Kochi Medical School (KMS). A total of 59 third-year students were randomly assigned to four groups: Group-1 used a textbook for self-instruction, Group-2 used CP, Group-3 used both types of learning materials, and Group-4 did not learn. Learning performance was evaluated by multiple-choice examination and OSCE. In order to clarify the influence of students' academic ability on the effectiveness of CAI, statistical analyses were conducted, assigning students as either high or medium or low performance students. High performance students from Group-1, -2 and -3 did not differ significantly in test performance after self-instruction. However, low performance students in Group-1 scored significantly lower than those in Group-2 and -3. All students in Group-2 and -3 reported that CP stimulated willingness to learn and assisted understanding. The present analysis suggested that effectiveness of CAI might be associated with the academic ability of students.

Quantifying surgeon's contribution to team effectiveness on a mixed team with a junior surgeon.

BACKGROUND: A surgical team often consists of an experienced surgeon and surgeons in training. This project quantified the contribution of the experienced surgeon to the teamwork in a team comprised of 1 experienced and 1 novice surgeon (Mixed Team). METHODS: An experienced and a novice surgeon in a Mixed Team were required to complete a peg transportation task and an intracorporeal suture task collaboratively. Tasks were evaluated by a summative score (up to 100 points) that was calculated on task speed and accuracy. Performances of 24 Mixed Teams were compared to 24 Novice Teams (each composed of 2 novices) and 8 Expert Teams (each composed of 2 experienced surgeons). RESULTS: The Mixed Teams performed better (67.6 points) than the Novice Teams (51.3; P < .001) but worse than the Expert Teams (88.3; P < .001). When examining individual performance in the Mixed Teams, we observed that experienced surgeons maintained their superior performance like they did in the Expert Teams (P = .153). Novices in the Mixed Teams, however, showed markedly better performances than they did in the Novice Teams (P = .024). CONCLUSION: Instant guidance and instruction from experienced surgeons inspire novices' performance, providing a foundation for surgical teamwork effectiveness.

Centre of Excellence For Simulation Education and Innovation (CESEI).

Simulation is becoming an integral part of medical education. The American College of Surgeons (ACS) was the first organization to recognize the value of simulation-based learning, and to award accreditation for educational institutions that aim to provide simulation as part of the experiential learning opportunity. Centre of Excellence for Simulation Education and Innovation (CESEI) is a multidisciplinary and interprofessional educational facility that is based at the University of British Columbia (UBC) and Vancouver Costal Health Authority (VCH). Centre of Excellence for Simulation Education and Innovation's goal is to provide excellence in education, research, and healthcare delivery by providing a technologically advanced environment and learning opportunity using simulation for various groups of learners including undergraduate, postgraduate, nursing, and allied health professionals. This article is an attempt to describe the infrastructure, services, and uniqueness of the Centre of Excellence for Simulation Education and Innovation.