E. Matthew Ritter

Teaching Breaking Bad News Using Mixed Reality Simulation

BACKGROUND Our novel teaching approach involved having students actively participate in an unsuccessful resuscitation of a high fidelity human patient simulator with a gun shot wound to the chest, followed immediately by breaking bad news (BBN) to a standardized patient wife (SPW) portrayed by an actress. METHODS Brief education interventions to include viewing a brief video on the SPIKES protocol on how to break bad news, a didactic lecture plus a demonstration, or both, was compared to no pretraining by dividing 553 students into four groups prior to their BBN to the SPW. The students then self-assessed their abilities, and were also evaluated by the SPW on 21 items related to appearance, communication skills, and emotional affect. All received cross-over training. RESULTS Groups were equal in prior training (2 h) and belief that this was an important skill to be learned. Students rated the experience highly, and demonstrated marked improvement of self-assessed skills over baseline, which was maintained for the duration of the 12-wk clerkship. Additionally, students who received any of the above training prior to BBN were rated superior to those who had no training on several communication skills, and the observation of the video seemed to offer the most efficient way of teaching this skill in a time delimited curriculum. CONCLUSION This novel approach was well received and resulted in improvement over baseline. Lessons learned from this study have enhanced our curricular approach to this vital component of medical education.

New directions in simulation-based surgical education and training: Validation and transfer of surgical skills, use of nonsurgeons as faculty, use of simulation to screen and select surgery residents, and long-term follow-up of learners

The Consortium of American College of Surgeons-Accredited Education Institutes was created to explore new opportunities in simulation-based surgical education and training beyond the scope of individual accredited institutes. During the Third Annual Meeting of the Consortium of American College of Surgeons-Accredited Education Institutes Consortium, 4 work groups addressed the validation and transfer of surgical skills, the use of nonsurgeons as faculty, the use of simulation to screen and select surgery residents, and long-term follow-up of learners. The key elements from the deliberations and conclusions are summarized in this manuscript.

Simulation-Based Selection of Surgical Trainees: Considerations, Challenges, and Opportunities

Received April 23, 2016; Revised May 17, 2016; Accepted May 23 From the Department of Surgery, University of Texas Southwester cal Center, Dallas (Gardner), Department of Surgery, Houston M Hospital, Houston (Dunkin), TX, Department of Surgery, Uniform vices University and Walter Reed National Military Medical Bethesda, MD (Ritter), Department of Surgery, Louisiana State U Health Sciences Center, New Orleans, LA (Paige), Department o gency Medicine, Summa Akron City Hospital, Akron, OH (Ahm Department of Surgery, Baystate Medical Center, Springfiel (Fernandez). Correspondence address: Aimee K Gardner, PhD, Department of University of Texas Southwestern Medical Center, 5323 Harry Hin Dallas, TX 75390. email: aimee.gardner@utsouthwestern.edu

Strangulated Inguinal Hernia

Strangulated inguinal hernia is a surgical emergency commonly encountered by nearly all general surgeons. If not recognized and treated promptly, mortality may be as high as 30%. A wide array of open and laparoscopic approaches can be employed to treat suspected strangulated hernias. Primary repair, permanent prosthetic mesh, absorbable prosthetic mesh, and biologic meshes have all been successfully used in the treatment of strangulated inguinal hernias, and all play a role in current treatment. We review the issues surrounding the diagnosis and treatment of strangulated inguinal hernia and propose an algorithm for surgical management.

Psychometric properties of the Fundamentals of Endoscopic Surgery (FES) skills examination

BackgroundThe Fundamentals of Endoscopic Surgery (FES) manual skills examination is a simulation-based assessment of five foundational skills in endoscopic surgery. With the FES skills exam becoming part of the board certification process in general surgery, continual investigation is needed to determine the validity with which the exam is supporting inferences and decision-making about examinees, as well as how it might be improved.MethodsThe present study retrospectively analyzed performance and demographic details for the initial 344 examinees completing the FES skills exam.ResultsThe five tasks showed distinct degrees of difficulty, with Loop Reduction being especially difficult for examinees. Tasks related to one another positively but moderately, suggesting that the exam assesses both general and task-specific skills. The number of lower-endoscopic cases completed by an examinee strongly predicted performance, while upper endoscopy experience and career level (e.g., resident vs. fellow vs. practicing) did not. Hand dominance and the type of simulator used were not found to be related to scores. However, three demographic variables that related to one another—gender, glove size, and height—were also related to performance and pass/fail status.ConclusionsThis study’s results generally support the validity argument for the FES skills exam while pointing to additional investigations to be undertaken as the exam is applied more broadly.

Off-site training of laparoscopic skills, a scoping review using a thematic analysis

BackgroundThe focus of research in simulation-based laparoscopic training has changed from examining whether simulation training works to examining how best to implement it. In laparoscopic skills training, portable and affordable box trainers allow for off-site training. Training outside simulation centers and hospitals can increase access to training, but also poses new challenges to implementation. This review aims to guide implementation of off-site training of laparoscopic skills by critically reviewing the existing literature.MethodsAn iterative systematic search was carried out in MEDLINE, EMBASE, ERIC, Scopus, and PsychINFO, following a scoping review methodology. The included literature was analyzed iteratively using a thematic analysis approach. The study was reported in accordance with the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement.ResultsFrom the search, 22 records were identified and included for analysis. A thematic analysis revealed the themes: access to training, protected training time, distribution of training, goal setting and testing, task design, and unsupervised training. The identified themes were based on learning theories including proficiency-based learning, deliberate practice, and self-regulated learning.ConclusionsMethods of instructional design vary widely in off-site training of laparoscopic skills. Implementation can be facilitated by organizing courses and training curricula following sound education theories such as proficiency-based learning and deliberate practice. Directed self-regulated learning has the potential to improve off-site laparoscopic skills training; however, further studies are needed to demonstrate the effect of this type of instructional design.

Cost Comparison of Fundamentals of Laparoscopic Surgery Training Completed With Standard Fundamentals of Laparoscopic Surgery Equipment versus Low-Cost Equipment ☆

OBJECTIVE Training for the Fundamentals of Laparoscopic Surgery (FLS) skills test can be expensive. Previous work demonstrated that training on an ergonomically different, low-cost platform does not affect FLS skills test outcomes. This study compares the average training cost with standard FLS equipment and medical-grade consumables versus training on a lower cost platform with non-medical-grade consumables. DESIGN Subjects were prospectively randomized to either the standard FLS training platform (n = 19) with medical-grade consumables (S-FLS), or the low-cost platform (n = 20) with training-grade products (LC-FLS). Both groups trained to proficiency using previously established mastery learning standards on the 5 FLS tasks. The fixed and consumable cost differences were compared. SETTING Training occurred in a surgical simulation center. PARTICIPANTS Laparoscopic novice medical student and resident physician health care professionals who had not completed the national FLS proficiency curriculum and who had performed less than 10 laparoscopic cases. RESULTS The fixed cost of the platform was considerably higher in the S-FLS group (S-FLS,

Systematic development of a proctor certification examination for the Fundamentals of Laparoscopic Surgery testing program.

3360; LC-FLS,

How Much Are We Spending on Resident Selection

879), and the average consumable training cost was significantly higher for the S-FLS group (S-FLS,

Do Resident Case Logs Meet ACGME Requirements? A Comparison Between Acute Care and Elective Cases

1384.52; LC-FLS,