James Ansell

The WIMAT colonoscopy suitcase model: a novel porcine polypectomy trainer

Aim Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training. The aim of this study was to assess its content validity.

Are general surgeons able to accurately self-assess their level of technical skills?

INTRODUCTION Self-assessment is a way of improving technical capabilities without the need for trainer feedback. It can identify areas for improvement and promote professional medical development. The aim of this review was to identify whether self-assessment is an accurate form of technical skills appraisal in general surgery. METHODS The PubMed, MEDLINE(®), Embase(™) and Cochrane databases were searched for studies assessing the reliability of self-assessment of technical skills in general surgery. For each study, we recorded the skills assessed and the evaluation methods used. Common endpoints between studies were compared to provide recommendations based on the levels of evidence. RESULTS Twelve studies met the inclusion criteria from 22,292 initial papers. There was no level 1 evidence published. All papers compared the correlation between self-appraisal versus an expert score but differed in the technical skills assessment and the evaluation tools used. The accuracy of self-assessment improved with increasing experience (level 2 recommendation), age (level 3 recommendation) and the use of video playback (level 3 recommendation). Accuracy was reduced by stressful learning environments (level 2 recommendation), lack of familiarity with assessment tools (level 3 recommendation) and in advanced surgical procedures (level 3 recommendation). CONCLUSIONS Evidence exists to support the reliability of self-assessment of technical skills in general surgery. Several variables have been shown to affect the accuracy of self-assessment of technical skills. Future work should focus on evaluating the reliability of self-assessment during live operating procedures.

Poster Exhibitions at Conferences: Are We Doing it Properly?

OBJECTIVE Literature exploring the educational value and quality of conference poster presentation is scarce. The aim of this study was to identify and describe the variation in poster exhibitions across a spectrum of conferences attended by trainees. DESIGN Prospective observational assessment of conference posters was carried out across 7 variables at 4 conferences attended by surgical trainees in 2012. Posters were compared by individual variables and according to overall poster score combining all 7 variables examined. The number of authors listed was also compared. SETTING AND PARTICIPANTS Random samples of consecutively numbered posters were examined at the exhibitions of 4 conferences, which included a UK national medical education conference (Association for the Study of Medical Education), a UK international surgical conference (Association of Surgeons of Great Britain and Ireland), a European oncology conference (European Society of Surgical Oncology), and a North American joint medical and surgical conference (Digestive Diseases Week). RESULTS Significant variation existed between conferences in posters and their presentation. The proportion of presenters failing to display their posters ranged from 3% to 26% (p < 0.0001). Adherence to size guidelines varied from 89% to 100% (p = 0.002). The inclusion of references ranged from 19% to 82% (p < 0.0001). The presence of a presenting author during the allocated session varied widely from 21% to 86% (p < 0.0001). No significant variation was observed in the proportion of posters that were formatted using aims, methods, results, and conclusion sections (81%-93%; p = 0.513) or in the proportion of posters that were identified as difficult to read (24%-28%; p = 0.919). Association for the Study of Medical Education outperformed each of the other exhibitions overall (p < 0.0001). Posters with greater than the median of 4 authors performed significantly better across all areas (p < 0.0001-0.042) except presenter attendance (p = 0.480). CONCLUSIONS Poster exhibitions varied widely, with room for improvement at all 4 conferences. Lessons can be learned by all conferences from each other to improve presenter engagement with and the educational value of poster exhibitions.

Piloting the ISCP Surgical Skills Assessment: The Wales Deanery Experience

The evidence for using surgical simulators in training and assessment is growing rapidly. A systematic review has demonstrated the validity of different simulators for a range of procedures. Research suggests that skills developed on simulators can be transferred to the operating theatre. The increased interest in simulation comes as a result of the need to streamline surgical training. This is reflected by the numerous simulation-based courses that have become an essential part of modern surgical training.

How do Surgical Trainees Without a Higher Degree Compare with their Postdoctoral Peers

In 2011 the royal college of surgeons published From Theory to Theatre. This document states that delivering high quality research is the responsibility of anyone involved in any aspect of surgery. In 2012 the college outlined plans to develop a nationwide research infrastructure to allow the expansion of clinical trials in surgery. This incorporates trainee research groups, which are growing in popularity and productivity. The aim is to give surgical trainees the opportunity to facilitate large scale, multicentre clinical trials. Current activity is therefore placing increasing emphasis on conducting good quality research at all stages of surgical training.

Core surgical training in Wales: pilot study of a multidisciplinary surgical boot camp

&NA; An attempt to create the ultimate core surgical training post.

A novel ex vivo porcine simulator for transanal endoscopic operation training.

National bowel screening programs have led to an increase in early rectal cancer and complex rectal polyp detection by using the transanal endoscopic operation (TEO). Our aim is to develop an ex vivo porcine simulator for TEO training. A video of the prototype is provided (Video 1, available online at www.giejournal.org). Porcine rectal tissue was injected with a “polyp mix” in order to simulate a rectal lesion. This was attached to a TEO device, as demonstrated in Figure 1. A simulated, partial-thickness transanal endoscopic procedure was performed by using the apparatus. The simulator re-created TEO in a realistic manner. The rectal lesion was removed with standard TEO techniques. The model also can be used to practice TEO suturing. This video demonstrates a unique way of simulating TEO that is reproducible and economically viable. The next stage is to validate this model for use in TEO skills training.

A new ex vivo animal simulation model for skills training in laparoscopic colorectal surgery

We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patients blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.

A novel simulation for transanal endoscopic operation training

BACKGROUND Transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) have been widely adopted since first being described by Buess et al in 1985. A specially designed rectoscope is used with laparoscopic imaging and angulated instrumentation to allow precise dissection of rectal lesions under a magnified view. We describe a novel ex vivo simulator for TEO/TEM training. TECHNIQUE A porcine rectal specimen was used to simulate the human rectum. A standardised liquid polyp mix is injected into the submucosal layer of the bowel. This solidifies at room temperature, allowing it to remain in situ, providing a realistic rectal lesion when visualised through the transanal endoscopic equipment (Fig 1). The stages of polyp removal can be practised including circumferential excision margin marking, polyp excision and suturing of the rectal defect. This simulation has been trialled by delegates on a laboratory-based TEO course (Fig 2).

Endoluminal Ultrasound of Neoduodenum Following Pancreas-Preserving Total Duodenectomy for Familial Adenomatous Polyposis

CONTEXT Familial adenomatous polyposis affects around 2-10 per 100,000 population. Untreated, it inevitably leads to colon cancer. Prophylactic panproctocolectomy has led to improved survival. The resulting extension to follow-up has revealed that 70-100% of patients with familial adenomatous polyposis go on to develop duodenal polyposis and the lifetime risk of duodenal carcinoma in this group is up to 10%. Treatment for those not locally resectable requires pancreaticoduodenectomy. In recent years, pancreas-preserving total duodenectomy has emerged as a safe alternative to pancreaticoduodenectomy. Endoscopy has previously been safely performed in patients following pancreas-preserving total duodenectomy. CASE REPORT We report successful endoscopic ultrasound (EUS) assessment and trans-neoduodenal EUS-guided fine needle aspiration biopsy (EUS-FNA) of the pancreas and adjacent tissue in a 45-year-old man with familial adenomatous polyposis who has previously undergone pancreas-preserving total duodenectomy. EUS confirmed the mass was most likely to represent a metastasis in a local lymph node. EUS-FNA confirmed invasive malignancy. A Kausch-Whipple pancreaticoduodenectomy was performed successfully and post-operative recovery has been excellent. CONCLUSION The authors consider this to be the first report of successful EUS and EUS-FNA performed through the neoduodenum fashioned during pancreas-preserving total duodenectomy.