Jette Led Sørensen

Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator

BackgroundSafe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopy. Virtual reality (VR) simulators may be useful tools for training and assessing basic and advanced surgical skills and procedures. This study aimed to investigate the construct validity of the LapSimGyn VR simulator, and to determine the learning curves of gynecologists with different levels of experience.MethodsFor this study, 32 gynecologic trainees and consultants (juniors or seniors) were allocated into three groups: novices (0 advanced laparoscopic procedures), intermediate level (>20 and <60 procedures), and experts (>100 procedures). All performed 10 sets of simulations consisting of three basic skill tasks and an ectopic pregnancy program. The simulations were carried out on 3 days within a maximum period of 2 weeks. Assessment of skills was based on time, economy of movement, and error parameters measured by the simulator.ResultsThe data showed that expert gynecologists performed significantly and consistently better than intermediate and novice gynecologists. The learning curves differed significantly between the groups, showing that experts start at a higher level and more rapidly reach the plateau of their learning curve than do intermediate and novice groups of surgeons.ConclusionThe LapSimGyn VR simulator package demonstrates construct validity on both the basic skills module and the procedural gynecologic module for ectopic pregnancy. Learning curves can be obtained, but to reach the maximum performance for the more complex tasks, 10 repetitions do not seem sufficient at the given task level and settings. LapSimGyn also seems to be flexible and widely accepted by the users.

Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized trial.

Objective:To investigate the impact of instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator. Background:Simulators are now widely accepted as a training tool, but there is insufficient knowledge about how much feedback is necessary, which is useful for sustainable implementation. Methods:A randomized trial complying with CONSORT Statement. All participants had to reach a predefined proficiency level for a complex operational task on a virtual reality simulator. The intervention group received standardized instructor feedback a maximum of 3 times. The control group did not receive instructor feedback. Participants were senior medical students without prior laparoscopic experience (n = 99). Outcome measures were time, repetitions, and performance score to reach a predefined proficiency level. Furthermore, influence of sex and perception of own surgical skills were examined. Results:Time (in minutes) and repetitions were reduced in the intervention group (162 vs 342 minutes; P < 0.005) and (29 vs 65 repetitions; P < 0.005). The control group achieved a higher performance score than the intervention group (57% vs 49%; P = 0.004). Men used less time (in minutes) than women (P = 0.037), but no sex difference was observed for repetitions (P = 0.20). Participants in the intervention group had higher self-perception regarding surgical skills after the trial (P = 0.011). Conclusions:Instructor feedback increases the efficiency when training a complex operational task on a virtual reality simulator; time and repetitions used to achieve a predefined proficiency level were significantly reduced in the group that received instructor feedback compared with the control group. Trial registration number: NCT01497782.

International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey.

Objectives To achieve international consensus across multiple specialties on a generic ultrasound rating scale using a Delphi technique. Methods Ultrasound experts from Obstetrics-Gynaecology, Surgery, Urology, Radiology, Rheumatology, Emergency Medicine, and Gastro-Enterology representing North America, Australia, and Europe were identified. A multi-round survey was conducted to obtain consensus between these experts. Of 60 invited experts, 44 experts agreed to participate in the first Delphi round, 41 remained in the second round, and 37 completed the third Delphi round. Seven key elements of the ultrasound examination were identified from existing literature and recommendations from international ultrasound societies. All experts rated the importance of these seven elements on a five-point Likert scale in the first round and suggested potential new elements for the assessment of ultrasound skills. In the second round, the experts re-rated all elements and a third round was conducted to allow final comments. Agreement on which elements to include in the final rating scale was pre-defined as more than 80% of the experts rating an element four or five, on importance to the ultrasound examination. Results Two additional elements were suggested by more than 10% of the experts in the first Delphi round. Consensus was obtained to include these two new elements along with five of the original elements in the final assessment instrument: 1) Indication for the examination 2) Applied knowledge of ultrasound equipment 3) Image optimization 4) Systematic examination 5) Interpretation of images 6) Documentation of examination and 7) Medical decision making. Conclusion International multispecialty consensus was achieved on the content of a generic ultrasound rating scale. This is the first step to ensure valid assessment of clinicians in different medical specialties using ultrasound.

The implementation and evaluation of a mandatory multi-professional obstetric skills training program

Objective. To implement and evaluate a simulation‐based training program. Design. Descriptive. Study period: June 2003–June 2006. Setting. Obstetric Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Population. Two training sessions were provided for all health professionals including doctors, midwives, auxiliary nurses, and 147 out 156 participants (94%) took part in the first training session and 192 out possible 201 (96%) took part in the second session. Methods. An intervention study of the impact of simulation‐based training in management of postpartum bleeding, shoulder dystocia, basic neonatal resuscitation, and severe preeclampsia. Main outcome measures. Before, just after and 9–15 months following the training, data were collected on the confidence and stress levels relating to the carrying out of certain procedures. In addition, a written objective test on basic neonatal resuscitation was administered. Data on any changes in work‐routines experienced by the participants were obtained by open‐ended questions. Registry data from the Danish Medical Birth Registry and from the hospital administration were included in the analysis. Results. Ninety‐two percent of all respondents had a positive attitude toward the training program. They considered management of shoulder dystocia, preeclampsia, and neonatal resuscitation less stresful and less unpleasant to perform after training. Confidence scores for all the trained skills improved significantly. A significant association was found between confidence in neonatal resuscitation and numbers of correct answers in the objective test. More than 90% found the training to have had a positive influence on their work. The need for organizational changes in the department became evident and necessary changes were implemented. Sick leave amongst midwives diminished significantly during the study period. Conclusions. A comprehensive evaluation of a mandatory simulation‐based program, implemented in a obstetric department, demonstrated a positive impact at individual and organizational levels.

Retention of laparoscopic procedural skills acquired on a virtual-reality surgical trainer

BackgroundVirtual-reality (VR) simulator training has been shown to improve surgical performance in laparoscopic procedures in the operating room. We have, in a randomised controlled trial, demonstrated transferability to real operations. The validity of the LapSim virtual-reality simulator as an assessment tool has been demonstrated in several reports. However, an unanswered question regarding simulator training is the durability, or retention, of skills acquired during simulator training. The aim of the present study is to assess the retention of skills acquired using the LapSim VR simulator, 6 and 18xa0months after an initial training course.Methods and materialsThe investigation was designed as a 6- and 18-month follow-up on a cohort of participants who earlier participated in a skills training programme on the LapSim VR. The follow-up cohort consisted of trainees and senior consultants allocated to two groups: (1) novices (experiencexa0<xa05 procedures, nxa0=xa09) and (2) experts (experiencexa0>xa0200 procedures during the past 3xa0years, nxa0=xa010). Each participant performed ten sessions. Assessment of skills was based on time, economy of movement and the error parameter “bleeding”. The novice group were re-tested after 6 and 18xa0months, whereas the expert group were only retested once, after 6xa0months. None of the novices performed laparoscopic surgery in the follow-up period. The experts continued their daily work with laparoscopic surgery.Results and conclusionsNovices showed retention of skills after 6xa0months. After 18xa0months, novices’ laparoscopic skills had returned to the pre-training level. This indicates that laparoscopic skills seemed to deteriorate in the period between 6 and 18xa0months without training. Experts showed consistent performance over time. This information can be included when planning training curricula in minimal invasive surgery.

Reliable and valid assessment of ultrasound operator competence in obstetrics and gynecology

To explore the reliability and validity of a recently developed instrument for assessment of ultrasound operator competence, the Objective Structured Assessment of Ultrasound Skills (OSAUS).

The Simulation Centre at Rigshospitalet, Copenhagen, Denmark

The Simulation Centre at Rigshospitalet was officially inaug-urated in December 2013 as part of the Centre for ClinicalEducation (CEKU) in Copenhagen. The advanced technicalsimulations, which constitute the bulk of the activities, havebeen developed gradually since 2006. CEKU is a research,development, and service provider for the pregraduate andpostgraduate health educations at the University of Copenha-gen and the postgraduate medical training at the CapitalRegion. The mission of CEKU, founded in 1995, was to trainmedical students in basic clinical skills as a preparation fortheir clerkships. The courses included basic procedural skills,resuscitation skills, and patient encounter skills trained usingsimulated patients. Over the years, the repertoire of clinicalskills was widened to include a variety of physical examinationskills, ultrasound skills, resuscitation at various levels, inter-professional skills, and patient communication skills, allcourses tailored to students’ academic years.

Which factors are associated with trainees' confidence in performing obstetric and gynecological ultrasound examinations?

To explore the association between clinical training characteristics and trainees level of confidence in performing ultrasound scans independently.

A structured four‐step curriculum in basic laparoscopy: development and validation

The objective of this study was to develop a four‐step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component.

'In situ simulation' versus 'off site simulation' in obstetric emergencies and their effect on knowledge, safety attitudes, team performance, stress, and motivation: study protocol for a randomized controlled trial

BackgroundUnexpected obstetric emergencies threaten the safety of pregnant women. As emergencies are rare, they are difficult to learn. Therefore, simulation-based medical education (SBME) seems relevant. In non-systematic reviews on SBME, medical simulation has been suggested to be associated with improved learner outcomes. However, many questions on how SBME can be optimized remain unanswered. One unresolved issue is how in situ simulation (ISS) versus off site simulation (OSS) impact learning. ISS means simulation-based training in the actual patient care unit (in other words, the labor room and operating room). OSS means training in facilities away from the actual patient care unit, either at a simulation centre or in hospital rooms that have been set up for this purpose.Methods and designThe objective of this randomized trial is to study the effect of ISS versus OSS on individual learning outcome, safety attitude, motivation, stress, and team performance amongst multi-professional obstetric-anesthesia teams.The trial is a single-centre randomized superiority trial including 100 participants. The inclusion criteria were health-care professionals employed at the department of obstetrics or anesthesia at Rigshospitalet, Copenhagen, who were working on shifts and gave written informed consent. Exclusion criteria were managers with staff responsibilities, and staff who were actively taking part in preparation of the trial. The same obstetric multi-professional training was conducted in the two simulation settings. The experimental group was exposed to training in the ISS setting, and the control group in the OSS setting. The primary outcome is the individual score on a knowledge test. Exploratory outcomes are individual scores on a safety attitudes questionnaire, a stress inventory, salivary cortisol levels, an intrinsic motivation inventory, results from a questionnaire evaluating perceptions of the simulation and suggested changes needed in the organization, a team-based score on video-assessed team performance and on selected clinical performance.DiscussionThe perspective is to provide new knowledge on contextual effects of different simulation settings.Trial registrationClincialTrials.gov NCT01792674.