S. Tierney

Construct validation of a novel hybrid surgical simulator

BackgroundSimulated minimal access surgery has improved recently as both a learning and assessment tool. The construct validation of a novel simulator, ProMis, is described for use by residents in training.MethodsProMis is a surgical simulator that can design tasks in both virtual and actual reality. A pilot group of surgical residents ranging from novice to expert completed three standardized tasks: orientation, dissection, and basic suturing. The tasks were tested for construct validity. Two experienced surgeons examined the recorded tasks in a blinded fashion using an objective structured assessment of technical skills format (OSATS: task-specific checklist and global rating score) as well as metrics delivered by the simulator.ResultsThe findings showed excellent interrater reliability (Cronbach’s α of 0.88 for the checklist and 0.93 for the global rating). The median scores in the experience groups were statistically different in both the global rating and the task-specific checklists (p < 0.05). The scores for the orientation task alone did not reach significance (p = 0.1), suggesting that modification is required before ProMis could be used in isolation as an assessment tool.ConclusionsThe three simulated tasks in combination are construct valid for differentiating experience levels among surgeons in training. This hybrid simulator has potential added benefits of marrying the virtual with actual, and of combining simple box traits and advanced virtual reality simulation.

Anatomical variation at the saphenofemoral junction

This study was designed to document the surgical anatomy of the saphenofemoral junction (SFJ).

Skills transfer after proficiency-based simulation training in superficial femoral artery angioplasty.

Introduction The purpose of this study was to explore whether basic endovascular skills acquired using proficiency-based simulation training in superficial femoral artery (SFA) angioplasty translate to real-world performance. Methods Five international experts were invited to evaluate a preliminary 28-item rating scale for SFA angioplasty using a modified Delphi study. To test the procedural scale, 4 experts and 11 final-year medical students then performed 2 SFA angioplasties each on the vascular intervention simulation trainer simulator. Thereafter, 10 general surgical residents (novices) received didactic training in SFA angioplasty. Trainees were then randomized with 5 trainees receiving further training on the vascular intervention simulation trainer simulator up to proficiency level. All 10 trainees then performed 1 SFA angioplasty on a patient within 5 days of training. The trainees’ performance was assessed by 1 attending consultant blinded to the trainees’ training status, using the developed procedural scale and a global rating scale. Results Four items were eliminated from the procedural scale after the Delphi study. There were significant differences in the procedural scale scores between the experts and the students in the first trial [mean (SD), 94.25 (2.22) vs. 74.90 (8.79), P = 0.001] and the second trial [95.25 (0.50) vs. 76.82 (9.44), P < 0.001]. Simulation-trained trainees scored higher than the controls on the procedural scale [86.8 (5.4) vs. 67.6 (6), P = 0.001] and the global rating scale [37.2 (4.1) vs. 24.4 (5.3), P = 0.003]. Conclusions Basic endovascular skills acquired using proficiency-based simulation training in SFA angioplasty do translate to real-world performance.

Preventing infection in general surgery: improvements through education of surgeons by surgeons

Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.

Role of patient awareness in prevention of peripheral vascular catheter-related bloodstream infection.

Infection • Author(s): Seamus Mark McHugh , MB, BCh, BAO, MRCSI, Mark Anthony Corrigan , MD, MRCSI, Borislav D. Dimitrov , PhD, Margaret Morris‐Downes , PhD, Fidelma Fitzpatrick , MD, Seamus Cowman , MSc, PhD, Sean Tierney , BSc, MCh, FRCSI, Arnold D. K. Hill , MCh, FRCSI, Hilary Humphreys , MD, FRCPI Source: Infection Control and Hospital Epidemiology, Vol. 32, No. 1 (January 2011), pp. 95-96 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/657630 . Accessed: 11/01/2011 10:59

Web-based training to improve knowledge and change practice in preventing healthcare infection

To the Editor—We read with interest the development and assessment of a web-based training program to improve knowledge about central line bloodstream infections. The course included video demonstrations of common errors, and knowledge was assessed using follow-up questionnaires, which showed significant improvements even 3-4 months after the completion of the course. The authors also suggest that those who had completed the training course were significantly more likely to comply with sterile practices. Increasingly, healthcare education is availing of the web with a blended learning approach including e-learning as well as more traditional approaches. In addition, there is increased use by healthcare professionals of handheld devices such as mobile phones, smartphones, and tablets to facilitate access to educational and professional materials. The benefits of eleaming include flexibility in terms of time and place, access to multimedia-rich resources, and the potential for interactions, all of which have been incorporated into the e-learning/ blended learning program used in the National Health Service in the United Kingdom to good effect. We have used 2 modules of this program, adapted for medical student use, to improve the teaching of issues relating to the prevention and control of healthcare-associated infection (HCAI), with demonstrable increases in the knowledge base. However, the educational challenge at the postgraduate level is probably greater, but the potential impact on patient safety is more significant.

Anatomical variation of the saphenofemoral junction may contribute to recurrent varicose veins

ConclusionThe anatomy of the saphenofemoral junction is highly variable. A thorough understanding of these variations is important in ensuring that the junction is both safely and adequately managed in patients with varicose veins. Failure to appreciate these variations may account for a significant proportion of recurrences.