Surgical and non-surgical education practices in female pelvic medicine and reconstructive surgery fellowships within the United States

Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.

Performance in the Fundamentals of Laparoscopic Surgery: Does it reflect global rating scales in the Objective Structured Assessment of Technical Skills in porcine laparoscopic surgery?

Objective:To correlate the utility of the Fundamentals of Laparoscopic Surgery(FLS)manual skills program with the Objective Structured Assessment of Technical Skills(OSATS)global rating scale in evaluating operative performance.Methods:The Asian Urological Surgery Training and Educational Group(AUSTEG)Laparoscopic Upper Tract Surgery Course implemented and validated the FLS program for its usage in laparoscopic surgical training.Delegates’basic laparoscopic skills were assessed using three different training models(peg transfer,precision cutting,and intra-corporeal suturing).They also performed live porcine laparoscopic surgery at the same workshop.Live surgery skills were assessed by blinded faculty using the OSATS rating scale.Results:From March 2016 to March 2019,a total of 81 certified urologists participated in the course,with a median of 5 years of post-residency experience.Although differences in task time did not reach statistical significance,those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks.However,they took longer to complete the precision cutting task than participants with less experience.Overall OSATS scores correlated weakly with all three FLS tasks(peg transfer time:r=0.331,r^(2)=0.110;precision cutting time:r=0.240,r^(2)=0.058;suturing with intracorporeal knot time:r=0.451,r^(2)=0.203).Conclusion:FLS task parameters did not correlate strongly with OSATS globing rating scale performance.Although FLS task models demonstrated strong validity,it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence,as evaluated by FLS and OSATS,respectively.

Exploring the use of virtual reality in surgical education

Virtual reality(VR)technologies have rapidly developed in the past few years.The most common application of the technology,apart from gaming,is for educational purposes.In the field of healthcare,VR technologies have been applied in several areas.Among them is surgical education.With the use of VR,surgical pathways along with the training of surgical skills can be explored safely,in a cost-effective manner.The aim of this mini-review was to explore the use of VR in surgical education and in the 3D reconstruction of internal organs and viable surgical pathways.Finally,based on the outcomes of the included studies,an ecosystem for the implementation of surgical training was proposed.

Current status and future of hepato–pancreatico–biliary surgery fellowship training in China

The medical education system,particularly the fellowship training system,of China has been continuously developing and improving.China established the fellowship training system in 2016,with the period for general surgeons being 3 years.Among the various general surgery subspecialties,hepatopancreatobiliary(HPB)surgery has a specialized training period of approximately 6 months.Ho-wever,owing to the intricate anatomical knowledge and sophisticated surgical skills involved in HPB surgery,training excellent HPB surgeons in such a short period has always been a major challenge in the field of surgical education.This editorial summarizes the current situation,existing problems that need to be implemented for improving HPB fellowship in China.Finally,we hope to build a qualified HPB fellowship system that continually adapts to social development.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

Performance of single versus two operators in laparoscopic surgery

Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic tasks require subjects to reach,grasp and transport a ring through a rollercoaster obstacle using a pair of laparoscopic graspers.The task was performed either bimanually(using both hands)or unimanually(using their preferred hands)in a dyad team.Results:Twelve participants completed all the tasks.The dyad teams recorded significantly greater number of anticipatory movements than individuals who performed the task bimanually(p<0.05).However,there is no significant difference in the task completion time(p=0.701)and the number of errors(p=0.860)recorded between the dyad and the bimanual group.Conclusion:Compared to a single operator,dyad operators performed the task with greater number of anticipatory movements.The increased movement synchronization can help benefit surgical education and team training.

Applying Bruce Lee’s Jeet Kune Do Combat Philosophy in Plastic &Reconstructive Surgery—7 Principles for Success

At first glance, it may appear that martial arts and surgery do not relate to each other at all. However, martial arts and surgery are all one on the path of knowledge and self discovery. Innovations are constantly being developed;some techniques stand the test of time while others are relegated to history. Martial arts and surgery have also branched out for example boxing, taekwondo, jujitsu and wrestling for martial arts whereas surgery has branched out to orthopaedics, paediatrics, cardiothoracic and neurosurgery to name a few. Some choose to specialize while others choose to be a generalist. Learning methodologies in martial arts and plastic surgery are similar. Martial arts students are the equivalent of surgical residents, and both have to enroll in a school that prepares them to be practitioners of their respective arts. In the last century, formal martial arts academies and surgical residency training programs have sprung up. The standards and entrance requirements vary from school to school as do training methodology and philosophical concepts. In this article, we seek to analyze Bruce Lee’s martial arts’ philosophy of Jeet Kune Do (JKD) and that how we can apply it to our personal path in Plastic & Reconstructive Surgery.

A longitudinal surgical systems strengthening research program for medical students:the exploration of a model for global health education

Background:In response to the staggering global burden of conditions requiring emergency and essential surgery,the development of international surgical system strengthening(SSS)is fundamental to achieving universal,timely,quality,and affordable surgical care.Opportunity exists in identifying optimal collaborative processes that both promote global surgery research and SSS,and include medical students.This study explores an education model to engage students in academic global surgery and SSS via institutional support for longitudinal research.Objectives:We set out to design a program to align global health education and longitudinal health systems research by creating an education model to engage medical students in academic global surgery and SSS.Program design and implementation:In 2015,medical schools in the United States and Colombia initiated a collaborative partnership for academic global surgery research and SSS.This included development of two longitudinal academic tracks in global health medical education and academic global surgery,which we differentiated by level of institutional resourcing.Herein is a retrospective evaluation of the first two years of this program by using commonly recognized academic output metrics.Main achievements:In the first two years of the program,there were 76 total applicants to the two longitudinal tracks.Six of the 16(37.5%)accepted students selected global surgery faculty as mentors(Acute Care Surgery faculty participating in SSS with Colombia).These global surgery students subsequently spent 24 total working weeks abroad over the two-year period participating in culminating research experiences in SSS.As a quantitative measure of the program’s success,the students collectively produced a total of twenty scholarly pieces in the form of accepted posters,abstracts,podium presentations,and manuscripts in partnership with Colombian research mentors.Policy implications:The establishment of scholarly global health education and research tracks has afforded our medical students an active role in international SSS through participation in academic global surgery research.We propose that these complementary programs can serve as a model for disseminated education and training of the future global systems-aware surgeon workforce with bidirectional growth in south and north regions with traditionally under-resourced SSS training programs.

Orthopaedic education in the era of surgical simulation: Still at the crawling stage

Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills. Although the need for a simulationbased curriculum in orthopaedic surgery is clear, several obstacles need to be overcome for a smooth transformation. The main issues to be addressed can be summarized as defining the skills and procedures so that simulation-based training will be most effective; choosing the right time period during the course of orthopaedic training for exposure to simulators; the right amount of such exposure; using objective, valid and reliable metrics to measure the impact of simulation-based training on the development and progress of surgical skills; and standardization of the simulation-based curriculum nationwide and internationally. In the new era of surgical education, successful integration of simulation-based surgical skills training into the orthopaedic curriculum will depend on efficacious solutions to these obstacles in moving forward.

Telementoring in education of laparoscopic surgeons: An emerging technology

Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these ad-vanced procedures. We highlight in the review several key emerging technologies such as the telementor-ing and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.

Augmented reality assisted surgery： a urologic training tool

Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.

Simulation training in endoscopic skull base surgery: A scoping review

Objective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning.Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes.The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines,we systematically searched PubMed,Embase,CINAHL,and Cochrane databases.Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references,with 55 studies ultimately meeting inclusion criteria.Of these,19 studies described cadaveric dissection models,17 discussed three-dimensional(3D)printed models,14 examined virtual surgical planning and augmented reality-based models,and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery,including high-fidelity cadaveric,virtual reality,and 3D-printed models.These models are an asset for trainee development and preoperative surgical preparation.

Teaching in the operating room:trends in surgical skills transfer in ophthalmology

Cataract surgery is arguably the most commonly performed operation in ophthalmology.Surgical skills transfer from experienced surgeons to resident surgeons is complicated by the fact that the teaching surgeon primarily acts as an observer rather than directly performing the procedure.Therefore,wet lab and simulator training are utilized to reduce the learning curve of the novice surgeons,which establishes tissue awareness,dexterity and muscle memory required to perform each step of the procedure,safely.Access to a wet lab and simulator environment is accomplished by establishing a surgical training curriculum in residency programs.In the operating room,topical anesthesia is a safe alternative for teaching cataract surgery.There are three well-described approaches to teaching individual steps of cataract surgery:forward,“backwards”,and deconstructed step-by-step instruction.Simulator training can be incorporated prior to live patient experience or integrated concurrently with learner presence in the operating room.The trend towards a competency-based instruction model has necessitated appropriate evaluation tools that include Objective Assessment of Skills in Intraocular Surgery(OASIS),Global Rating Assessment of Skills in Intraocular Surgery(GRASIS),and the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubrics(ICO-OSCAR).We review the literature on trends in surgical teaching in ophthalmology,with the focus on cataract surgery instruction to the novice surgeon.

混合现实技术在口腔颌面部肿瘤诊疗中的应用

口腔颌面部肿瘤是口腔颌面外科的常见疾病,以虚拟手术设计、手术导航为代表的数字化外科技术目前已成为口腔颌面部肿瘤外科诊治的主要辅助手段。然而,现有的数字化技术在三维可视化成像、术中手眼配合等方面仍存在提升空间。目前,以混合现实技术为代表的三维可视化技术已经在医学领域迅速发展和应用,通过将三维虚拟图像叠加到真实的手术环境中,可辅助实现医学影像实时立体呈现,已逐步应用于口腔颌面部肿瘤的诊治中。术前可基于影像数据构建肿瘤及其周边重要结构三维模型,在混合现实环境中,进行个性化术前评估和手术方案设计;术中将混合现实技术与手术导航技术相结合,可以在术区真实环境中实时显示三维虚拟模型,克服单纯使用导航技术的手眼协调问题,进一步提高口腔颌面部肿瘤手术的精确性和安全性。混合现实技术与远程互联网医疗技术相结合,还可以提供高质量的教学平台,推动地区口腔颌面外科诊疗水平的发展。混合现实技术的局限性主要在于术区影像遮挡、单纯使用时精度不足、配准时间长等。笔者结合国内外文献报道以及本课题组的临床实践,对混合现实技术在口腔颌面部肿瘤诊疗中的应用进行归纳与总结。

外科师生对机器人手术教学的态度、兴趣、优势和挑战的调研

目的旨在调研北京协和医院泌尿外科学员(住院医师)和教师(主治及以上医师,简称为上级医师)对于机器人手术教学的看法。方法在教师和学员中开展了包含36个问题的调查问卷,覆盖机器人手术教学的挑战和益处、培训方法、学员的学习准备情况等,比较教师和学员对上述调查问题的问卷结果。结果共有20名住院医师和15名上级医师参与调研。2组医师在实习期间、低年资住院医师培训期间、高年资住院医师培训期间、科室组织的教学课程期间进行机器人手术学习的人数占比差异均有统计学意义(P<0.05)。在6个优劣势比较中,2组医师均认为机器人手术优于腹腔镜手术。在7个优劣势比较中,2组医师均认为机器人手术优于开放手术。更多的住院医师比上级医师倾向于通过机器人模拟平台完成机器人手术教学,差异有统计学意义(95.00%vs60.00%,P<0.05)。住院医师和上级医师对于机器人手术的术中教学的赞同人数比例分别为90.00%和100%。更多的上级医师比住院医师倾向学员先学习在手术台旁协助,然后学习在控制台操作(93.33%vs45.00%),差异有统计学意义(P<0.05)。结论上级医师和住院医师对于如何学习机器人手术有不同看法,了解师生对于机器人手术教学的态度有助于优化机器人手术术中教学方案。

远程健康教育在日间手术患者中的应用研究进展

远程健康教育对于日间手术患者具有重要作用。通过文献回顾,总结国内外远程健康教育在日间手术患者中的应用形式、内容要素与评价要素。远程健康教育在日间手术患者中的应用取得了显著成效,但也存在远程系统不完善、教育内容不规范以及受益人群受限等问题。建议进一步完善远程系统与教育内容,关注远程健康教育在不同患者群体中的应用效果,提高远程健康教育的实施效果等。

小型猪在颞骨解剖及手术培训中的教学应用初探

目的 探索利用小型猪开展颞骨解剖及活体手术培训的方法,提出利用小型猪开展颞骨解剖及手术培训的新思路。方法 对小型猪尸头标本进行系统的颞骨解剖研究,优化解剖方法和流程,评估将其作为颞骨解剖培训标本的可行性。对活体小型猪模拟开展耳外科手术,优化活体手术模拟流程。结果 小型猪中耳、内耳结构与人类相似,其颞骨标本可用于低年资医生颞骨解剖培训,活体小型猪可用于开展中耳、内耳手术培训,为耳外科医生手术培训提供新路径。结论 小型猪可用于颞骨解剖及活体手术培训,在耳外科医生培训中具有教学价值。

基于VR技术的宫颈LEEP锥切术虚拟仿真教学探索

宫颈LEEP手术适用于宫颈上皮内恶性病变的处理,是预防宫颈癌的重要手段。然而,由于隐私等诸多原因,单纯的理论教学使学生很难对该技术的操作有直观的体验,导致对相关疾病的认识不够全面,且本科医学教学又是为学生进一步深造奠基的重中之重。随着医学技术的发展,虚拟现实(virtual reality,VR)技术的重要性逐渐受到许多学者的关注。部分学者认为将VR技术中的一些好的理念应用到实际教学中,能够有效增加学生的理论知识感知能力和实际操作技能。文章通过VR技术实现宫颈LEEP锥切术的仿真教学训练,并进一步结合人工智能纠错模拟沉浸式的医疗环境,根据训练过程发现问题并解决问题,以改进和提升教学效果。

移动医疗时代脊柱微创日间手术模式探索

现代医学在近些年取得了长足的发展,尤其是微创外科技术更是逐渐成为一些腰椎疾病的首选治疗方式。自从解放军总医院开展微创脊柱外科技术结合日间手术模式以来,有效地缓解了患者"看病难、住院难、手术等待时间长"的问题。引入临床路径,做到规范化、程序化,在极大减轻医生工作量的同时提升了工作效率,并且在降低住院天数、减少住院花费、提高患者满意度方面取得了显著的效果。

远程医学在外科和外科教学中的应用

远程医学促进了外科临床以及外科教学的发展,远程医学网络为医学生和医务人员提供了方便快捷的获得医学知识的途径。远程医学能够使得全世界医学院或者医院的学生、医务人员能够参与不同专业领域内的学习和临床实践,进行国内外的学术交流、足不出户就能够参加学术会议,进行医学教育和临床活动。