Evaluation of Procedural Simulation as a Training and Assessment Tool in General Surgery—Simulating a Laparoscopic Appendectomy

2017 ◽  
Vol 74 (2) ◽  
pp. 243-250 ◽  
Author(s):  
Flemming Bjerrum ◽  
Jeanett Strandbygaard ◽  
Susanne Rosthøj ◽  
Teodor Grantcharov ◽  
Bent Ottesen ◽  
...  
Keyword(s):  
Laparoscopic Appendectomy ◽  
General Surgery ◽  
Assessment Tool

scholarly journals Development and clinical implementation of a structured, simulation-based training programme in laparoscopic appendectomy: description, validation and evaluation

2021 ◽  
pp. bmjstel-2020-000728
Author(s):  
Benedicte Skjold-Odegaard ◽  
Hege Langli Ersdal ◽  
Jörg Assmus ◽  
Bjorn Steinar Olden Nedrebo ◽  
Ole Sjo ◽  
...  
Keyword(s):  
Laparoscopic Appendectomy ◽  
General Surgery ◽  
Intraclass Correlation ◽  
Real Life ◽  
Training Programme ◽  
Clinical Implementation ◽  
Self Assessment ◽  
Good Reliability ◽  
Common Procedure ◽  
Simulation Based

BackgroundLaparoscopic appendectomy is a common procedure in general surgery but is likely underused in structured and real-life teaching. This study describes the development, validation and evaluation of implementing a structured training programme for laparoscopic appendectomy.Study designA structured curriculum and simulation-based programme for trainees and trainers was developed. All general surgery trainees and trainers were involved in laparoscopic appendectomies. All trainees and trainers underwent the structured preprocedure training programme before real-life surgery evaluation. A standardised form evaluated eight technical steps (skills) of the procedure as well as an overall assessment, and nine elements of communication (feedback), and was used for bilateral evaluation by each trainee and trainer. A consecutive, observational cohort over a 12-month period was used to gauge real-life implementation.ResultsDuring 277 eligible real-life appendectomies, structured evaluation was performed in 173 (62%) laparoscopic appendectomies, for which 165 forms were completed by 19 trainees. Construct validity was found satisfactory. Inter-rater reliability demonstrated good correlation between trainee and trainer. The trainees’ and trainers’ stepwise and overall assessments of technical skills had an overall good reliability (intraclass correlation coefficient of 0.88). The vast majority (92.2%) of the trainees either agreed or strongly agreed that the training met their expectations.ConclusionStructured training for general surgery residents can be implemented for laparoscopic appendectomy. Skills assessment by trainees and trainers indicated reliable self-assessment. Overall, the trainees were satisfied with the training, including the feedback from the trainers.

scholarly journals Single incision multiport laparoscopic appendectomy using a 2 mm alligator forceps: our experience of 60 cases

2020 ◽  
Vol 7 (8) ◽  
pp. 2714
Author(s):  
Srikant Patro ◽  
Ashish K. Sahoo ◽  
Nikhil Muduli ◽  
Ashish K. Mishra ◽  
Tapan Kumar ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Prospective Study ◽  
Laparoscopic Appendectomy ◽  
General Surgery ◽  
Operative Time ◽  
Single Incision ◽  
Single Incision Laparoscopic Surgery ◽  
Medical College ◽  
Post Operative Pain ◽  
A Prospective Study

Single incision laparoscopic surgery is an emerging branch of minimally assess surgery to reduce scar and post-operative pain. Appendicitis is a common general surgical problem encountered in day to day practice. Different methods of appendectomy have been described by different surgeons from open to laparoscopic and now single incision laparoscopic surgery has been practised. This is a prospective study carried out in our Department of General Surgery SCB Medical College, Cuttack from February 2019 to March 2020; 60 patients had undergone the procedure and the results are published noted under headings of post-operative pain at (6 hours, 12 hours, 24 hours and 48 hours), post-operative requirement of analgesia (diclofenac) at (6 hours, 12 hours, 24 hours and 48 hours), operative time, days to resume bowel activity, days of hospital stay, post-operative complication in accordance to Clavien-Dindo classification.

scholarly journals A Liver Surgery Assessment Tool Identified Predictors of Meaningful Autonomy During Hepatectomy in a Complex General Surgery Oncology Fellowship

2021 ◽  
Vol 233 (5) ◽  
pp. S219
Author(s):  
Megan A. Satyadi ◽  
Benjamin D. Powers ◽  
Samer A. Naffouje ◽  
Jason B. Fleming ◽  
Sean Dineen ◽  
...  
Keyword(s):  
General Surgery ◽  
Liver Surgery ◽  
Assessment Tool

scholarly journals Evaluation the role of laparoscopic management of complicated appendicitis

2020 ◽  
Vol 7 (3) ◽  
pp. 636
Author(s):  
Samir Hosny Mahmoud ◽  
Mahmoud T. Ayoub ◽  
Mohamed B. Kotb ◽  
Mostafa Abdelghafor
Keyword(s):  
Laparoscopic Appendectomy ◽  
General Surgery ◽  
Open Appendectomy ◽  
Clinical Findings ◽  
Complicated Appendicitis ◽  
University Hospitals ◽  
Post Operation ◽  
Perforated Appendix ◽  
Study Population ◽  
Complete Blood Counts

Background: A laparoscopic appendectomy (LA) was performed mostly on uncomplicated appendicitis due to opinions about its safety when it was first introduced. Nevertheless, there are still concerns about surgical difficulties in managing complicated appendicitis with laparoscopy, possible post-op complications and conversion to an open appendectomy (OA) during the surgery.Methods: The study consists of 30 patients who underwent laparoscopic appendectomy in department of General Surgery at Assiut University hospitals. The study population was enrolled after fulfilling the selection criteria from department of General Surgery. Informed consent was taken from all the patients who are involved in this study. Patients diagnosis was based on clinical findings, complete blood counts, and abdominal sonography.Results: Thirty patients underwent laparoscopic appendectomy for complicated appendicitis. Of the 30 patients, perforated appendix cases are 27, gangrenous appendix are 1, appendicular abscess only one case. Post operation wound infection, conversion rate and hospital stay rate very less.Conclusions: The present study proved that laparoscopic appendectomy is the best approach in complicated appendicitis.

scholarly journals Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

2021 ◽  
Author(s):  
Benedicte Skjold-Ødegaard ◽  
Hege Langli Ersdal ◽  
Jörg Assmus ◽  
Kjetil Soreide
Keyword(s):  
Gender Bias ◽  
Surgical Training ◽  
Laparoscopic Appendectomy ◽  
General Surgery ◽  
Intraclass Correlation ◽  
Faculty Evaluation ◽  
Real Life ◽  
Surgical Residents ◽  
Gender Based ◽  
Surgery Resident

Abstract Background Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in ‘entry-level’ real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery. Methods A structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model. Results A total of 165 paired sessions were completed to evaluate resident–faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female–female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty. Conclusions This study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.

scholarly journals Construction and validation of a surgical skills assessment tool for general surgery residency program

2015 ◽  
Vol 42 (6) ◽  
pp. 407-412 ◽  
Author(s):  
Elizabeth Gomes dos Santos ◽  
Gil Fernando da Costa Mendes de Salles
Keyword(s):  
Skill Acquisition ◽  
General Surgery ◽  
Assessment Tool ◽  
Surgical Skills ◽  
Skills Assessment ◽  
Evaluation Instrument ◽  
Survey Tool ◽  
General Surgery Residency ◽  
The Face ◽  
Surgery Residency Program

Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r)) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.

scholarly journals Introduction of Mini-clinical Evaluation Exercise for the Formative Assessment of Postgraduates in the General Surgery Discipline

2020 ◽  
Author(s):  
Kailash Charokar ◽  
Anil Kapoor
Keyword(s):  
Formative Assessment ◽  
Clinical Evaluation ◽  
General Surgery ◽  
Assessment Tool ◽  
Clinical Skills ◽  
Statistical Significance ◽  
P Value ◽  
Global Rating ◽  
Feedback Questionnaire ◽  
One Year

Introduction: The common practice prevalent in most of the Postgraduate (PG) teaching institutes is that while the PGs are clinically evaluating the patients for the traditional long case, they are mostly not directly observed by the faculty. The presentation of the case by PGs is the main focus of assessment. Workplace Based Assessment (WPBA) tools assess the clinical competence of students at the ‘does’ level of Miller’s pyramid, while they perform in a real setting. Aim: To assess the feasibility, acceptability and effectiveness of Mini-Clinical Evaluation Exercises (Mini-CEX) for the PGs in Surgery. Materials and Methods: This educational intervention study was conducted in the General Surgery Department, over a period of one year. Sixteen PGs of 1st, 2nd, and 3rd-year residency participated in the study, and 13 faculty as assessors. The Mini-CEX was conducted and the abim.org proforma was used to record the observations by the faculty. The perceptions of the PGs and faculty were obtained at the end of the study using a predesigned validated feedback questionnaire. The change in the level of acquisition of clinical skills of the PGs was evaluated using the group mean, median and rank. The Friedman test was applied to calculate the statistical significance at p<0.05 using Statistical Package for the Social Sciences (SPSS) version 20. Results: A total of 124 Mini-CEX encounters were conducted over a period of one year. The mean satisfaction score for the Mini-CEX encounters was 7.3±0.88 and 6±0.89 on the global rating (0-9) among the PGs and faculty respectively. While 14 PGs (87.5%) accepted that Mini-CEX was easy to conduct as compared to the traditional long case. Ten faculty (76.5%) accepted that it was feasible to conduct with the prevailing professional workload. Twelve PGs perceived that Mini-CEX was an effective tool for improving clinical skills. Statistically significant (p-value <0.05) improvement was found in the competencies of medical interviewing, physical examination, counseling skills, and professionalism. Conclusion: Mini-CEX was acceptable to the PGs and faculty. It was found to be an effective and formative assessment tool for learning clinical skills in a supportive workplace-based environment for clinical skills improvements

Age Norms for Auditory-Perceptual Neurophonetic Parameters: A Prerequisite for the Assessment of Childhood Dysarthria

2020 ◽  
Vol 63 (4) ◽  
pp. 1071-1082
Author(s):  
Theresa Schölderle ◽  
Elisabet Haas ◽  
Wolfram Ziegler
Keyword(s):  
Assessment Tool ◽  
Developmental Trajectories ◽  
Voice Quality ◽  
Typically Developing ◽  
Typically Developing Children ◽  
Age Norms ◽  
Elementary School Age ◽  
Speech Characteristics ◽  
Substantial Progress ◽  
Computer Based

Purpose The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment. Method One hundred forty-four typically developing children (3;0–9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria. Results The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds. Conclusions The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic–physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age. Supplemental Material https://doi.org/10.23641/asha.12133380

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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