Training to proficiency in surgery using simulation: is there a moral obligation?

2022 ◽  
pp. medethics-2021-107678
Author(s):  
Conor Toale ◽  
Marie Morris ◽  
Dara O Kavanagh
Keyword(s):  
Learning Curve ◽  
New Technology ◽  
Training Paradigm ◽  
Surgical Ethics ◽  
Surgical Trainees ◽  
Simulation Based ◽  
Predetermined Level ◽  
Trainee Surgeon ◽  
The Right ◽  
To Receive

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

scholarly journals Learning curve of trainees performing laparoscopic appendectomy- a register-based study

2021 ◽  
Author(s):  
Nathalie Young ◽  
Lennart Boström ◽  
Gabriel Sandblom ◽  
Hans Järnbert Pettersson
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Moving Average ◽  
Operation Time ◽  
Patient Characteristics ◽  
First Year ◽  
Complication Rates ◽  
Surgical Trainees ◽  
Trainee Surgeon ◽  
Training Programmes

Abstract Background Appendectomy is one of the first procedures that surgical trainees are expected to manage alone. The purpose of this study was to analyse the learning curve of a cohort of surgical trainees and to explore the association between trainee surgeon volume and complication rate. Method The study was based on a cohort extracted from the local appendectomy register at Södersjukhuset (transl. South Hospital), Stockholm. The register includes patient characteristics, surgical method, operation time, and 30-day complications. First-year surgical trainees attending the hospital’s trainee programme were included and followed over five years of training. Trainees who had performed less than ten procedures during the period of the study were excluded. The learning curve was described using moving average of order ten for each trainee, studying the trend in operation time with increasing volume. The cumulative sum technique was used to chart changes in complication rates of the trainees. Results 586 procedures performed by 9 surgical trainees were included, of which 97.6% were performed laparoscopically. A plateau in operation time on the learning curve was reached at 60 procedures. For three of the trainees, the 30-day complication rate decreased after completing the learning curve, whereas for two others it increased. In a multivariate analysis, operation times differed more between the trainees than it did between procedures performed early or late in the programme. Shortest versus longest mean operation time (41 min versus 89 min). Conclusion At least 60 procedures are required to reach sufficient proficiency in appendectomy. This highlights the importance of meticulous selection of surgical trainees, structure of training programmes, feedback, and assessment.

DMSA-scintigraphy in paediatrics: Is the evaluation of the geometric mean necessary for the calculation of the differential renal function?

2001 ◽  
Vol 40 (04) ◽  
pp. 107-110 ◽  
Author(s):  
B. Roßmüller ◽  
S. Alalp ◽  
S. Fischer ◽  
S. Dresel ◽  
K. Hahn ◽  
...  
Keyword(s):  
Renal Function ◽  
Geometric Mean ◽  
Region Of Interest ◽  
Posterior View ◽  
Renal Abnormality ◽  
Anterior View ◽  
Differential Renal Function ◽  
The Mean ◽  
The Right ◽  
To Receive

SummaryFor assessment of differential renal function (PF) by means of static renal scintigraphy with Tc-99m-dimer-captosuccinic acid (DMSA) the calculation of the geometric mean of counts from the anterior and posterior view is recommended. Aim of this retrospective study was to find out, if the anterior view is necessary to receive an accurate differential renal function by calculating the geometric mean compared to calculating PF using the counts of the posterior view only. Methods: 164 DMSA-scans of 151 children (86 f, 65 m) aged 16 d to 16 a (4.7 ± 3.9 a) were reviewed. The scans were performed using a dual head gamma camera (Picker Prism 2000 XP, low energy ultra high resolution collimator, matrix 256 x 256,300 kcts/view, Zoom: 1.6-2.0). Background corrected values from both kidneys anterior and posterior were obtained. Using region of interest technique PF was calculated using the counts of the dorsal view and compared with the calculated geometric mean [SQR(Ctsdors x Ctsventr]. Results: The differential function of the right kidney was significantly less when compared to the calculation of the geometric mean (p<0.01). The mean difference between the PFgeom and the PFdors was 1.5 ± 1.4%. A difference > 5% (5.0-9.5%) was obtained in only 6/164 scans (3.7%). Three of 6 patients presented with an underestimated PFdors due to dystopic kidneys on the left side in 2 patients and on the right side in one patient. The other 3 patients with a difference >5% did not show any renal abnormality. Conclusion: The calculation of the PF from the posterior view only will give an underestimated value of the right kidney compared to the calculation of the geometric mean. This effect is not relevant for the calculation of the differntial renal function in orthotopic kidneys, so that in these cases the anterior view is not necesssary. However, geometric mean calculation to obtain reliable values for differential renal function should be applied in cases with an obvious anatomical abnormality.

PROBLEM ASPECTS OF THE IMPLEMENTATION OF CRIMINAL PROCEDURAL NORMS OF PROTECTION OF THE VICTIMS FROM CRIME

2020 ◽  
pp. 72-76
Author(s):  
Яна Валерьевна Самиулина
Keyword(s):  
Preventive Measure ◽  
Criminal Procedure ◽  
Legal Rights ◽  
Criminal Proceedings ◽  
Effective Mechanism ◽  
The Russian Federation ◽  
The Individual ◽  
The Right ◽  
To Receive ◽  
Selection Of

В настоящей статье предпринята попытка исследовать отдельные проблемные аспекты института потерпевшего в российском уголовном процессе. В этих целях подвергнуты анализу правовые нормы, регламентирующие его процессуальный статус. Раскрываются отдельные пробелы уголовно-процессуального законодательства в сфере защиты законных прав и интересов потерпевшего. Автор акцентирует внимание на том, что совершенствование уголовно-процессуального законодательства в части расширения правомочий потерпевшего по отстаиванию своих нарушенных преступлением прав следует продолжить. На основании проведенного исследования действующего законодательства в части регламентации прав потерпевшего от преступления предлагается расширить перечень получаемых им копий постановлений, указанных в п. 13 ч. 2 ст. 42 УПК РФ. Автор предлагает включить в перечень указанной законодательной нормы право получения потерпевшим копии постановления об избрании конкретного вида меры пресечения, избранного в отношении подозреваемого (обвиняемого). Для создания действенного механизма защиты интересов потерпевших от преступления юридических лиц предлагаем ч. 9 ст. 42 УПК РФ изложить в следующей редакции: «в случае признания потерпевшим юридического лица его процессуальное право в уголовном процессе осуществляет представляющий его профессиональный адвокат». This article attempts to investigate certain problematic aspects of the institution of the victim in the Russian criminal process. For this purpose, analyzed the individual norms governing his procedural status. Separate gaps of the criminal procedure legislation in the sphere of protection of the legal rights and interests of the victim are disclosed. The author emphasizes that the improvement of the criminal procedure legislation in terms of the extension of the victim’s authority to defend his rights violated by the crime should be continued. On the basis of the study of the current legislation regarding the regulation of the rights of the victim of a crime, it is proposed to expand the list of decisions received by him, referred to in paragraph 13, part 2 of article 42 Code of Criminal Procedure. The author proposes to include in the list of the indicated legislative norm the right to receive the victim a copy of the decision on the selection of a specific type of preventive measure, selected in relation to the suspect (accused). To create an effective mechanism for protecting the interests of legal entities victims of a crime, we offer part 9 of art. 42 of the Code of Criminal Procedure of the Russian Federation shall be reworded as follows: «if a legal entity is recognized as a victim, his procedural right in criminal proceedings is exercised by the professional lawyer representing him».

Safe Use of the Assimilative Capacity of the Marine Environment for Waste Disposal – Is It Feasible?

1986 ◽  
Vol 18 (4-5) ◽  
pp. 233-244 ◽  
Author(s):  
J. E. Portmann ◽  
R. Lloyd
Keyword(s):  
Marine Environment ◽  
Salt Marshes ◽  
Safety Margin ◽  
Assimilative Capacity ◽  
Anthropogenic Inputs ◽  
Upper Limit ◽  
Safe Limits ◽  
Control Authority ◽  
The Right ◽  
To Receive

For centuries the sea has absorbed a variety of inputs from rivers, streams, salt marshes and the atmosphere. It is generally accepted that additional limited inputs by man are unlikely to have a significant effect on the marine environment. Various control systems have been constructed to provide a framework within which the regulation of anthropogenic inputs can be achieved. These are briefly reviewed. With care, and in the light of past experience in both freshwater and marine environments, reasonable assumptions or estimations can be applied where uncertainties exist; safe limits can therefore be set for discharges. Case histories are used to illustrate the contention that it is possible to assess the assimilative capacity of a marine area to receive wastes. There is a major distinction to be drawn between contamination and pollution of the marine environment. Moreover, acknowledgement of the assimilative capacity concept in the marine environment does not automatically provide dischargers with the right to utilise that capacity either in part or to the upper limit. What it does is indicate the upper limit which must not be exceeded if pollution is to be avoided, and provide an indication to the control authority of the safety margin involved in the discharge limits they set accordingly.

scholarly journals 845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S A Joiya ◽  
M Hamid ◽  
Z Siddiqui
Keyword(s):  
Learning Curve ◽  
Skill Acquisition ◽  
Postoperative Recovery ◽  
Task Completion ◽  
Complication Rates ◽  
Novice Group ◽  
Surgical Trainees ◽  
Long Duration ◽  
Hospital Stays ◽  
Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

FREE EXPRESSION OR EQUAL SPEECH?

2020 ◽  
Vol 37 (2) ◽  
pp. 153-169
Author(s):  
Teresa M. Bejan
Keyword(s):  
Freedom Of Expression ◽  
Free Expression ◽  
Freedom Of Association ◽  
Classical Liberal ◽  
Freedom Of Thought ◽  
The Right ◽  
Equal Right ◽  
To Receive ◽  
The Ideal

AbstractThe classical liberal doctrine of free expression asserts the priority of speech as an extension of the freedom of thought. Yet its critics argue that freedom of expression, itself, demands the suppression of the so-called “silencing speech” of racists, sexists, and so on, as a threat to the equal expressive rights of others. This essay argues that the claim to free expression must be distinguished from claims to equal speech. The former asserts an equal right to express one’s thoughts without interference; the latter the right to address others, and to receive a hearing and consideration from them, in turn. I explore the theory of equal speech in light of the ancient Athenian practice of isegoria and argue that the equality demanded is not distributive but relational: an equal speaker’s voice should be counted as “on a par” with others. This ideal better captures critics’ concerns about silencing speech than do their appeals to free expression. Insofar as epistemic and status-harms provide grounds for the suppression and exclusion of some speech and speakers, the ideal of equal speech is more closely connected with the freedom of association than of thought. Noticing this draws attention to the continuing—and potentially problematic—importance of exclusion in constituting effective sites of equal speech today.

Nikaidoh Procedure: The Wet Lab Trainee’s Perspective

2021 ◽  
Vol 12 (1) ◽  
pp. 124-127
Author(s):  
César Castillo Romero ◽  
Gabriella Ricciardi
Keyword(s):  
Learning Curve ◽  
Congenital Heart ◽  
Surgical Skill ◽  
Computer Screen ◽  
Simulation Based ◽  
Wet Lab ◽  
Congenital Surgery

Congenital heart surgeons’ training is complex and challenging. The learning curve is long and the increasing complexity of pathologies is demanding. In order to develop adequate surgical-skill competencies, “in vivo” and simulation-based practicing are paramount. Simulation can be performed either on a computer screen or animal hearts and prosthetic models. In this article, we illustrate a porcine Wet Lab simulation for the Nikaidoh operation to point out its potential advantage to learn complex congenital surgery procedures.

scholarly journals Using Imagination to Overcome Fear: How Mental Simulation Nudges Consumers’ Purchase Intentions for Upcycled Food

2021 ◽  
Vol 13 (3) ◽  
pp. 1130
Author(s):  
Xiaoke Yang ◽  
Yuanhao Huang ◽  
Xiaoying Cai ◽  
Yijing Song ◽  
Hui Jiang ◽  
...  
Keyword(s):  
Environmental Sustainability ◽  
New Technology ◽  
Product Evaluation ◽  
Mental Simulation ◽  
Purchase Intentions ◽  
Control Group ◽  
Human Beings ◽  
Simulation Based ◽  
Simulation Group ◽  
Future Self

Upcycled food, a new kind of food, provides an effective solution to reduce the food waste from the source on the premise of food security for human beings. However, the commercial success of upcycled food and its contribution to environmental sustainability are determined by consumers’ purchase intentions. In order to overcome consumers’ unfamiliarity with upcycled food and fear of new technology, based on the cue utility theory, we adopted scenario simulation through online questionnaires in three experiments to explore how mental simulation can improve consumers’ product evaluation and purchase intentions for upcycled food. Through ANOVA, the t-test, and the Bootstrap methods, the results showed that, compared with the control group, consumers’ product evaluation and purchase intentions for upcycled food in the mental simulation group significantly increased. Among them, consumers’ inspiration played a mediation role. The consumers’ future self-continuity could moderate the effect of mental simulation on consumers’ purchase intentions for upcycled food. The higher the consumers’ future self-continuity, the stronger the effect of mental simulation. Based on the above results, in the marketing promotion of upcycled food, promotional methods, such as slogans and posters, could be used to stimulate consumers, especially the mental simulation thinking mode of consumer groups with high future self-continuity, thus improving consumers’ purchase intentions for upcycled food.

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