scholarly journals Acquiring Advanced Laparoscopic Colectomy Skills – The Issues

2020 ◽  
Vol 27 (5) ◽  
pp. 24-35
Author(s):  
Hizami Amin-Tai ◽  
Abdel Latif Khalifa Elnaim ◽  
Michael Pak Kai Wong ◽  
Ismail Sagap
Keyword(s):  
Learning Curve ◽  
Laparoscopic Colectomy ◽  
Enhanced Recovery ◽  
Training Programme ◽  
Minimal Invasive ◽  
Learning Curves ◽  
Training Systems ◽  
Video Recordings ◽  
And Performance ◽  
National Training

Colorectal surgery has been revolutionised towards minimally invasive surgery with the emergence of enhanced recovery protocol after surgery initiatives. However, laparoscopic colectomy has yet to be widely adopted, due mainly to the steep learning curve. We aim to review and discuss the methods of overcoming these learning curves by accelerating the competency level of the trainees without compromising patient safety. To provide this mini review, we assessed 70 articles in PubMed that were found through a search comprised the keywords laparoscopic colectomy, minimal invasive colectomy, learning curve and surgical education. We found England’s Laparoscopic Colorectal National Training Programme (LAPCO-NTP) England to be by far the most structured programme established for colorectal surgeons, which involves preclinical and clinical phases that end with an assessment. For budding colorectal trainees, learning may be accelerated by simulator-based training to achieve laparoscopic dexterity coupled with an in-theatre proctorship by field experts. Task-specific checklists and video recordings are essential adjuncts to gauge progress and performance. As competency is established, careful case selections with the proctor are essential to maintain motivation and ensure safe performances. A structured programme to establish competency is vital to help both the proctor and trainee gauge real-time progress and performance. However, training systems both inside and outside the operating theatre (OT) are equally useful to achieve the desired performance.

Application Research of Personal Learning Curve in Staff Skill Testing

2012 ◽  
Vol 433-440 ◽  
pp. 3200-3205
Author(s):  
Yan Wei Du ◽  
Xian Long Xu
Keyword(s):  
Learning Curve ◽  
Operation Time ◽  
Working Hours ◽  
Scientific Basis ◽  
Learning Curves ◽  
Learning Ability ◽  
Forming Process ◽  
Personal Learning ◽  
And Performance ◽  
Definition Of

According to the characteristics of many varieties small batch production, the assembly workers with operating accurate, coordination and strong learning ability are needed in a manual assembly line. Some scientific operating skills test is used to evaluate staff in recruitment, working hours formulate and performance evaluation. The origins and definition of learning curve were introduced. The characteristics of operation skills were analyzed. The mirror painting instrument was used to test the learning ability of workers for new operation skills. Workers were asked to face the graphics within the mirror, and to depict the graphics using the testing pen. The mistake number and the operation time were recorded. Learning curves were drawn out. Everyone worker movement skills forming process was analyzed on the basis of the above data. The test process and analyze conclusion provide the scientific basis and the decision support for the enterprises.

scholarly journals Evaluation of Holmium Laser Enucleation of the Prostate Learning Curves with and without a Structured Training Programme

2020 ◽  
Vol 14 (4) ◽  
pp. 191-199
Author(s):  
Thilo Westhofen ◽  
Philipp Weinhold ◽  
Maurice Kolb ◽  
Christian G. Stief ◽  
Giuseppe Magistro
Keyword(s):  
Adverse Events ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Operation Time ◽  
Training Programme ◽  
Learning Curves ◽  
Holmium Laser ◽  
Urinary Flow ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

<b><i>Background/Aims: </i></b>To evaluate perioperative parameters, early functional outcomes, and the safety profile of holmium laser enucleation of the prostate learning curves with and without mentoring. <b><i>Methods: </i></b>The learning curves of 2 surgeons of their first 100 consecutive patients treated with holmium laser enucleation of the prostate were retrospectively analyzed. We analyzed demographic parameters, clinical outcomes, adverse events, and the progress during each learning experience. <b><i>Results:</i></b> The only statistically significant differences between the two learning curves were found for operation time (138.2 ± 60.7 vs. 98.2 ± 37.7 min; p < 0.001) in favor of the supervised approach, the total weight of resected prostatic tissue (81.5 ± 50.5 vs. 65.0 ± 6.7 g; p < 0.001) with more tissue removal by the surgeon without guidance, and the perioperative hemoglobin drop (1.9 ± 1.4 vs. 1.1 ± 1.0 g/dl; p < 0.001) in favor of the learning curve with a training programme. In multivariate logistic regression, the time factor was independently associated with a higher drop in hemoglobin levels (OR 1.015; 95% CI 1.000-1.023; p = 0.001). The improvements of clinical outcomes as determined by International Prostate Symptom Score, quality of life, peak urinary flow rate and postvoid residual volume were comparable. After the first 50 procedures the mean operation time significantly improved from 147 to 107.5 minutes for the learning curve without supervision (p < 0.001), whereas the surgical time was consistent throughout the 100 cases with a mentoring programme. The overall incidence of treatment-related adverse events was significantly higher without the training programme (16 vs. 5%; p = 0.008). <b><i>Conclusions: </i></b>Our study clearly showed the benefits of a structured training programme to overcome the steep learning curve.

scholarly journals Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula

2021 ◽  
Author(s):  
Karsten Arthur van Loon ◽  
Linda Helena Anna Bonnie ◽  
Nynke van Dijk ◽  
Fedde Scheele
Keyword(s):  
At Risk ◽  
Postgraduate Medical Education ◽  
Training Programme ◽  
Workplace Environment ◽  
Medical Specialists ◽  
Professional Activities ◽  
National Training ◽  
Local Medical Care

Abstract Introduction Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. Method For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Results An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme. Discussion Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.

scholarly journals LEARNING CURVE IN SINGLE-LEVEL MINIMALLY INVASIVE TLIF: EXPERIENCE OF A NEUROSURGEON

2017 ◽  
Vol 16 (4) ◽  
pp. 279-282 ◽  
Author(s):  
Samuel Romano-Feinholz ◽  
Sergio Soriano-Solís ◽  
Julio César Zúñiga-Rivera ◽  
Carlos Francisco Gutiérrez-Partida ◽  
Manuel Rodríguez-García ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Learning Curves ◽  
Surgical Experience ◽  
Surgical Time ◽  
Intraoperative Bleeding ◽  
Single Level ◽  
Piecewise Regression ◽  
The Mean

ABSTRACT Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.

scholarly journals Lapco: national training programme for laparoscopic colorectal surgery

2009 ◽  
Vol 91 (8) ◽  
pp. 274-275 ◽  
Author(s):  
Mark Coleman
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Resection ◽  
Laparoscopic Colorectal Surgery ◽  
Clinical Excellence ◽  
Training Programme ◽  
Open Resection ◽  
Department Of Health ◽  
Action Team ◽  
Colorectal Surgeons ◽  
National Training

In 2006 the National Institute for Health and Clinical Excellence issued guidance that laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable. Due to the lack of trained colorectal surgeons a waiver was issued, which is due to be reviewed in September 2009. In 2007 the Cancer Action Team (CAT) at the Department of Health (DH) instituted the national training programme (NTP) for laparoscopic colorectal surgery (LCS) for colorectal consultants in England. The intention is to provide all suitable patients with bowel cancer in need of resection, access to a trained surgeon for laparoscopic resection. The programme is funded by the CAT.

Research on the Potential of Resource Saving and Emission Reducing in Anhui Province: Based on Environment Learning Curve

2011 ◽  
Vol 361-363 ◽  
pp. 1000-1004
Author(s):  
Qi Li
Keyword(s):  
Energy Consumption ◽  
Learning Curve ◽  
Water Consumption ◽  
Exponential Model ◽  
Learning Curves ◽  
Anhui Province ◽  
Resource Saving ◽  
Environmental Learning ◽  
Discharge Water ◽  
Resource And Environment

Based on the statistics data from 1990 to 2008 in Anhui province, this article selects four indexes which include energy consumption, SO2 discharge, water consumption and COD discharge per ten thousand yuan GDP, and establishes environment learning curves of energy consumption and air pollution, water consumption and pollution in Anhui province. According to these models, the potentials of resources saving and pollution reducing in different periods are calculated and analyzed, represented by the decrease of each index when the per capita GDP increase 1000 yuan. The result shows that: (1) With the growth of GDP per capital, each index falls by power exponential model which follows "environmental learning curve", illustrating that the burden of resource and environment was steady declining. (2) The potentials of saving energy resources and reducing pollution in Anhui province gradually descents from 1990 to 2008, illustrating that the reduction in marginal cost by the development of technology is becoming smaller and smaller, and the enhancement of resource using efficiency and pollution reducing efficiency is not unlimited.

scholarly journals REGIONAL TECHNOLOGICAL LEARNING IN TURKISH CEMENT INDUSTRY

2020 ◽  
Vol 8 (4) ◽  
pp. 204-216
Author(s):  
Gurkan Calmasur ◽  
◽  
Meryem Emre Aysin ◽  
Keyword(s):  
Learning Curve ◽  
Linear Models ◽  
Raw Materials ◽  
Analysis Data ◽  
Vital Role ◽  
Learning Curves ◽  
Cement Industry ◽  
Company Performance ◽  
Technological Learning ◽  
The Impact

The learning curve reflects the reduction in average costs as the company's cumulative production increases. These curves are utilized when measuring company performance, managing production processes, and planning. In terms of cost reduction and profitability, the impact of learning is particularly important. The learning curves have been traditionally used in industries. In this study, the learning curves concerning the cement industry are examined. The cement sector inherits a high export potential in Turkey. Additionally, it is the industry branch that supplies the raw materials needed by countries' construction industries. On the other hand, the construction sector is a leading sector that mobilizes other markets. This sector is a major contributor to production, investment, and employment and plays a vital role in the development of the country. This paper aims to make a detailed analysis of the learning curves regarding the Turkish cement industry at the regional level covering the 2000-2018 period. In order to realize this aim, the linear and cubic learning models have been applied and the technological learning values for regions from 2000 to 2018 have been calculated. For the analysis, data of 68 factories operating in the Turkish cement industry obtained from Turkey Cement Manufacturers' Association have been used. The estimated results suggest that cubic models explain technological learning better than the linear models. The results indicated that learning levels differed across regions and times. While the highest learning level was observed in 2004, the highest level of forgetting was recorded in 2018. Finally, we can state that the learning curve of the Turkish cement industry between 2000 and 2018 is convex.

scholarly journals The Effects of a Running Consistency Programme on Footfall Variability and Performance in the Long Jump

2016 ◽  
Vol 23 (3) ◽  
pp. 145-152
Author(s):  
Marcin Starzak ◽  
Hubert Makaruk ◽  
Anna Starzak
Keyword(s):  
Training Programme ◽  
Control Group ◽  
Education Students ◽  
Acceleration Phase ◽  
Physical Education Students ◽  
Step Velocity ◽  
Post Test ◽  
Long Jump ◽  
And Performance ◽  
Experimental Group

Abstract Introduction. The main purpose of this study was to evaluate the effect of a training programme aimed to enhance toe-toboard consistency on footfall variability and performance in the long jump. Material and methods. The study involved 36 male physical education students. The experimental group participated in a 12-week training programme, whereas the control group was limited to taking part in the classes held at university. All participants performed 6 long jump trials during two testing sessions. The kinematic parameters were assessed using the Optojump Next device and were further analysed to determine the variability of footfall placement during the approach run. Results. The analysis revealed a significant (p < 0.01) decrease in footfall variability in the experimental group between the pre-test and post-test. After the completion of the training programme, the participants significantly (p < 0.05) improved their take-off accuracy. Additionally, they significantly (p < 0.05) increased their velocity in the last five steps before take-off and the effective distance of the jump (p < 0.001). Conclusions. The results of this study indicate that through specific training, it is possible to improve the consistency of the steps in the acceleration phase of the approach run in the long jump. Moreover, decreasing footfall variability helps achieve a more stable step pattern which may be beneficial for greater accuracy at the take-off board and makes it possible to increase step velocity at the final stage of the approach run.

scholarly journals Learning curve in rat dissection for experimental sciatic nerve repair

2019 ◽  
pp. 243-248
Author(s):  
Marin Andrei ◽  
Marin Georgiana Gabriela ◽  
Dobrete Nicoleta Amalia ◽  
Enescu Dan Mircea
Keyword(s):  
Sciatic Nerve ◽  
Learning Curve ◽  
Nerve Regeneration ◽  
Experimental Model ◽  
Rat Model ◽  
Surgical Intervention ◽  
Nerve Repair ◽  
Learning Curves ◽  
Rat Sciatic Nerve ◽  
Nerve Surgery

The baseline for any key research in nerve regeneration is an experimental model and the sciatic nerve in the rat model is the workhorse in this field. Although physically resistant to external traumas, a surgical intervention constitutes a major distress even for a rat. In the following presentation, we will analyse the learning curves for different stages in the rat sciatic nerve surgery as well as possible factors which influence these times.

Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

2021 ◽  
pp. 019262332110679
Author(s):  
Yuval Ramot ◽  
Serge Rousselle ◽  
Michal Steiner ◽  
Yossi Lavie ◽  
Nati Ezov ◽  
...  
Keyword(s):  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Experimental Conditions ◽  
Single Action ◽  
Treatment Groups ◽  
Novel Device ◽  
Fibrotic Scar ◽  
And Performance ◽  
Tissue Approximation

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

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