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Surgical Training - Science topic

Research and techniques
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Minimally invasive surgery technique has taken the central role in modern surgery specially in abdominal surgery. So, every surgeons need to get trained into the field of minimally invasive surgery.
Training by using simulation technology (with virtual reality) allows the surgeon to learn or improve their laparoscopic surgical skills in a safe and stress free environment.
Various simulation training sets ( you know, they are different from conventional "endotrainer", as they contains computerized system which visually mimic and imitate operative response of an organ/part like whole Gall bladder+CBD+ structures of calot's triangle+ liver bed.... everything as seen during lap cholecystectomy ) are available in the market for hands on training in laparoscopic and robotic surgery.Quality of some of the machines, specially one with 3D technology, is really good.They give near real views with operative response of that particular abdominal parts and even a very realistic view of the operation theater as well.
But the simulation sets are not widely available in all the institutes.
I invite all learned surgeons to share their views on simulation techniques as a methods of laparoscopic surgical training and inputs about the cost and names of the companies that supply them.
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Beyond doubt. Lot of evidence supports the role of sinulation in improving laparoscopic skills.
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According to Dawson and colleagues (2007), some surgical faculty identified some shortcoming of knowledge and skills. Example of these include the choice of catheter, balloon , and stent size. Adequate placing of the sheath was also identified as an issue in training residents.
What do vascular surgical residents struggle most with in their surgical education and training? Do vascular surgical residents and attendings believe that their medical education should be changed from the current standards?
Dawson and colleagues (2007)
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In the past 15 years or so, there has been exponential growth of technology in surgery. This new era requires a specialized workforce. The 20th century was truly the age of surgeons; however, the 21st century will be the age of multidisciplinary patient care. One good example is the treatment of cancer patients
Are General Surgery trained personnel perform better in other specialties too?
How are their performance on other surgical specialties?
Any evidence to suggest their skill transferability to other disciplines?
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Dear Dr Sunny Chu Lik Au:
Thank for raising this important question. There is a dilemma of general or subspecialty. Subspecialty is important in developing the management of cases but in the same time it created a pinhole vision of the physicians and no one is looking to the patient as one unit and look to the overall need. Each subspecialty want to put the optimum for his work regardless of the overall need of the patient or his stage need.
I support my colleagues in the importance of training in general surgery for every other surgical specialty. I suggest 1 year as minimum time spend in general surgery if not making degree in general surgery as requirement for doing subspecialty study.
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At least one semester has passed since the Covid-9 pandemia appeared worldwide. Many residency programs have stopped or reduced significantly their clinical and surgical training activities due to the known risks of exposure and contagion with SARS-CoV-2 virus. What has happened and what is going to happen to specialties medical education?
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Virtual patient technology can not replace real life interactions with patients but it does offer advantage in form of constructivist theory where arranging information can facilitate learning with added advantage of avoiding errors
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Various models like Apprenticeship model, BID model, Koen's Model, One Minute Preceptor (OMP), 4C/ID model etc have been previously utilized for surgical resident's training. Dynamics of student learning and resident learning, however, in operating room are significantly different. Which models of learning are appropriate for medical student's learning in Operating Room and why?
We are trying to establish the role of structured learning process of a medical graduate in Operating Room (OR) setting and trying to analyze the potential role of various models being currently used for surgical resident training in OR-based learning of a medical student.
You can also record your response in this survey below:
This can take your time but eventually it would be productive one.
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In today's era of sub specialisation in all surgical Fields specially orthopaedics, hands on surgical training in specialty of choice is a must. Considering the steep learning curve for most technically demanding surgeries, are cadaveric courses helpful for the young trainee ?
Some argue that it's the way forward to hone one's surgical skills while others are of the opinion that it's more of a commercialised driven industry activity.
Do such courses equip a young surgeon enough to operate independently on a real patient ?
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I believe there is some utility to the cadaveric course in as far as exposing trainees to surgical approaches and equipment use is concerned. They , however, can not be stand alone courses and have to ultimately be combined with supervised real live surgery before a surgeon can operate independently
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In particular, medical, surgical or ultrasonographic skills with the use of simulation metrics outputs. Example of a laparoscopic basic skills simulator with embedded metrics (SurgTrac) in this link.
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Dear Nazar,  I am now fully retired but if you google Minimal Access Therapy Training Unit at University of Surrey they have a video of a symposium they had on your subject.It is a few years ago so the Business Manager Alison Snook would be able to update you and can be contacted on alisons@mattu.org.uk. Best of luck. Chris Sutton
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studies have shown that training novice intubators how to perform glidoscope for intubation have higher success rate at performing regular DL intubation than the ones who learn DL only
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i'm a Surgeon ,I don't use directly but I notice that Anesthesist use Glidescope for teaching  and for difficult intubation
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During learning curve of laparoscopic skills such as anastomosis and intracorporal suturing surgeon can use laparoscopic training box. Do you belevie it is useful ?
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I think Box-Training has no role in advanced laparoscopic training. Indeed, it has a certain importance in basic laparoscopic training. For advanced training Virtual Reality trainers (e.g. Simbionix, SurgicalScience) are suitable.
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There is a need for fresh frozen unembalmed cadavers for surgical training, how many times can this cadavers be reused? Can a cadaver can be frozen and defrosted several times (how many times) so that it can be reused several times for different surgical procedures? Please urgently advise.
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Interesting question. We rarely use fresh frozen material in our teaching due to problems with preservation. Some of the surgical training does utilize fresh frozen material, but it is typically a one-time usage. Multiple freeze-thaw cycles will quickly degrade tissue (try it with a bone-in chicken) and bacterial growth is nearly impossible to prevent. Some of the above mentioned embalming techniques may help. Standard embalming allows for dissection, but the tissue is too stiff for a 'life-like' feel as is typically desired in surgical training. Short answer...3-4 times for minimally invasive techniques, once for more aggressive surgeries. Best of luck.
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Gaining experience and involvement in research is paramount to appreciate not only the evidence-based medicine but also to understand various important aspects of disease processes and their treatment. Surgical trainees very often ask about the most appropriate time when they should get involved in research during their training period, which, I believe, is dependent on the organisation of individual surgical training programme. I would very much appreciate your views based on your individual current practice.
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A few years ago there was a proposal on how to organise residency training in the U.S. in the 21st century; the paper is attached. This included a proposal on when to include research during the course of training. The thought was that after a few years (2-3) of general surgery "basic" training, residents should be allowed to focus their training efforts on an area of specialty. This also would allow residents to then chose to take time away from clinical training to pursue a postgraduate degree in research, to then later on be allowed to return to complete their training. I believe how much research is done, should also be dependent on how much time away from clinical training gets accredited towards your board certification as a surgeon. However, from personal experience I believe the time should be a minimum of 2 years (1 is always too little to perform any meaninung "basic science") and perhaps a maximum of 3 years (all the suregons in training I know, including myself, tend to go a little bit crazy if we're away from patient care/operating for too long). I personally believe that performing research after your board certification is slightly suboptimal, because by that age and level of surgical expertise, you should really be "operating high volumes" to perfect your skills; something which is often possible at a fellowship / young consultant level. Thus, my personal opinion is: Graduate from med school, 2-3 year clinical training (surgery), 2-3 years research, back to surgery to complete training and continue on to fellowship. Of note the fellowship can then sometimes also include some more research, which will definitely then be of higher quality, then if the candidate has never performed any research at all until that date....but these are my personal thoughts too.
Cheers,
O.
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The motion capture data is needed to train classification models which could basically help surgical trainees to improve their body posture and manual techniques applying motion capture technology. The data would be recorded during exercises on surgery training system like CAST (see attached link) or similar systems. After classifiers have been trained using different algorithms and different sets of extracted features, their performance and reliability will be evaluated in order to find the best combination of classification algorithm and feature extraction. The final goal is a reliable classifier which tells trainees what exactly they have to improve in their movements and maybe even how to. Of course that's easier said than done though - and there are many intermediate steps to accomplish prior to that.
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Dear Tobias,
If it is helpfull, i did a lot of those measurements in the Netherlands in multiple hospitals ( see publications). You may find it interesting to know how we used classifiers to determine the skills levels of surgeons. If so, you can always contact me. And if you are willing to come to the NL, i know some surgeons that can participate as well.
Good luck and kind regards,
Tim
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A confident grasp over Surgical Anatomy is essential for a trainee surgeon to be proficient in Operative Surgery. However, many 'Structured' training programs do not have a specific system for assessment or evaluation of knowledge of Surgical Anatomy. Mostly it is assumed that the residents will pick this up as they pass through their training.
Should Surgical Anatomy be a separately assessed component of training?
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Surgery as an art and science is based on the intricacies of navigating human anatomy. Surgical anatomy, ideally, should distil one's skills to near perfection - upgrading the structured topographical approach learned through cadaver dissection in medical school to standards that appreciate aesthetics, efficiency and safety for the patient. Thus, surgical anatomy should be the bedrock of surgical residency training and only after demonstrating competency beyond reproach should a surgical resident be considered truly a master.