We had a great response to the webinar (Mar 6) "Tools in Surgical Simulation" - co-presented by Dr. John Paige, Louisiana State University School of Medicine and Dr. Nick Sevdalis and Louise Hull, Imperial College London, Department of Surgery and Cancer.

Abstract: The presentation will focus on technical, non-technical, team, and debriefing tools related to surgical simulation.

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"Tools in Surgical Simulation"

Co-Presented by:
John T. Paige, MD
Louisiana State University School of Medicine

and

Nick Sevdalis, PhD
and Louise Hull, BSc, MSc
Imperial College London

Abstract: The presentation will focus on technical, non-technical, team, and debriefing tools related to surgical simulation.

Hosted by: 
Education Management Solutions (EMS) 
www.EMS-works.com

Wednesday, March 6, 2013

2:00 pm EST
(1:00 pm CST; 12 Noon MST; 11:00 am PST)

Webinars are one hour in length.

Space is limited!

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For more information about the webinar, please email Gwen.Wille@EMS-works.com, or call 610-701-7002 x243.

TORONTO - It's a pivotal event that comes in the education of all would-be surgeons. At some point, medical students who plan to make a career of opening up and fixing other human beings have to make that first cut.

If Drs. Teodor Grantcharov and Vanessa Palter have their way, however, that first application of scalpel to skin will occur on a computer screen, not on the torso of a living, breathing person. And not just the first cut. They believe surgical residents ought to achieve an established level of proficiency in a virtual operating room before they start plying their scalpel in a real OR.

"There are studies that show that in the first 50 cases, the risk of major complications is significantly higher than after the next 30 cases. And all these studies are done on real patients," says Grantcharov, an associate professor of medicine at the University of Toronto and a surgeon who specializes in minimally invasive procedures at St. Michael's, one of the university's teaching hospitals. To Grantcharov, the idea of allowing surgical residents to operate before they've met a set skill level in a virtual OR is outdated. Simulation tools are now available and are found with increasing frequency in medical schools across North America. They provide an alternate route for surgical residents to climb the early — and risk-filled — part of the learning curve.

"I always found it ridiculous to talk about learning curves on real patients," says Grantcharov, a towering figure decked out in clogs, scrubs and a Toronto Maple Leafs surgical cap. "We want to see the learning curve in the simulation theatre or on the computer. Talking about learning curves of procedures on patients — I think it's unethical."

And inefficient. Grantcharov and Palter — a surgical resident who is also working on a PhD — recently published a study showing that surgical residents who train first in a simulation lab significantly outperform colleagues who receive only standard surgical training.

The study compared University of Toronto surgical residents who completed a five-month long simulation training module to residents who received conventional surgical training. All the residents performed a laparoscopic right hemicolectomy — an operation where a tumour is removed from the right side of the colon using small incisions, not the large cuts commonly used for operations in the past.

The procedures were videotaped and graded by outside experts. Residents who had trained on the simulators scored an average of 16 points (out of 20) where surgical residents who didn't get the additional virtual training scored an average of eight. The findings were published this month in the journal Annals of Surgery. But the results were so persuasive the University of Toronto's medical school made the virtual training program mandatory for surgery students even before the study was published. Grantcharov says the program was first offered in February and was hugely popular among students. He says it's critical to offer the virtual training as part of a curriculum; letting students work on simulators on their own doesn't achieve the goal.

More.

Surgery residents committed eight times as many errors during simulated procedures when realistic distractions and interruptions were introduced than when they completed procedures without interruption, investigators reported.

The residents made major surgical errors during eight of 18 simulated procedures with distractions versus only one of 18 operations that occurred without intrusions.

Additionally, more than half of the residents forgot a key memory task related to the surgery when they were interrupted as compared with 22% during uninterrupted surgery, as reported online in Archives of Surgery.

"This study provided statistically significant evidence to support the hypothesis that realistic operating-room (OR) distractions and interruptions increase the likelihood of errors in a simulated laboratory setting with novice surgeons," Robin L. Feuerbacher, PhD, of Oregon State University-Cascades in Bend, Ore., and co-authors wrote in conclusion.

"This finding is important because it implies that OR distractions and interruptions may lead to adverse patient outcomes," they added.

Despite the high error rate, the authors said the results should not be interpreted as representative of operating-room (OR) experience in general.

"It must be noted that the distractions and interruptions were timed to occur at critical points and occurred more frequently than observed in an OR," they wrote. "Consequently, these results should not be used to infer that almost half of all surgical procedures with distractions and interruptions are expected to have major surgical errors."

More.

TORONTO -- It's a pivotal event that comes in the education of all would-be surgeons. At some point, medical students who plan to make a career of opening up and fixing other human beings have to make that first cut.

If Drs. Teodor Grantcharov and Vanessa Palter have their way, however, that first application of scalpel to skin will occur on a computer screen, not on the torso of a living, breathing person. And not just the first cut. They believe surgical residents ought to achieve an established level of proficiency in a virtual operating room before they start plying their scalpel in a real OR.

"There are studies that show that in the first 50 cases, the risk of major complications is significantly higher than after the next 30 cases. And all these studies are done on real patients," says Grantcharov, an associate professor of medicine at the University of Toronto and a surgeon who specializes in minimally invasive procedures at St. Michael's, one of the university's teaching hospitals.

To Grantcharov, the idea of allowing surgical residents to operate before they've met a set skill level in a virtual OR is outdated.
Simulation tools are now available and are found with increasing frequency in medical schools across North America. They provide an alternate route for surgical residents to climb the early -- and risk-filled -- part of the learning curve.

"I always found it ridiculous to talk about learning curves on real patients," says Grantcharov, a towering figure decked out in clogs, scrubs and a Toronto Maple Leafs surgical cap. We want to see the learning curve in the simulation theatre or on the computer. Talking about learning curves of procedures on patients -- I think it's unethical."

And inefficient. Grantcharov and Palter -- a surgical resident who is also working on a PhD -- recently published a study showing that surgical residents who train first in a simulation lab significantly outperform colleagues who receive only standard surgical training.

The study compared University of Toronto surgical residents who completed a five-month long simulation training module to residents who received conventional surgical training. All the residents performed a laparoscopic right hemicolectomy -- an operation where a tumour is removed from the right side of the colon using small incisions, not the large cuts commonly used for operations in the past.

The procedures were videotaped and graded by outside experts. Residents who had trained on the simulators scored an average of 16 points (out of 20) where surgical residents who didn't get the additional virtual training scored an average of eight.

More.

(CBS News)  A popular saying in medical school has long been "See one, do one, teach one" -- meaning that young doctors are expected to learn as they go. CBS News medical correspondent Dr. Jon LaPook looks at one new technology that is changing the way doctors prepare for surgery.
Dr. Neel Kantak is a first-year plastic surgery resident at Harvard Medical School.

"I don't think that anything we do in surgery is natural," he said. "I think most of the movements are things people are not born with the coordination to do."

So Dr. Kantak and others come to Beth Israel Deaconess Medical Center's skills lab to practice laparascopic surgery -- procedures done through tiny incisions. The hope is extra surgery training can lower complication rates for patients and costs for insurers.

"When you make the right move," said Kantak, "the tissue gets split the same way it would if you were in an operating room."

The virtual surgery simulator uses touch feedback to help surgeons hone motor skills -- like picking up small objects and knot tying -- they will need in an operating room.

"What the simulation lab allows us to do is develop the coordination," said Kantak, "so when someone tells us, 'This should be your next move,' you have the ability to actually do it with you hands."

The virtual training taking pl ace in labs such as this breaks away from methods students have traditionally used, including practicing on live patients.

Read more.

Hospital operating rooms (ORs) are highly intense work environments that require the OR team to function as a well-honed unit under stressful conditions. Ongoing training opportunities are critical to improving the competency and cooperation of these OR teams. Training on patient simulators of various OR crisis scenarios improves OR team-based competencies such as communication, role clarity, and mutual support, concludes a new study.

For the study, patient simulators were set up in ORs at a 157-bed hospital. Seven crisis scenarios were duplicated, including cardiac arrhythmia, shock, and problems with anesthesia. OR personnel participated in two separate training sessions lasting up to 3 hours. Following each training session, participants were asked about their experience and how it affected team-related competency. A total of 45 team members participated, representing surgical residents, nurse anesthetists, circulating nurses, and surgical technicians.

Post-training scores improved significantly compared with pretraining scores. The scores increased from 4 out of 15 items related to teamwork competencies after the first training (Module 1) to 9 out of 15 items after the second training (Module 2). Competency areas that showed improvement after completion of the two trainings included role clarity, team orientation, open communication, and mutual support and backup behavior. Observers who were placed in the OR during the high-fidelity simulations witnessed distinct improvements in teamwork abilities from one module to the next.

The researchers conclude that such competency improvements can then be adopted in actual clinical practice in the OR. The study was supported in part by the Agency for Healthcare Research and Quality (HS16680).

See "Attitudinal changes resulting from repetitive training of operating room personnel using high-fidelity simulation at the point of care," by John T. Paige, M.D., Valeriy Kozmenko, M.D., Tong Yang, M.D., M.S., and others, in The American Surgeon 75(7), pp. 584-591, 2009.

Click here to access the article.