BACKGROUND: Postpartum hemorrhage is a significant cause of both maternal morbidity and mortality worldwide and is increasing in incidence. This study aimed to assess improvement and identify shortcomings in trainee performance in different simulation systems in the management of postpartum hemorrhage.
OBJECTIVE: To perform a pilot study evaluating and comparing high- and low-fidelity simulation models, assessing improvement in repeated performance with high-fidelity mode and identifying mistakes made assessed using Objective Structured Assessment of Technical Skills and thereby exploring what aspects of emergency management of postpartum hemorrhage should be prioritized in teaching settings and assessing what simulation setup is most effective in achieving competence.
METHODS: This was a prospective randomized, single-blinded, single-institution trial in a population of 17 junior obstetrical trainees at the Charité University Hospital Obstetric Simulation Center in Berlin. Trainees were randomized into 2 groups, with either initial low-fidelity simulation or high-fidelity simulation, followed by repeated assessment of performance, using the high-fidelity model simulation system. Individual simulation sessions were video-recorded and transcribed, and the timing of interventions was documented. Strandardized Objective Structured Assessment of Technical Skills forms were used as a checklist for performance.
RESULTS: There was a statistically significant general improvement in performance (P=.02; 24.7-27.2 of 31.0 points; average of 8.7%) in the second cycle of simulation assessment and a statistically significant training effect (P=.043; 24.4-28.4 of 31.0 points; average of 12.9%) in the group that underwent repeat simulation assessment from the initial low-fidelity system to the high-fidelity system compared with the group using the same high-fidelity setup (P=.276; 25.0-25.8 of 31.0; average of 2.4%).
CONCLUSIONS: There was an improvement in the performance when trainees underwent a repeated cycle of simulation assessment changing from a low-fidelity system to a high-fidelity system. Simulation assessment can identify mistakes and learning gaps that are important for obstetrical trainees. This study found that trainees make the same mistakes, regardless of which simulation model was initially used.

OBJECTIVE: To assess the short-term and skill-retention effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries (OASIS).
METHODS: This prepost experimental study recruited 31 obstetrics and gynecology residents from Peking Union Medical College Hospital. OASIS repair skill evaluations (at all timepoints) comprised a task-specific checklist (TSC), global rating scale (GRS), and pass/fail grade. A beef-tongue model was adopted in the simulation curriculum. After baseline testing, residents completed a structured 1-h workshop. Two weeks later, a second test was performed, followed by a one-to-one teaching workshop, with the proper completion of a checklist as the end-point. Three months later, residents completed a third test.
RESULTS: The overall pass rate at baseline was 16.1%, with higher GRS scores (p = 0.035) in senior residents. Additionally, previewing the procedure before class and a history of OASIS repair observation were associated with higher TSC and GRS scores. Significant skill improvement was observed in the second and third tests, with pass rates of 96.8% and 93.5% respectively. Both TSC and GRS scores were improved compared with baseline (p < 0.001).
CONCLUSIONS: A structural simulation curriculum integrating deliberate practice under supervision improves OASIS repair competence and achieves satisfactory skill retention.

We investigated whether surgical skill and procedure were related to oncological outcomes in cervical cancer patients who underwent Laparoscopic Radical Hysterectomy (LRH).
We previously assessed data of LRH from 251 patients with FIGO stage (2009) IA2, IB1and IIA1 cervical cancer collected for JGOG 1081s study. 1) The JGOG 1081s cohort study was re-examined to refine the surgical details and extend the follow-up period as chart review. 2) Unedited videos for recurrent cases and matched non-recurrent control cases were newly compared by experts for various surgical skills and surgical procedures using the modified Objective Structured Assessment of Technical Skills (OSATS) tool, without awareness of the recurrence status as video review.
After a median follow-up of 46 months, tumors had recurred in 31 of the 251 patients. The five-year Recurrence-Free Survival rate was 86.9% (81.8-90.6) and five-year Overall Survival rate was 93.7% (87.5-96.8). Multivariate analysis from chart reviews found that an experience with LRH of less than 20 cases per institution was an independent prognostic factor for recurrence (Hazard Ratio (HR) 2.49, 95%CI 1.12-5.53, p = 0.025). For the surgical video review, we compared 23 videos of recurrent cases with 23 background-matched non-recurrent controls. Lower modified OSATS scores from the video review were consistently trended to have a higher risk of recurrence.
Our new study has found that LRH surgical experience and skill trended to have better oncological outcomes.

To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries.
PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021.
Randomized controlled trials, prospective comparative studies, and prospective single-group studies with pre- and posttraining assessments that reported surgical simulation-based training before gynecologic surgery were included.
Reviewers independently identified the studies, obtained data, and assessed the study quality. The results were analyzed according to the type of gynecologic surgery, simulation, comparator, and outcome data, including clinical and patient-related outcomes. The maximum likelihood random effects model meta-analyses of the odds ratios and standardized mean differences were calculated with estimated 95% confidence intervals.
Twenty studies, including 13 randomized controlled trials, 1 randomized crossover trial, 5 nonrandomized comparative studies, and 1 prepost study were identified. Most of the included studies (14/21, 67%) were on laparoscopic simulators and had a moderate quality of evidence. Meta-analysis showed that compared with traditional surgical teaching, high- and low-fidelity simulators improved surgical technical skills in the operating room as measured by global rating scales, and high-fidelity simulators decreased the operative time. Moderate quality evidence was found favoring warm-up exercises before laparoscopic surgery. There was insufficient evidence to conduct a meta-analysis for other gynecologic procedures.
Current evidence supports incorporating simulation-based training for a variety of gynecologic surgeries to increase technical skills in the operating room, but data on patient-related outcomes are lacking.

暂无摘要。

UNASSIGNED: The coronavirus disease 2019 (COVID-19) pandemic presents in-person exposure risk during surgical education. We aimed to validate the feasibility of fully remote faculty-supervised surgical training sessions focused on coronary artery bypass grafting using a synthetic simulator and online video-chat software.
UNASSIGNED: This observational study organized 24 sessions of 2-hour remote training. Each session involved three trainees, one faculty, and one host. A total of 70 trainees and 24 faculties were enrolled. The participants joined the remote sessions via online video-chat, and performed focused training in coronary artery anastomosis using a commercially available simulator. A survey was conducted to validate the feasibility of the remote sessions. Performance improvement of the trainees who repeatedly participated (n = 13) were analyzed comparing initial and final scores of various performance indicators.
UNASSIGNED: All trainees and faculties were satisfied with the efficacy of the remote session. Additionally, most trainees (79%) and faculties (95%) agreed that the remote training sessions were equivalent to conventional on-site training seminars. A significant improvement between initial and last sessions was observed in the scoring components of near side (3.4 ± 1.0 vs. 4.1 ± 0.9; P = 0.02), far side (3.3 ± 0.8 vs. 3.9 ± 0.8; P = 0.03), external appearance (3.5 ± 0.8 vs. 4.2 ± 0.7; P = 0.01), and internal appearance (2.8 ± 0.9 vs. 4.0 ± 0.9; P = 0.004).
UNASSIGNED: Faculty-supervised remote surgical training sessions were executed with satisfactory results. This methodology may have important implications for surgical education during the COVID-19 pandemic.

OBJECTIVE: Demonstrated competence through frequent assessment is an expected goal for progressive development in competency-based medical education curricula. The Objective Structured Assessment of Technical Skill (OSATS) is considered a valid method of formative assessment, but in few instances have standards been set for determining competence. The present study used borderline regression methods to examine standard setting of performance on a complex technical task with novices assessed using an OSATS checklist.
METHODS: This was a single institution prospective single arm experimental design study. Participants were 58 non-medical undergraduate students with no previous surgical experience, who observed a computer-based training module on end-to-side vascular anastomosis. Subsequently, participants were provided two 20-minute training sessions, two weeks apart where they received expert feedback whilst performing the task on a low-fidelity model. After each training session, participants completed the task unaided. Sessions were recorded and assessed using an OSATS checklist retrospectively by experts.
RESULTS: Paired t-test analyses indicate that for both the checklist total score (t(52) = 8.05, p < 0.001) and the global rating score (t(53) = 8.15, p < 0.001), individuals performed significantly better in Phase 2. Borderline regression analyses indicated that in Phase 1 (R2 = .60) and Phase 2 (R2 = .75), the OSATS checklist could adequately capture variation in performance in novices. Further, the checklist could reliably classify novices at three of the five global rating performance levels. Pass rates determined by regression equations improved from Phase 1 to Phase 2 on all global rating levels.
CONCLUSIONS: With the increasing focus on competency-based medical education, it is imperative that training programs have the capacity to accurately assess outcomes and set minimum performance standards. Borderline regression methods can accurately differentiate novice learners of varying performance levels before and after training on a complex technical skill task using an OSATS checklist.

Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal.
Blinded modified Delphi consensus process.
Tertiary care center.
A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as \"keep\" or \"remove\" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items.
The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to \"keep\" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus.
It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated.
5. Laryngoscope, 131:1168-1174, 2021.

The aim of this study was to develop a simulated technical skills examination specific to oral and maxillofacial surgery, assessing the validity of the test and its psychometric properties and obtaining feedback on the examination from both resident trainees and expert evaluators. The Oral and Maxillofacial Objective Structured Assessment of Technical Skills (OMOSATS) examination is a simulated procedure-based eight-station technical skills examination. Fourteen oral and maxillofacial surgery (OMFS) residents of various levels participated in 12-minute surgical tasks and were evaluated by blinded expert OMFS surgeons. The tasks included suturing, tracheostomy, arthroscopy, dental implant placement, plate bending and lag screw application, microvascular anastomosis, and skin grafting. These tasks reflect a broad range of technical milestones necessary for the practice of OMFS. Tasks were evaluated using a validated global rating scale and task-specific checklists. The results of the pilot study indicated strong face and construct validity for seven of the eight OMOSATS stations in discerning the level of training based on technical skill demonstrated at each of the eight surgical stations. Additionally, through one-way ANOVA, P-values were observed to confirm the level of discernment. The OMOSATS examination is a novel way to assess the technical skills of OMFS residents. This type of performance-based assessment has been used in other surgical domains for many years. There is strong evidence to support the use of technical skills examinations to help evaluate, teach, and provide surgeon educators with training outcomes for our OMFS trainees.

The use of 3-dimensional (3D)-printed models is promising in nasal endoscopic technique training. Here, we aimed to develop postsurgical simulants for use in conjunction with 3D-printed nasal models and to assess their usefulness in helping residents transfer basic endoscopic skills acquired during simulation training to clinical situations.
The secretion simulant was prepared via a crosslinked reaction between sodium alginate and acrylamide, whereas the packing simulant was prepared using a superabsorbent polymer. After the simulants\' fidelity and utility were evaluated by 5 rhinologists using a 5-point Likert scale, 46 novice residents were trained using the 3D-printed nasal models and postsurgical simulants for 2 weeks. A checklist and Global Rating Scale (GRS) were used to assess their performances before and after training, and the time to finish each task was also recorded. Following training, the qualified trainees operated on real patients and were reevaluated.
The simulants\' similarity and usefulness scored ≥4.0, and the training cost was 28 CNY ($4 USD) per session. Following training, the checklist and GRS scores increased, and the operation time decreased (all p < 0.05). There were no statistical differences between the trainees\' performances on the models with the simulants and on patients (all p > 0.05).
The low-cost simulated secretion and dressing are safe to use. The application of the simulants in conjunction with that of 3D-printed nasal models in a simulated task setting can help residents in transferring endoscopic skills acquired during simulation teaching to real patients.