BACKGROUND: Non-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons\' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation.
METHODS: Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared.
RESULTS: We included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p= 0.034) and more e-FAST detailed patients (35% vs. 21 %; p= 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n= 6 [6 %] vs. n= 12 [13 %]; p= 0.128), more temporary closure with abdominal packing (n= 17 [17 %] vs. n= 10 [11 %]; p= 0.327), and less re-operation for bleeding (n= 0 [0 %] vs. n= 5 [6 %]; p= 0.046).
CONCLUSIONS: The French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients.

This study aims to profile biomechanical abilities during sprint front crawl by identifying technical stroke characteristics, in light of performance level. Ninety-one recreational to world-class swimmers equipped with a sacrum-worn IMU performed 25 m all-out. Intra and inter-cyclic 3D kinematical variabilities were clustered using a functional double partition model. Clusters were analysed according to (1) swimming technique using continuous visualisation and discrete features (standard deviation and jerk cost) and (2) performance regarding speed and competition calibre using respectively one-way ANOVA and Chi-squared test as well as Gamma statistics. Swimmers displayed specific technical profiles of intra-cyclic (smoothy and jerky) and inter-cyclic stroke regulation (low, moderate and high repeatability) significantly discriminated by speed (p < 0.001, η2 = 0.62) and performance calibre (p < 0.001, V = 0.53). We showed that combining high levels of both kinds of variability (jerky + low repeatability) are associated with highest speed (1.86 ± 0.12 m/s) and competition calibre (ℽ = 0.75, p < 0.001). It highlights the crucial importance of variabilities combination. Technical skills might be driven by a specific alignment of stroke pattern and its associated dispersion according to the task constraints. This data-driven approach can assist eyes-based technical evaluation. Targeting the development of an explosive swimming style with a high level of body stability should be considered during training of sprinters.

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BACKGROUND: Surgical skills acquisition is under continuous development due to the emergence of new technologies, and there is a need for assessment tools to develop along with these. A range of neuroimaging modalities has been used to map the functional activation of brain networks while surgeons acquire novel surgical skills. These have been proposed as a method to provide a deeper understanding of surgical expertise and offer new possibilities for the personalized training of future surgeons. With studies differing in modalities, outcomes, and surgical skills there is a need for a systematic review of the evidence. This systematic review aims to summarize the current knowledge on the topic and evaluate the potential use of neuroimaging in surgical education.
METHODS: We conducted a systematic review of neuroimaging studies that mapped functional brain activation while surgeons with different levels of expertise learned and performed technical and non-technical surgical tasks. We included all studies published before July 1st, 2023, in MEDLINE, EMBASE and WEB OF SCIENCE.
RESULTS: 38 task-based brain mapping studies were identified, consisting of randomized controlled trials, case-control studies, and observational cohort or cross-sectional studies. The studies employed a wide range of brain mapping modalities, including electroencephalography, functional magnetic resonance imaging, positron emission tomography, and functional near-infrared spectroscopy, activating brain areas involved in the execution and sensorimotor or cognitive control of surgical skills, especially the prefrontal cortex, supplementary motor area, and primary motor area, showing significant changes between novices and experts.
CONCLUSIONS: Functional neuroimaging can reveal how task-related brain activity reflects technical and non-technical surgical skills. The existing body of work highlights the potential of neuroimaging to link task-related brain activity patterns with the individual level of competency or improvement in performance after training surgical skills. More research is needed to establish its validity and usefulness as an assessment tool.

BACKGROUND: Determining limb length in gastric bypass procedures is a crucial step to ensure significant weight loss without risking malnutrition. This study investigated the effect of ex vivo training on the skills needed to determine limb lengths.
METHODS: This was a single-center ex vivo training experiment in a teaching hospital in the Netherlands. We designed a training exercise with marked ropes in a laparoscopic trainer box. All ten surgical residents participated and practiced the skill of estimating limb length. Before and after the two-week period their results on a 150-centimeter limb length task were evaluated.
RESULTS: Before training, 10 surgical residents estimated 150 centimeters of small bowel with an absolute deviation of 21% [range 9-30]. After the training experiment, the residents measured with 8% [2-20] deviation (P = .17). The 8 residents who trained sufficiently improved statistically significantly to an absolute deviation of 5% [2-17] (P = .012). Over 70% of the participants felt their skills had improved.
CONCLUSIONS: With sufficient training, surgical residents\' skills in measuring small bowel length improved when tested in an ex vivo model. Residents became more confident in their laparoscopic measurement skills. This ex vivo training model is a alternative and addition to on-site training.

OBJECTIVE: The aim of this study was 2-fold: (1) to examine the relationships between psychophysiological responses and locomotor demands with variations in technical performance during 2v2 and 4v4 conditioned games and (2) to compare psychophysiological and locomotor responses among players exhibiting higher and lower technical performance levels during the conditioned games.
METHODS: Twenty-four male youth soccer players (16.3 ± 0.8 y old) participating at the trained/developmental level underwent monitoring for psychophysiological responses (including heart rate, rating of perceived exertion, and visual analog scale), locomotor demands (such as distance covered), and technical performance variables (including successful and unsuccessful passes and shots, as well as lost balls) across 2v2 and 4v4 formats. These formats were applied 4 times within a single session and were replicated twice over 2 weeks.
RESULTS: Large correlations between the number of lost balls per minute and mean heart rate were found in both the 2v2 and 4v4 games (r = .586 and r = .665, respectively). Successful shots were inversely and largely correlated with mean heart rate (r = -.518) in 4v4 games. The number of interceptions per minute was inversely and significantly correlated with the visual analog scale in 2v2 and 4v4 games (r = -.455 and r = -.710, respectively). The frequency of lost balls was significantly higher among players who attained a higher mean heart rate (2v2: +42.9%, P = .031, d = -0.965; 4v4: +57.1%, P < .001, d = -2.072).
CONCLUSIONS: Coaches should be aware that highly psychophysiologically demanding scenarios may significantly impair technical performance. Therefore, prioritizing technical performance by deliberately adjusting the intensity should be considered.

BACKGROUND: Good technical skills are crucial for surgeons. Yet although surgical training programs strive to assess technical aptitude when selecting surgical residents, valid assessments of such aptitude are still lacking. Surgical simulators have been proposed as a potentially effective tool for this purpose. The current study aims to develop a technical aptitude test using a virtual reality surgical simulator, and to validate its use for the selection of surgical residents.
METHODS: The study had three phases. In Phase 1, we developed an initial version of the technical aptitude test using the Lap-X-VR laparoscopic simulator. In Phases 2 and 3 we refined the test and collected empirical data to evaluate four main sources of validity evidence (content, response process, internal structure, and relationships with other variables), and to evaluate the feasibility and acceptability of the test. Specifically, Phase 2 comprised a review of the test by 30 senior surgeons, and in Phase 3 a revised version of the test was administered to 152 interns to determine its psychometric properties.
RESULTS: Both the surgeons and interns rated the test as highly relevant for selecting surgical residents. Analyses of the data obtained from the trial administration of the test supported the appropriateness of the score calculation process and showed good psychometric properties, including reliability (α = 0.83) and task discrimination (mean discrimination = 0.5, SD = 0.1). The correlations between test scores and background variables revealed significant correlations with gender, surgical simulator experience, and video game experience (ps < 0.001). These variables, however, explained together only 10% of the variance in test scores.
CONCLUSIONS: We describe the systematic development of an innovative virtual reality test for assessing technical aptitude in candidates for surgical training, and present evidence for its validity, feasibility and acceptability. Further validation is required to support the application of the test for selection, as well as to discern the impact of gender, surgical simulator experience, and video game experience on the fairness of test results. However, the test appears to be a promising tool that may help training programs assess the suitability of candidates for surgical training.

BACKGROUND: Simulation-based training (SBT) aids healthcare providers in acquiring the technical skills necessary to improve patient outcomes and safety. However, since SBT may require significant resources, training all skills to a comparable extent is impractical. Hence, a strategic prioritization of technical skills is necessary. While the European Training Requirements in Neonatology provide guidance on necessary skills, they lack prioritization. We aimed to identify and prioritize technical skills for a SBT curriculum in neonatology.
METHODS: A three-round modified Delphi process of expert neonatologists and neonatal trainees was performed. In round one, the participants listed all the technical skills newly trained neonatologists should master. The content analysis excluded duplicates and non-technical skills. In round two, the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula (CAMES-NAF) was used to preliminarily prioritize the technical skills according to frequency, importance of competency, SBT impact on patient safety, and feasibility for SBT. In round three, the participants further refined and reprioritized the technical skills. Items achieving consensus (agreement of ≥75%) were included.
RESULTS: We included 168 participants from 10 European countries. The response rates in rounds two and three were 80% (135/168) and 87% (117/135), respectively. In round one, the participants suggested 1964 different items. Content analysis revealed 81 unique technical skills prioritized in round two. In round three, 39 technical skills achieved consensus and were included.
CONCLUSIONS: We reached a European consensus on a prioritized list of 39 technical skills to be included in a SBT curriculum in neonatology.

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Simulation-based training (SBT) aims to acquire technical and non-technical skills in a simulated fashion without harming the patient. Simulation helps the anaesthesiologist acquire procedural competence and non-technical abilities. In thoracic anaesthesia, various simulators are available with varying degrees of fidelity and costs. Apart from improving bronchoscopy-related skills, other potential applications of SBT include the practice of lung isolation in normal and difficult airway scenarios, troubleshooting complications during surgeries, and certification of the proficiency of anaesthesiologists. A pragmatic approach is required for choosing the simulator based on its availability, cost, and benefits. Although the literature supports SBT to improve procedural skills, retention of the skills and their translation into improving clinical outcomes remain largely unproven. Randomised, controlled studies targeting the effect of SBT on the improvement of clinical outcomes of patients are needed to prove their worth.