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1.
J Robot Surg ; 18(1): 143, 2024 Mar 30.
Article in English | MEDLINE | ID: mdl-38554218

ABSTRACT

Robotic surgery offers potential advantages over laparoscopic procedures, but the training for configuring robotic systems in the operating room remains underexplored. This study seeks to validate immersive virtual reality (IVR) headset training for setting up the CMR Versius in the operating room. This single-blinded randomized control trial randomised medical students with no prior robotic experience using an online randomiser. The intervention group received IVR headset training, and the control group, e-learning modules. Assessors were blinded to participant group. Primary endpoint was overall score (OS): Likert-scale 1-5: 1 reflecting independent performance, with increasing verbal prompts to a maximum score of 5, requiring physical assistance to complete the task. Secondary endpoints included task scores, time, inter-rater reliability, and concordance with participant confidence scores. Statistical analysis was performed using IBM SPSS Version 27. Of 23 participants analysed, 11 received IVR and 12 received e-learning. The median OS was lower in the IVR group than the e-learning group 53.5 vs 84.5 (p < 0.001). VR recipients performed tasks independently more frequently and required less physical assistance than e-learning participants (p < 0.001). There was no significant difference in time to completion (p = 0.880). Self-assessed confidence scores and assessor scores differed for e-learning participants (p = 0.008), though not IVR participants (p = 0.607). IVR learning is more effective than e-learning for preparing robot-naïve individuals in operating room set-up of the CMR Versius. It offers a feasible, realistic, and accessible option in resource-limited settings and changing dynamics of operating theatre teams. Ongoing deliberate practice, however, is still necessary for achieving optimal performance. ISCRTN Number 10064213.


Subject(s)
Computer-Assisted Instruction , Robotic Surgical Procedures , Robotics , Virtual Reality , Humans , Clinical Competence , Computer-Assisted Instruction/methods , Operating Rooms , Reproducibility of Results , Robotic Surgical Procedures/methods
2.
J Surg Educ ; 80(10): 1395-1402, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37567800

ABSTRACT

INTRODUCTION: Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. METHOD: CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. RESULTS: Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, ηp2=0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, ηp2=0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, ηp2=0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. DISCUSSION: ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.

3.
Endosc Int Open ; 10(9): E1218-E1224, 2022 Sep.
Article in English | MEDLINE | ID: mdl-36118643

ABSTRACT

Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1-5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P  = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3-5), P  < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5-5], P  = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1-3], P  < 0.001, P  = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

4.
Endosc Int Open ; 10(4): E321-E327, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35433225

ABSTRACT

Background and study aims This study aimed to assess the quality of endoscopy training in a UK Statutory Educational Body compared with Joint Advisory Group on Gastrointestinal Endoscopy Training standards (JETS). Methods A total of 28,298 training procedures recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in 18 hospitals during 2019 were analyzed. Data included trainer and trainee numbers, training list frequency, procedures, direct observation of procedural skills (DOPS) completion, and key performance indicators. Results Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median trainers and trainees per unit were 11 (6-18) and 12 (7-16), respectively, (ratio 0.8 [0.7-1.3]). Annual training list frequency per trainee was 13 (10-17), 35.0 % short of Joint Advisory Group (JAG) standard (n = 20, P = 0.001, effect size -0.56). Median points per adjusted training list were 11 (5-18). Median DOPS per trainee and trainer were three (1-6) and four (1-7) respectively; completing 0.2 DOPS (0.1-0.4) per list and amounting to six (2-12) per 200 procedures: fewer than half of the JAG standard (20 per 200) (P < 0.001, -0.61). Esophagogastroduodenoscopy median KPI: J maneuver 94 % (90-96), D2 intubation 93 % (91-96); Colonoscopy KPI: cecal intubation 82 % (72-90), polyp detection rate 25 % (18-34). Compound hospital score ranged from nine to 26 (median 17 [14-20]). Conclusions Important performance disparity emerged with three-fold variation in compound hospital training quality and most units underperforming compared with JAG standards. Trainees and training program directors should be aware of such metrics to improve quality endoscopy educational programs and consider formal adjuncts to optimize training.

6.
Postgrad Med J ; 98(1157): 205-211, 2022 Mar.
Article in English | MEDLINE | ID: mdl-33414176

ABSTRACT

PURPOSE OF THE STUDY: Established over 2000 years ago, horoscopes remain a regular feature in contemporary society. We aimed to assess whether there could be a link between zodiac sign and medical occupation, asking the question-did your specialty choose you? STUDY DESIGN: A questionnaire-based study was distributed using an online survey tool. Questions explored the zodiac sign, specialty preferences and personality features of physicians. RESULTS: 1923 physicians responded between February and March 2020. Variations in personality types between different medical specialties were observed, introverts being highly represented in oncology (71.4%) and rheumatology (65.4%), and extroverts in sexual health (55%), gastroenterology (44.4%) and obstetrics and gynaecology (44.2%) (p<0.01). Proportions of zodiac signs in each specialty also varied; for example, cardiologists were more likely to be Leo compared with Aries (14.4% vs 3.9%, p=0.047), medical physicians more likely Capricorn than Aquarius (10.4% vs 6.7%, p=0.02) and obstetricians and gynaecologists more likely Pisces than Sagittarius (17.5% vs 0%, p=0.036). Intensive care was the most commonly reported second choice career, but this also varied between zodiac signs and specialties. Fountain pen use was associated with extroversion (p=0.049) and gastroenterology (p<0.01). CONCLUSIONS: Personality types vary in different specialties. There may be links to zodiac signs which warrant further investigation.


Subject(s)
Obstetrics , Physicians , Students, Medical , Career Choice , Humans , Personality , Specialization , Surveys and Questionnaires
7.
Postgrad Med J ; 98(1163): 689-693, 2022 Sep 01.
Article in English | MEDLINE | ID: mdl-37062978

ABSTRACT

PURPOSE OF STUDY: Factors influencing physician specialty choice is a prominent topic given the recruitment challenges faced by various specialties. We aimed to assess whether specialty exposure in the first foundation year was a positive predictive factor for permanent career choice. STUDY DESIGN: A questionnaire-based study was distributed online using a survey tool. Questions recorded the foundation rotations of participants as well as their chosen medical specialty. RESULTS: 1181 responses were included in the analysis. 23% of respondents had undertaken a Foundation Year 1 (F1) rotation in their career specialty. Having undertaken a foundation rotation in anaesthetics, cardiology, emergency medicine, endocrinology, gastroenterology, genito-urinary medicine, intensive care, obstetrics and gynaecology, oncology, paediatrics, palliative care, psychiatry, radiology, respiratory and rheumatology was found to be statistically significantly linked to choosing that specialty as a career (p<0.01). There was a significant correlation between the second foundation rotation and career choice (p=0.02). CONCLUSIONS: For many specialties, direct experience within foundation training has a positive effect on later career choice.


Subject(s)
Emergency Medicine , Radiology , Students, Medical , Humans , Child , Love , Surveys and Questionnaires , Emergency Medicine/education , Career Choice
9.
J Surg Educ ; 78(5): 1702-1708, 2021.
Article in English | MEDLINE | ID: mdl-33455895

ABSTRACT

AIMS: Unity of effort is an important component of strategic leadership and management theory associated with Core Surgical Training (CST) outcome. The aim was to determine the impact of team diversity on task completion: a creative design challenge, during CST Boot camp. METHODS: Attendees (n = 44) at a single Statutory Education Body's CST Boot camp were stratified into teams related to specialty theme, and set a design challenge as described by Peter Skillman, to build the tallest free-standing tower out of spaghetti (20 pieces), tape (1 m), and string (1 m), with a marshmallow on top in 18 minutes. Primary outcome measure was tower height. RESULTS: Five teams (50%) completed the task with the tallest tower measuring 70 cm (median 51, range 0-70). Median satisfaction with the simulation exercise was 4 (2-5) on a scale of 0 to 5, with 5 corresponding with highest satisfaction. Successful task completion was associated with team surgical specialty (p = 0.032), ethnicity ratio (p = 0.010,), and gender ratio (p = 0.003), respectively. On multivariable analysis, only team gender ratio was independently associated with tower height (Hazard ratio 0.515, 95% confidence interval 0.350-0.759, p = 0.001). CONCLUSION: Modern leadership theory emphasizes the important dynamic relationship between individual team members, the team, and task completion. General surgery themed teams with a gender mix were most successful in completing the design challenge; whether relative simulation performance predicts strategic organizational skill and career progression will be the next question.


Subject(s)
Clinical Competence , Internship and Residency , Curriculum , Educational Measurement , Leadership , Patient Care Team
10.
Esophagus ; 18(2): 267-277, 2021 04.
Article in English | MEDLINE | ID: mdl-32865623

ABSTRACT

BACKGROUND: The aim of this study was to assess the relative prognostic value of biomarkers to measure the systemic inflammatory response (SIR) and potentially improve prognostic modeling in patients undergoing potentially curative surgery for esophageal adenocarcinoma (EC). METHODS: Consecutive 330 patients undergoing surgery for EC between 2004 and 2018 within a regional UK cancer network were identified. Serum measurements of haemoglobin, C-reactive protein, albumin, modified Glasgow Prognostic Score (mGPS), and differential neutrophil to lymphocyte ratio (NLR) were obtained before surgery, and correlated with histopathological factors and outcomes. Primary outcome measures were disease-free (DFS) and overall survival (OS). RESULTS: Of 330 OC patients, 294 underwent potentially curative esophagectomy. Univariable DFS analysis revealed pT, pN, pTNM stage (all p < 0.001), poor differentiation (p = 0.001), vascular invasion (p < 0.001), R1 status (p < 0.001), perioperative chemotherapy (p = 0.009), CRP (p = 0.010), mGPS (p = 0.011), and NLR (p < 0.001), were all associated with poor survival. Multivariable Cox regression analysis of DFS revealed only NLR [Hazard Ratio (HR) 3.63, 95% Confidence Interval (CI) 2.11-6.24, p < 0.001] retained significance. Multivariable Cox regression analysis of OS revealed similar findings: NLR [HR 2.66, (95% CI 1.58-4.50), p < 0.001]. CONCLUSION: NLR is an important SIR prognostic biomarker associated with DFS and OS in EC.


Subject(s)
Adenocarcinoma , Esophageal Neoplasms , Biomarkers , Esophageal Neoplasms/drug therapy , Humans , Lymphocytes/pathology , Prognosis
11.
BJS Open ; 5(6)2021 11 09.
Article in English | MEDLINE | ID: mdl-35022675

ABSTRACT

BACKGROUND: Gastric cancer (GC) treatment levies substantial financial burden on health services. Potentially curative surgery with or without chemotherapy is offered to patients with locoregional disease. This study aimed to examine treatment costs related to life-years gained in patients having potentially curative treatment (gastrectomy) and those receiving best supportive care (BSC). METHODS: Some 398 consecutive patients with GC were classified according to treatment modality (116 BSC, 282 gastrectomy). Cost calculations for 1 year's treatment from referral were made according to network diagnostic, staging and treatment algorithms. Primary outcome was overall survival (OS). RESULTS: GC median survival after BSC was 8 months, costing €5413, compared with gastrectomy median survival of 34 months, costing €22 753 for 1 year's treatment: cost per life-year gained €9319. Cost incurred for stage I GC was €22 434, stage II €23 498, stage III €22 445, and stage IV €22 032. Based on these values, the cost per quality adjusted life-year (QALY) for BSC for stage I GC was -€8335 stage II -€8952, stage III -€11 317, and stage IV -€25 669. CONCLUSION: Potentially curative treatment that included gastrectomy improved OS four-fold compared with BSC and was cost-effective at national thresholds of readiness to pay per QALY.


Subject(s)
Stomach Neoplasms , Cost-Benefit Analysis , Humans , Quality-Adjusted Life Years , Stomach Neoplasms/surgery
12.
Clin Nutr ESPEN ; 40: 220-225, 2020 12.
Article in English | MEDLINE | ID: mdl-33183540

ABSTRACT

BACKGROUND & AIMS: This study aimed to determine the prognostic significance of low muscle volume (LMV) Bioelectrical Impedance Analysis (BIA), defined skeletal muscle index (SMI, Kg/m2 male ≤8.75, female ≤5.75) in patients undergoing potentially curative surgery for Oesophageal Cancer (OC). METHODS: A prospective study of 122 patients diagnosed with OC [median age 65 yr, 104 male, 65 neoadjuvant therapy] who underwent preoperative BIA (Maltron Bioscan 920). Primary outcome measure was Overall Survival (OS). RESULTS: LMV was identified in 11 (9.0%) of patients, which was associated with low lean muscle mass (27.3 vs. 31.1 kg, p = 0.012), low body fat (8.8 vs.19.3 kg, p < 0.001), and greater total body water (72.2 vs. 62.2%, p = 0.001), and more open & close laparotomies (36.4 vs. 8.1%, p = 0.012). Median and 5-year OS was 16 months and 18.2% in LMV patients, compared with 51 months and 52.4% in non-sarcopenic patients (p = 0.002). On multivariable analysis of pre-operative variables, only LMV (HR 2.75; 95% CI 1.33-5.66, p = 0.006) was associated with OS. CONCLUSION: BIA is an important prognostic indicator in OC and focused pre-habilitation consequently has strong potential.


Subject(s)
Esophageal Neoplasms , Adipose Tissue , Aged , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/surgery , Female , Humans , Male , Muscle, Skeletal , Prognosis , Prospective Studies
13.
Ann Vasc Surg ; 58: 317-325, 2019 Jul.
Article in English | MEDLINE | ID: mdl-30731229

ABSTRACT

BACKGROUND: This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs. METHODS: A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required. RESULTS: Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess. CONCLUSIONS: Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.


Subject(s)
Aneurysm, False/therapy , Embolization, Therapeutic/instrumentation , Femoral Artery , Substance Abuse, Intravenous/complications , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Clinical Decision-Making , Computed Tomography Angiography , Embolization, Therapeutic/adverse effects , Female , Femoral Artery/diagnostic imaging , Humans , Ligation , Male , Middle Aged , Patient Selection , Retrospective Studies , Treatment Outcome , Ultrasonography, Doppler
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