Synchronized Video-Review as a Tool to Enhance Reflection and Feedback: A Design-Based Feasibility Study.

INTRODUCTION: UK surgical training currently faces the challenge of expanding surgical skills in a context of reduced training opportunities. Video-review in theatre offers the potential to gain more from each learning opportunity and to enhance feedback. AIM: This was a designed-based study to test the feasibility of using synchronized video-review as a reflective tool to enhance surgical training and to gain a deeper understanding of intraoperative feedback. METHOD: Ten supervised laparoscopic cholecystectomy operations were video-recorded using a synchronized split screen, to show trainees' actions, instrument manipulation, and interactions with other theatre staff. This was followed up by joint review of the operation-recording by both the trainee and supervisor. Video-review sessions were audio-recorded along with the consultant and Specialist Registrar interviews after the review session. Audio recordings were thematically analyzed. Supervisors completed the Procedure-Based Assessment forms, twice: post operation and post video-review to check potential trainers' enhanced insight. Forms were analyzed to note any changes and to triangulate the findings. RESULTS: Overall trainee and supervisor feedback was positive. Trainees and supervisors reported the video-review added value in terms of reflection-on-action. It removed the stress of conducting/supervising the operation in real time and focused the attention on feedback. Satisfaction was reported across trainee levels with both scrubbed and unscrubbed supervisors. Audio-visual review allowed trainees to understand the feedback better and to identify new targets beyond those gained from the verbal feedback during the procedure. It also facilitated appraisal of the trainer's teaching. DISCUSSION: This study established the feasibility of using synchronized video-review as a reflection-on-action tool to potentially enhance surgical training by improving feedback. It identified trainees' difficulty in processing intraoperative feedback due to mental overload from the operation. It showed the limitations of current verbal feedback practice, using Procedure-Based Assessment forms, with regard to enhancing technical and nontechnical skills due to denial and memory fading.

The Development of an Online Standalone Cognitive Hazard Training for Laparoscopic Cholecystectomy: A Feasibility Study.

INTRODUCTION: In the UK, surgical training is under pressure due to reductions in training time and training opportunities, which pose patient safety risks. Cognitive, nontechnical, training has been suggested as a possible solution inspired by the identified benefits in aviation industry. A recent review article highlighted the need for such training despite its high cost and the need for expert trainers. AIM: This study aimed to design and test the feasibility of an online standalone module to address the current gap in cognitive surgical training. METHOD: An online standalone, Cognitive Hazard Training module for laparoscopic cholecystectomy was created. It combined multiple choice questions, extended matching items, and single-line free text questions. It contained relevant sketch images and real life hazards video clips, highlighting potential mistakes to enhance: Safety knowledge, reduce bias, and improve self-limitation awareness. Two experts were invited to validate the prototype before testing its feasibility in one English Deanery training environment. RESULTS: In total 93 candidates signed up to review the training. However only 47 (50%) later participated and 33 completed the Module. Those included 3 juniors, 20 higher trainees, and 10 consultants. Candidates' answers were quantitatively analysed. Qualitative feedback was also collected from 27 candidates, via semi-structured interviews. The overall feedback from the feasibility study was positive. Results supported this online resource value in enhancing knowledge and awareness. Interview data also suggested the module's potential to change trainees' practice by being more cautious and adhering to the safety steps of dissection. DISCUSSION: This new training module overcomes some of the previously reported problems in surgical cognitive training. It is a stand-alone online resource with low running cost and does not require expert trainers. The feasibility study supported the aim to enhance hazard awareness and create an attitude shift towards adherence to safety steps during the procedure.

Colorectal stents: do we have enough evidence?

BACKGROUND: The use of colonic stents has significantly evolved over the last few years. Emergency surgery for colonic obstructions is usually associated with significant mortality, morbidity and often stoma formation. Colonic stents provide an alternative way to relieve colonic obstruction, and hence avoiding the risks associated with emergency surgery. This literature review aims to summarize the important current evidence regarding colorectal stenting and show whether further evaluation of the procedure is required. RESULTS: The available large number of non-randomized studies suggests that Self-Expandable-Metal-Stents (SEMS) placement for acute colonic obstruction could be considered as safe and effective alternative to surgery in experienced hands either as a bridge to surgery or as a palliative measure. This evidence has led to SEMS being widely adopted. However, randomized evidence has begun to show the defects that are inherent in the low level evidence that has so far supported SEMS use and it may be that reports of randomized controlled trials may clarify the patient population where SEMS placement is appropriate. CONCLUSION: While we are still waiting for the outcome of the multicentre randomized controlled trials in the UK and Europe, clinicians must be aware of the current evidence limitations and apply SEMS use pragmatically.

Left thyroid hemiagenesis in a patient with primary hyperparathyroidism.

The case of a patient with primary hyperparathyroidism with the incidental finding of left thyroid hemiagenesis with isthmus involvement is presented. Thyroid hemiagenesis is a rare congenital abnormality. There have been approximately 310 cases reported in the literature to date. It has been reported as an incidental finding with a wide range of associated pathological conditions. It is important to consider this in patients being prepared for thyroid lobectomy due to the inevitability of postoperative hypothyroidsm. Due to the female predominance of thyroid disease, hemiagenesis was first thought to be more common in women. Left lobe cases accounts for the majority of instances and isthmus is absent in half the cases. Ultrasonography is the diagnostic tool of choice.