Concurrent validity of objective assessment by finger tracking for open surgical suturing training.

BACKGROUND: The aim of this study is to evaluate whether the parameters 'time' and 'distance', measured by SurgTrac, correlate with the assessment of the same skills by blinded experts. METHODS: Basic open suturing tasks were executed by medical students. SurgTrac software measured objective parameters by tracking fingers. The executed tasks were recorded by a tablet and additionally assessed by a blinded expert with a Competency Assessment Tool-form (CAT-form). A Pearson's correlation was used to investigate the correlation between the parameters and the outcomes of the expert assessment. RESULTS: A strong correlation between the measured parameters of SurgTrac and the expert-assessment was found for knot tying by hand (r â€‹= â€‹-0.703) and vertical mattress suture (r â€‹= â€‹-0.644) and a moderate correlation for transcutaneous suture (r â€‹= â€‹-0.555) and intracutaneous suture (r â€‹= â€‹-0.451). CONCLUSION: The use of finger tracking by SurgTrac showed a good concurrent validity for the basic open suturing tasks knot tying by hand, transcutaneous suture and vertical mattress suture.

Alcohol's impact on fine motor skills: Insights from minimally invasive surgical simulation.

Background: Alcohol misuse among medical professionals poses a significant concern, and there is a lack of clarity in (inter)national guidelines regarding alcohol use during work. Moreover, there exists an insufficient body of research on the specific impact of alcohol on fine motor skills within the medical sector, specifically surgery. This study aims to investigate the impact of alcohol on fine motor skills in a minimally invasive surgical setting. Methods: A cross-sectional study was conducted at Lowland Science on August 19th, 20th, and 21st, 2022, during the Lowlands music festival in Biddinghuizen, the Netherlands. Participants were divided into five groups based on measured alcohol consumption. Exclusion criteria included drug use, prior surgical experience, being underage, and previous participation. The main outcomes were the number of correctly transferred rings during the PEG transfer task and the number of errors. Blood alcohol concentration (BAC) was measured using a breathalyser. Results: A total of 1056 participants were included in the study. The results indicated an inverse relationship between BAC levels and surgical performance, with higher alcohol levels associated with a decrease in performance (p = 0.023). However, there was no significant difference in the number of errors among the five groups (p = 0.597). The group with the highest alcohol consumption (BAC >0.08 %) exhibited significantly worse performance compared to the group with a BAC of 0.0 % (p = 0.002). Conclusion: This study uncovers a negative impact of increased alcohol intake on fine motor skills in a minimally invasive surgery simulation exercise. While there was no effect on the occurrence of errors. Professional medical organizations should reconsider and explicate their position on alcohol use in (surgical) healthcare.

Management after non-curative endoscopic resection of T1 rectal cancer.

Since the introduction of population-based screening, increasing numbers of T1 rectal cancers are detected and removed by local endoscopic resection. Patients can be cured with endoscopic resection alone, but there is a possibility of residual tumor cells remaining after the initial resection. These can be located intraluminally at the resection site or extraluminally in the form of (lymph node) metastases. To decrease the risk of residual cells progressing towards more advanced disease, additional treatment is usually needed. However, with the currently available risk stratification models, it remains challenging to determine who should and should not be further treated after non-curative endoscopic resection. In this review, the different management strategies for patients with non-curatively treated T1 rectal cancers are discussed, along with the available evidence for each strategy and relevant considerations for clinical decision making. Furthermore, we provide practical guidance on the management and surveillance following non-curative endoscopic resection of T1 rectal cancer.

Experts in Minimally Invasive Surgery are Outperformed by Trained Novices on Suturing Skills.

INTRODUCTION: Learning minimally invasive suturing can be challenging, creating a barrier to further implementation, especially with the development of easier methods. Nevertheless, mastering intracorporeal knot tying is crucial when alternative techniques prove inadequate. Therefore, the minimally invasive surgery (MIS) suturing skills of MIS experts are compared with a group of novices during their learning curve on a simulator. METHODS: The novice participants repeatedly performed the intracorporeal suturing task on the EoSim MIS simulator (up to a maximum of 20 repetitions). The experts (>50 MIS procedures and advanced MIS experience) completed the same task once. The first and last exercises of the novices and the expert tasks were all blindly recorded and assessed by two independent assessors using the Laparoscopic Suturing Competency Assessment Tool (LS-CAT). Additionally, objective assessment parameters, "time" and "distance", using instrument tracking, were collected. The scores of the experts were then compared with the novices. RESULTS: At the end of the training, novices significantly outperformed the experts on both the expert assessment (LS-CAT: 16.8 versus 26.8, P = 0.001) and objective parameters (median time: 190 s versus 161 s, P < 0.001; median distance: 6.1 m versus 3.6 m, P < 0.001). Although the experts showed slightly better performance than the novices during their first task, the difference was not significant on the expert assessment (LS-CAT experts 16.8, novices 20.5, P = 0.057). CONCLUSIONS: Our findings underscore the significance of continued MIS suturing training for both residents and surgeons. In this study, trained novices demonstrated a significant outperformance of experts on both quantitative and qualitative outcome parameters within a simulated setting.

Assessment of Minimally Invasive Suturing Skills: Is Instrument Tracking an Accurate Prediction?

Introduction: Minimally invasive surgery (MIS) suturing demands advanced surgical skills. Therefore, it is important these skills are adequately trained and assessed. Assessment and feedback can consist of judgments and scores of expert observers or objective parameters using instrument tracking. The aim of this study was to determine to what extent objective parameters correspond to expert assessment. Methods: Participants performed an intracorporeal suturing task on the EoSim simulator repeatedly (maximum 20 repetitions) during training. The best discriminating parameters, which previously shown construct validation, were combined into a composite score, using regression analysis. All videos were blinded and assessed by 2 independent reviewers using the validated laparoscopic suturing competency assessment tool (LS-CAT). These scores were compared with the composite score. Results: A 100 videos of 16 trainees, during separate points on their learning curve, and 8 experts were used. The parameters "time" and "distance" were statistically significantly correlated with all LS-CAT domains. The composite score (calculated from "time" and "distance") showed improvement between the first and the last knot (57% versus 94%, P < .001). Also the LS-CAT score improved (28 versus 17, P < .001). However, the correlation of the composite score with the LS-CAT score was weak (R: 0.351), with an accuracy of 55/100 when pooling the outcomes based on inadequate, adequate, or good performance. Conclusion: Instrument tracking parameters (using Surgtrac) could give an indication of the skill level, however, it missed important elements, essential for reliable assessment. Therefore, expert assessment remains superior to determine the skill level in MIS suturing skills.

The effect of continuous at-home training of minimally invasive surgical skills on skill retention.

BACKGROUND: Skill deterioration of minimally invasive surgical (MIS) skills may be prevented by continuous training. The aim of this study is to evaluate whether unsupervised continuous at-home training of MIS skills results in better skill retention compared to no training. METHODS: Medical doctors followed a two-week interval training for two MIS tasks (precise peg transfer and interrupted suture with knot tying), ending with a baseline test. They were randomly assigned to the no-practice group or continuous-practice group. The latter practiced unsupervised at home every two weeks during the study period. Skill retention was measured after three and six months on both tasks by the total time needed, distance traveled by instruments and LS-CAT score (8 best possible score and > 40 worst score). RESULTS: A total of 38 participants were included. No significant differences in performance were found at pre-test or baseline. At six months the no-practice group needed more time for the suturing task (309 s vs. 196 s at baseline, p = 0.010) and the LS-CAT score was significantly worse (30 vs. 20 at baseline, p < 0.0001). The continuous-practice group performed the suturing task significantly better than the no-practice group at both three and six months (17 vs. 25, p < 0.001 and 17 vs. 30, p < 0.001) and faster as well (p = 0.034 and p = 0.001). CONCLUSION: This study shows a skill decay after only a few months of non-use and shows better skill retention after continuous unsupervised at-home practice of MIS skills. This indicates an added value of regular at-home practice of surgical skills.

The Barriers and Enhancers to Trust in a Just Culture in Hospital Settings: A Systematic Review.

OBJECTIVES: Healthcare workers wanting to report errors often encounter a culture of fear or blame. A just culture can improve patient safety by promoting safe and open communication, trust is hereby essential. We defined trust in a just culture when healthcare professionals believe that error communication is honest, safe, and reliable. In this study, we investigated barriers and enhancers to trust in error reporting in a just culture. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Emcare, and Web of Science database were searched on June 21, 2021. RESULTS: Several factors were found to influence trust in error reporting in a just culture, namely, organizational factors, team factors, and experience. Trust depends on the management style, open information about error handling, a focus on patient safety instead of blaming an individual, a well-executed walk-round, a code of professionalism, and a departmental incident reporting system (organizational factors). A close relationship between employee and primary supervisor, with discussion of the nature of an error and ascribing clear roles to physicians in care teams, can be enhancers of trust in error reporting. Moreover, creating a mutual understanding of the challenges faced by professionals can enhance trust (team factors). Trust in error reporting is also influenced by a health professional's experience and training in patient safety. Factors such as a lack of confidence in clinical skills, more fear of shame/blame by less experienced workers, and knowledge of the existing error reporting system will influence a person's trust in error reporting (experience). CONCLUSIONS: This systematic review identified barriers and enhancers to trust in error reporting in a just culture. The barriers and enhancers can be divided into 3 main themes: organizational factors, team factors, and experience. Findings show that trust can be learned and created based on practical principles.