Design and utilisation of a novel, high-fidelity, low-cost, hybrid-tissue simulation model to facilitate training in robot-assisted partial nephrectomy.

Robot-assisted partial nephrectomy (RAPN) has rapidly evolved as the standard of care for appropriately selected renal tumours, offering key patient benefits over radical nephrectomy or open surgical approaches. Accordingly, RAPN is a key competency that urology trainees wishing to treat kidney cancer must master. Training in robotic surgery is subject to numerous challenges, and simulation has been established as valuable step in the robotic learning curve. However, simulation models are often both expensive and suboptimal in fidelity. This means that the number of practice repetitions for a trainee may limited by cost restraints, and that trainees may struggle to reconcile the skills obtained in the simulation laboratory with real-world practice in the operating room. We have developed a high-fidelity, low-cost, customizable model for RAPN simulation based on porcine tissue. The model has been utilised in teaching courses at our institution, confirming both feasibility of use and high user acceptability. We share the design of our model in this proof-of-concept report.

Performance in Irish Selection and Future Performance in Surgical Training.

Importance: Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity. Objective: To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments. Design, Setting, and Participants: This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022. Exposures: Selection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview. Main outcomes and measures: Assessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses. Results: Data were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (ß = 0.31; 95% CI, 0.14-0.48) and simulated environments (ß = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (ß = 0.55; 95% CI, 0.22-0.87). Conclusions and Relevance: In this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.

Resident Training for Successful Professional Interactions.

BACKGROUND: Conflict between healthcare professionals is a common feature of modern healthcare environments, contributing to more stressful working conditions and burnout in frontline staff. In the Royal College of Surgeons in Ireland we undertook to design and deliver a course called 'Professional Interactions' which would equip junior residents in surgery and other acute care specialties with the skills to better manage conflict and bullying. METHODS: The design of this course was based on a Transformative Learning Theory conceptual framework. Key teaching modalities included rational discourse, role-playing, simulations, case studies, reflection exercises and experience with critical incidents and feedback. This experiential learning session was followed with an online short course to reinforce the learning objectives. RESULTS: We in the National Surgical Training Programme have been delivering structured mandatory education to our residents on this topic for over a decade. Each iteration of this programme has been modified based on resident and faculty feedback as well as emerging evidence in the field of communication skills. Recent course evaluation data included feedback from 203 course participants, which represented a 66% response rate. Ninety-two percent of those respondents rated the course as 'Excellent' or 'Good' and that they would use the skills learned 'Daily or 'Weekly'. 85 percent reported a perceived improvement in conflict management skills. CONCLUSIONS: Conflicts and difficult interactions between colleagues in the workplace are a frequent feature of healthcare practice. Teaching residents skills to manage these interactions more successfully may help towards developing a culture of mutual respect in hospital-based practice.

Objective assessment of surgical trainees' non-technical skills: Improved performance following a two-year program of instruction.

BACKGROUND: Non-technical skills (NTS) encompass personal skills such as communication, situational awareness, decision making, teamwork and leadership. Poor performance of these skills has been shown to contribute to medical error. The Royal College of Surgeons in Ireland (RCSI) has delivered a mandatory program of instruction in NTS to all surgical trainees since 2005. We investigated whether the NTS of surgical trainees improved after the first two years of this program. METHODS: Baseline data was collected in a three-station OSCE assessment of NTS at the beginning of Year one and again at end of Year two of surgical training. RESULTS: Trainees' mean percentage NTS scores improved significantly over the two-year period for the NTS assessment (P < .001). A significant difference was demonstrated using within-subject (paired) t-tests between the Year one and two time points for all three OSCE stations: Consent (-5.39; P < .001); Colleague Conflict (-8.63; P < .001); and Disclosure of Error (-7.56; P < .001). CONCLUSIONS: RCSI offers a unique mandatory program of instruction in NTS. There was a statistically and practically significant improvement in the NTS scores of surgical trainees over the two-year period of the program.

Use of a Novel Measure of Nontechnical Skills in Surgical Trainees: Is There an Association With Technical Skills Performance?

OBJECTIVE: To investigate whether scores on a psychological measure of concentration and interpersonal characteristics, The Attentional and Interpersonal Style Inventory (TAIS), are associated with performance of surgical skills. DESIGN: Postgraduate surgical trainees completed an operative surgical skills assessment in the simulation laboratory and the psychological measure (TAIS). The surgical skills assessment consisted of 6 tasks (3 per trainee): laceration suturing; lipoma excision; incision and closure of a laparotomy wound; bowel anastomosis; saphenofemoral junction ligation and basic laparoscopic skills. The association between operative surgical skill performance and TAIS factors was investigated. SETTING: The TAIS assessments and surgical skills assessments were conducted at the National Surgical Training Centre at the Royal College of Surgeons in Ireland (RCSI). PARTICIPANTS: One hundred and two surgical trainees in years one and two (PGY 2-3 equivalent) participated in the study. RESULTS: Performance on 2 of the 6 tasks assessed (bowel anastomosis and lipoma excision) were positively associated with multiple TAIS factors (energy, confidence, competitiveness, extroversion, self-criticism and performing under pressure). Another factor, focus over time, was significantly associated with scores on the lipoma excision task. CONCLUSIONS: Trainees with high levels of energy, confidence, competitiveness, extroversion, and focus over time and low levels of self-criticism demonstrated better performance on specific technical skills tasks.

Are residents accurate in their assessments of their own surgical skills?

BACKGROUND: An appropriate level of awareness of one's own technical skill is essential to being an effective self-directed learner. The aim of this study was to analyze surgical residents' self-awareness by examining their ability to predict and assess their own performance in an objective surgical skills examination. METHODS: Surgical residents' (n = 216) pre-examination self-predicted scores and post-examination self-assessed scores were compared with objectively measured scores. Accuracy of score prediction and self-assessment were compared with resident demographics (age, gender, year of training, and nationality). RESULTS: Post-examination self-assessed scores correlated with objectively assessed scores (r = .34; P < .001). Higher year of training, older age, and non-European nationality were predictive of accuracy in self-prediction and self-assessment. CONCLUSIONS: Demographic variables that predict more accurate self-awareness of technical skill have been identified. Surgical training programs may use these data to anticipate the trainees who need assistance in developing better self-awareness.

The importance of expert feedback during endovascular simulator training.

OBJECTIVES: Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers? METHODS: Eighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15. RESULTS: A clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively). CONCLUSION: VR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty.