• CIED implant
• Cardiac resynchronization therapy
• Metrics
• Pacing
• Proficiency-based progression
• Training

• MINS™
• automated performance metrics
• gynecological oncology
• hinotori™
• robotic surgery
• telemedicine

• Sysmex Corporation

• Humans
• Virtual Reality
• Augmented Reality
• Orthopedic Procedures/education
• Computer Simulation
• Sports
• Orthopedics/education
• Clinical Competence
• Simulation Training/methods

• CIED implant
• Cardiac resynchronization therapy
• Pacing
• Proficiency-based progression
• Surgical skill
• Training

• Clinical Competence
• Humans
• Prospective Studies
• Simulation Training
• Female
• Male
• Swine
• Curriculum
• Animals
• Task Performance and Analysis
• Prosthesis Implantation/education
• Video Recording
• Education, Medical, Graduate/methods
• Learning Curve
• Medical Errors/prevention & control
• Adult
• Defibrillators, Implantable
• Cardiologists/education
• Models, Animal

• Medtronic Europe

• Hand surgery
• Resident education
• Simulation

• Humans
• Arthroscopy/education
• Cognition/physiology
• Clinical Competence

• Construct validity
• Robot-assisted partial nephrectomy
• Surgical training
• Training model

• Humans
• Robotic Surgical Procedures/methods
• Learning
• Benchmarking
• Blood Transfusion
• Nephrectomy

• Humans
• Arthroscopy/methods
• Orthopedics/education
• Rotator Cuff Injuries
• Educational Status
• Curriculum

• Assessment
• Education
• Training

• Humans
• Pilot Projects
• Cervical Vertebrae/surgery
• Spinal Fusion/methods
• Diskectomy/methods
• Virtual Reality

• Arthroscopic skills
• Arthroscopic training
• Case volume
• Simulator training
• Surgical education

• Humans
• Arthroscopy/education
• Internship and Residency
• Clinical Competence
• Orthopedics/education
• Educational Measurement
• Simulation Training/methods

• Basic skill training
• GEARS
• proficiency-based progression
• robotic surgery
• training

• ISBAR
• communication
• deterioratingpatient
• e-learning
• feedback
• proficiency-based progression

• Humans
• Computer-Assisted Instruction
• Curriculum
• Learning
• Simulation Training
• Students, Medical

• Construct validation
• Metrics
• Proficiency-based training
• Renal cancer
• Robot-assisted partial nephrectomy
• Surgical training

• Humans
• Robotic Surgical Procedures/methods
• Robotics
• Reproducibility of Results
• Surgeons
• Clinical Competence
• Nephrectomy/education

• Humans
• Male
• Female
• Benchmarking
• Defibrillators, Implantable
• Prospective Studies
• Curriculum
• Cardiac Resynchronization Therapy

• bypass
• bypass simulator
• microanastomosis
• neurosurgical training
• vascular neurosurgery

• Clinically relevant outcome measures
• Clinically relevant performance metrics
• Proficiency-based training
• Robotic surgical education

• #Urology
• basic skills training
• proficiency‐based progression
• robotic surgery
• surgical simulation
• training

• Humans
• Robotic Surgical Procedures
• Prospective Studies
• Robotics
• Anastomosis, Surgical
• Benchmarking

Ischemic stroke is one of the leading causes of death and long-term disability in the West. Mechanical revascularization techniques are considered the standard of care for large vessel occlusive stroke. Traditional apprenticeship models involve doctors training their skills on patients. Simulation platforms have long been recognized as an alternative to this. There has however been very little robust assessment of the training outcomes achieved on some of these platforms. At best, these simulations increase understanding of the procedural process and may help improve some technical skills; at worst they may instill bad habits and poor technique. The prerequisite of any simulation process must be to teach what to do, with which devices, in the correct sequence as well as what not to do. It should provide valid metric-based feedback to the trainee that is objective, transparent, and fair for formative and summative performance feedback. It should deliver a training program that measures the performance progress of trainees against expert benchmarks—benchmarks that represent an evidence-based peer-reviewed standard. In this paper, we present a perspective for PBP training for thrombectomy based on our experience with the process of procedure characterization, metric validation, and early experience of using this approach for proficiency training. Patient outcomes are not only determined by optimal performance in the Angio Suite but also by an efficient patient procedure pathway. There will be value in utilizing the PBP training standard not only for the procedure itself but also for the constituent elements of the stroke pathway to further improve treatment outcomes for ischemic stroke patients.

• 3D printing
• Assessment
• Hip arthroscopy
• Medical simulation

• 31A2 pertrochanteric fracture
• Construct validity
• Objective assessment
• Procedure metrics
• Proficiency based progression

• Clinical Competence
• Fracture Fixation, Intramedullary
• Humans
• Orthopedic Surgeons
• Orthopedics
• Reproducibility of Results

The purpose of this study is to investigate the importance of general and specific surgical skills for hip arthroscopy from the perspective of surgeons in China. Concurrently, we intend to identify the preferred type of simulation that would facilitate competency of surgical trainees in performing arthroscopy and reinforce their preparation for carrying out the actual surgical procedure.

An online survey comprising 42 questions was developed by experts in hip arthroscopy and sent to 3 online communities whose members are arthroscopic surgeons in China. The responses collected were based on a 5-point Likert scale, with an open-ended comment section. Data were analyzed using one-way AVOVA and post hoc Tukey’s test.

A total of 159 valid responses from 66 junior specialist surgeons, 68 consultant surgeons, and 25 senior consultant surgeons (from 130 institutions in 27 out of 34 provincial administrative districts in China) were collected. Cognitive ability was identified as the overall most important attribute for hip arthroscopic trainees to possess, while skills relevant to the treatment of femoroacetabular impingement (FAI) were considered as the most important specific skills by the surgeons surveyed. In addition, simulation using cadaveric specimens was considered the most favorable method for surgeons to practice their surgical skills.

In designing a training program for hip arthroscopy, it is essential to incorporate features that evaluate cognitive skills. It would be helpful for trainees to specifically practice skills that are often used in the treatment of some very common diseases of the hip joint, such as FAI. Using high-fidelity physical models for simulation to train skills of hip arthroscopy could be an ideal alternative and effective way to overcome problems arising from the lack of accessibility to cadaveric specimens.

The online version contains supplementary material available at 10.1007/s11548-022-02708-x.

• Hip arthroscopy
• Medical simulation
• Surgeon
• Surgical training

In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.

A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics.

The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task.

PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills.

ClinicalTrials.gov Identifier: NCT04541615.

• Metrics
• Proficiency-based progression
• Surgical training
• eLearning

• COVID-19
• Clinical Competence
• Computer-Assisted Instruction
• Curriculum
• Humans
• Pandemics
• Prospective Studies
• Robotic Surgical Procedures/education
• SARS-CoV-2

• education
• medical errors
• surgery

This study aimed to evaluate the use of binary metric-based (proficiency-based progression; PBP) performance assessments and global evaluative assessment of robotic skills (GEARS) of a robotic-assisted low anterior rectal resection (RA-LAR) procedure.

A prospective study of video analysis of RA-LAR procedures was carried out using the PBP metrics with binary parameters previously developed, and GEARS. Recordings were collected from five novice surgeons (≤30 RA-LAR previously performed) and seven experienced surgeons (>30 RA-LAR previously performed). Two consultant colorectal surgeons were trained to be assessors in the use of PBP binary parameters to evaluate the procedure phases, surgical steps, errors, and critical errors in male and female patients and GEARS scores. Novice and experienced surgeons were categorized and assessed using PBP metrics and GEARS; mean scores obtained were compared for statistical purpose. Also, the inter-rater reliability (IRR) of these assessment tools was evaluated.

Twenty unedited recordings of RA-LAR procedures were blindly assessed. Overall, using PBP metric-based assessment, a subgroup of experienced surgeons made more errors (20 versus 16, P = 0.158) and critical errors (9.2 versus 7.8, P = 0.417) than the novice group, although not significantly. However, during the critical phase of RA-LAR, experienced surgeons made significantly fewer errors than the novice group (95% CI of the difference, Lower = 0.104 – Upper = 5.155, df = 11.9, t = 2.23, p = 0.042), and a similar pattern was observed for critical errors. The PBP metric and GEARS assessment tools distinguished between the objectively assessed performance of experienced and novice colorectal surgeons performing RA-LAR (total error scores with PBP metrics, P = 0.019–0.008; GEARS scores, P = 0.029–0.025). GEARS demonstrated poor IRR (mean IRR 0.49) and weaker discrimination between groups (15–41 per cent difference). PBP binary metrics demonstrated good IRR (mean 0.94) and robust discrimination particularly for total error scores (58–64 per cent).

PBP binary metrics seem to be useful for metric-based training for surgeons learning RA-LAR procedures.

• Benchmarking
• Clinical Competence
• Colorectal Neoplasms
• Female
• Humans
• Male
• Prospective Studies
• Reproducibility of Results
• Robotic Surgical Procedures/education

• Colorectal Robotic Surgery Working Group
• European School of Coloproctology (ESC)
• European Society of Coloproctology (ESCP)
• Intuitive Surgical and Medtronic
• Medtronic
• AO Education Institute
• Arthroscopic Association of North America

• Dental education
• Dental operative skills training
• Preclinical skills
• Simulation-based training

• Objective Structured Assessment of Technical Skill
• Proficiency
• Simulation
• Surgery
• Training
• Urology

• Clinical Competence
• Computer Simulation
• Humans
• Internship and Residency
• Learning Curve
• Simulation Training/methods

• Department of Health
• Medical Research Council

• Epidural failure
• Implementation
• Labour analgesia
• Proficiency-based progression training

• Clinical Competence
• Education, Medical/methods
• Feedback
• General Surgery/education
• Humans
• Simulation Training/methods

• 3D printed models
• Eye tracking
• Machine learning
• Patient safety
• Proficiency-based progression
• Robotic-assisted surgery
• Surgical education
• Telementoring
• Training

• Education/methods
• Education/organization & administration
• Education, Distance/methods
• General Surgery/education
• Humans
• Inventions/trends
• Mentoring/trends
• Models, Anatomic
• Patient Safety
• Robotic Surgical Procedures/education
• Robotic Surgical Procedures/standards
• Robotic Surgical Procedures/trends
• Urology

• University College London (UCL)

To evaluate participant opinions on the appropriateness of different viewing angles by asking 8 questions, using visual content techniques.

Survey information from participants was used in this study. We used images of a patient who was operated on for symptomatic knee instability. Participants were asked whether the visual angle could determine the femoral tunnel entry point or evaluate anterior cruciate ligament (ACL) integrity.

Questionnaires were completed by 40 participants. When all responses were evaluated, participant opinions on the accessory medial portal (AMP) were more positive than opinions on images taken from the anterolateral portal (ALP). These observations were statistically significant (P < .005). Both ACL integrity assessments and femoral tunnel entry site questions were evaluated, we observed that participant opinions on the AMP for both types of evaluation were more positive than opinions on the ALP. This observation was statistically significant (P < .005). When evaluations with photos and video transcripts were compared, no significant differences in terms of participant opinions were observed (P < .005).

AMP use may be a valuable tool for assistant and postgraduate education, as it offers a more suitable view angle for ACL reconstruction.

Level V, survey study.

• #EndoUrology
• #PCSM
• #Prostate Cancer
• #uroonc
• construct validation
• proficiency-based metrics
• proficiency-based training
• robot-assisted radical prostatectomy
• surgical training

• Benchmarking
• Clinical Competence
• Consensus
• Humans
• Male
• Medical Errors/statistics & numerical data
• Prostatectomy/education
• Prostatectomy/methods
• Prostatectomy/standards
• Prostatic Neoplasms/surgery
• Robotic Surgical Procedures

To compare the effectiveness, in comparison to a control group (C), of module-based training (MBT) and traditional learning (TL) as a means of acquiring arthroscopic skills on an arthroscopic surgery simulator.

Thirty health sciences students with no previous arthroscopy experience were recruited and randomized into 1 of 3 groups: MBT, TL, or C (1:1:1 ratio). Participants in MBT were required to independently practice on a VirtaMed ArthroS simulator (VirtaMed AG, Zurich, Switzerland) for a minimum of 2 hours per week, whereas TL received one-on-one coaching by a senior orthopaedic resident for 15 minutes per week. The control group received no training. All groups were assessed at baseline and at 4 weeks based on objective measures generated by the surgical simulator (procedure time, camera path length, meniscus cutting score, detailed visualization, safety score and total score), and subjective ratings scales (Objective Assessment of Arthroscopic Skill [OAAS] global assessment form, and Competency-Based Assessment form).

Participants in the MBT group trained on average 113 min/week whereas the TL group trained on average 24 min/week. Three-way repeated-measures analysis of variance showed significant group by time interactions for procedure time (P = .006), camera path length (P = .008), safety score (P = .013), total score (P = .003), OAAS form (P < .001), and Competency-Based Assessment form (P < .001). MBT group was superior to C group for procedure time (P = .02), camera path length (P = .003), total score (P = .004), and OAAS form (P = .021), but there were no significant post-hoc differences between MBT and TL groups, or TL and C groups after Bonferroni correction. Total practice time explained 37.5% of the final simulator total score variance.

Knee arthroscopy simulation training with self-learning modules can improve skills in areas such as procedure time, camera path length, and total score in untrained participants compared with a control group.

Module-based simulation training provides additional training time and improves technical skills in naive health science students. It is hoped that this effect can be preserved and applied to junior resident developing in a busy residency program.

Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures.

To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale.

Controlled laboratory study.

Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests.

There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training (P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL (P = .0045) and VR (P = .0003), with no significant difference between the groups.

A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool.

There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.

• Arthroscopic Surgery Skill Evaluation Tool (ASSET)
• shoulder arthroscopy
• simulation training

• AA, abdominal aorta
• AP/PA, Anterior-Posterior/Posterior-Anterior
• CT, Computed Tomography
• CTV-N, Clinical Target Volume of the lymph node area
• CTV-T, Clinical Target Volume of the primary Tumor
• DICOM, Digital Imaging and Communications in Medicine
• DSC, Dice Similarity Coefficient
• Flank target volume
• GTVpre/post, pre- and postoperative Gross Tumor Volume respectively
• HR, High-Risk
• Highly-conformal radiotherapy
• IGRT, Image-Guided Radiotherapy
• IMRT, Intensity-Modulated Radiotherapy
• IR, Intermediate-Risk
• IVC, inferior vena cava
• Inter-clinician variation
• MRI, Magnetic Resonance Imaging
• OAR, organs at risk
• Pediatric renal tumors
• Quality assurance
• RT, radiotherapy
• RTOG, Radiation Oncology Group
• RTSG, Renal Tumor Study Group
• SIOP, International Society for Pediatric Oncology
• TVintersect, intersect target volume
• TVref, reference target volumes
• WT, Wilms’ tumor
• Wilms tumor
• n.a., not applicable
• part, participant
• ref, reference