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Article ; Online: Assessment and application of non-technical skills in robotic-assisted surgery: a systematic review.

Mahendran, Vimaladhithan / Turpin, Laura / Boal, Matthew / Francis, Nader K

2024 Volume 38, Issue 4, Page(s) 1758–1774

Abstract: Background: Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in ... ...

Abstract	Background: Undeniably, robotic-assisted surgery (RAS) has become very popular in recent decades, but it has introduced challenges to the workflow of the surgical team. Non-technical skills (NTS) have received less emphasis than technical skills in training and assessment. The systematic review aimed to update the evidence on the role of NTS in robotic surgery, specifically focusing on evaluating assessment tools and their utilisation in training and surgical education in robotic surgery. Methods: A systematic literature search of PubMed, PsycINFO, MEDLINE, and EMBASE was conducted to identify primary articles on NTS in RAS. Messick's validity framework and the Modified Medical Education Research Study Quality Instrument were utilised to evaluate the quality of the validity evidence of the abstracted articles. Results: Seventeen studies were eligible for the final analysis. Communication, environmental factors, anticipation and teamwork were key NTS for RAS. Team-related factors such as ambient noise and chatter, inconveniences due to repeated requests during the procedure and constraints due to poor design of the operating room may harm patient safety during RAS. Three novel rater-based scoring systems and one sensor-based method for assessing NTS in RAS were identified. Anticipation by the team to predict and execute the next move before an explicit verbal command improved the surgeon's situational awareness. Conclusion: This systematic review highlighted the paucity of reporting on non-technical skills in robotic surgery with only three bespoke objective assessment tools being identified. Communication, environmental factors, anticipation, and teamwork are the key non-technical skills reported in robotic surgery, and further research is required to investigate their benefits to improve patient safety during robotic surgery.
MeSH term(s)	Humans ; Robotic Surgical Procedures/education ; Clinical Competence ; Awareness ; Communication ; Operating Rooms
Language	English
Publishing date	2024-03-11
Publishing country	Germany
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-024-10713-1
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Article ; Online: Evaluation status of current and emerging minimally invasive robotic surgical platforms.

Boal, M / Di Girasole, C Giovene / Tesfai, F / Morrison, T E M / Higgs, S / Ahmad, J / Arezzo, A / Francis, N

Surgical endoscopy

2023 Volume 38, Issue 2, Page(s) 554–585

Abstract: Background: The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" ...

Abstract	Background: The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework. Methods: A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature. Results: 21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0. Conclusions: The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.
MeSH term(s)	Humans ; Robotics ; Minimally Invasive Surgical Procedures ; Natural Orifice Endoscopic Surgery ; Gynecology ; Robotic Surgical Procedures ; Laparoscopy
Language	English
Publishing date	2023-12-20
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10554-4
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Article ; Online: The application of objective clinical human reliability analysis (OCHRA) in the assessment of basic robotic surgical skills.

Gorard, Jack / Boal, Matthew / Swamynathan, Vishaal / Ghamrawi, Walaa / Francis, Nader

Surgical endoscopy

2023 Volume 38, Issue 1, Page(s) 116–128

Abstract: Background: Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based ... ...

Abstract	Background: Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based assessment tool that provides in-depth analysis of individual technical errors. We conducted a feasibility study to assess the concurrent validity and reliability of OCHRA when applied to basic, generic robotic technical skills assessment. Methods: Selected basic robotic surgical skill tasks, in virtual reality (VR) and dry lab equivalent, were performed by novice robotic surgeons during an intensive 5-day robotic surgical skills course on da Vinci® X and Xi surgical systems. For each task, we described a hierarchical task analysis. Our developed robotic surgical-specific OCHRA methodology was applied to error events in recorded videos with a standardised definition. Statistical analysis to assess concurrent validity with existing tools and inter-rater reliability were performed. Results: OCHRA methodology was applied to 272 basic robotic surgical skills tasks performed by 20 novice robotic surgeons. Performance scores improved from the start of the course to the end using all three assessment tools; Global Evaluative Assessment of Robotic Skills (GEARS) [VR: t(19) = - 9.33, p < 0.001] [dry lab: t(19) = - 10.17, p < 0.001], OCHRA [VR: t(19) = 6.33, p < 0.001] [dry lab: t(19) = 10.69, p < 0.001] and automated VR [VR: t(19) = - 8.26, p < 0.001]. Correlation analysis, for OCHRA compared to GEARS and automated VR scores, shows a significant and strong inverse correlation in every VR and dry lab task; OCHRA vs GEARS [VR: mean r = - 0.78, p < 0.001] [dry lab: mean r = - 0.82, p < 0.001] and OCHRA vs automated VR [VR: mean r = - 0.77, p < 0.001]. There is very strong and significant inter-rater reliability between two independent reviewers (r = 0.926, p < 0.001). Conclusion: OCHRA methodology provides a detailed error analysis tool in basic robotic surgical skills with high reliability and concurrent validity with existing tools. OCHRA requires further evaluation in more advanced robotic surgical procedures.
MeSH term(s)	Humans ; Robotic Surgical Procedures/education ; Reproducibility of Results ; Clinical Competence ; Robotics/education ; Virtual Reality ; Computer Simulation
Language	English
Publishing date	2023-11-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10510-2
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Article ; Online: Evolution of practice in the management of parapneumonic effusion and empyema in children.

Griffith, D / Boal, M / Rogers, T

Journal of pediatric surgery

2018 Volume 53, Issue 4, Page(s) 644–646

Abstract: Aim: To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre.: Method: We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion ... ...

Abstract	Aim: To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre. Method: We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema between December 2006 and December 2015. Digital database searches were performed to identify demographic data, referring hospital, radiological and microbiological investigations. Length of stay and morbidity were analysed. Results: One hundred fifteen patients had 159 interventions over the study period. Fifty-four children were successfully treated with intercostal drainage (ICD) and urokinase fibrinolysis alone. There were 19 primary video assisted thoracoscopic surgeries (VATS) and 12 VATS after initial intercostal drains. Thirty-three children required a thoracotomy, a reduction of 26% from the previous era (p=0.009). The median length of stay was 9days (range 2-54). Conclusion: Parapneumonic effusion can be successfully treated with intercostal drainage and intrapleural fibrinolytics, but a proportion requires further surgical intervention. In our hospital, increased utilisation of fibrinolysis and VATS occurred with a corresponding decrease in the need for thoracotomy. Patients needing thoracotomy all had severe disease on ultrasound, but ultrasound did not reliably predict failure of fibrinolytic therapy. Level of evidence: III.
MeSH term(s)	Adolescent ; Chest Tubes/trends ; Chest Tubes/utilization ; Child ; Child, Preschool ; Combined Modality Therapy/trends ; Combined Modality Therapy/utilization ; Drainage/trends ; Drainage/utilization ; Empyema, Pleural/complications ; Empyema, Pleural/diagnosis ; Empyema, Pleural/therapy ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Infant ; Infant, Newborn ; Length of Stay/trends ; Male ; Pleural Effusion/complications ; Pleural Effusion/diagnosis ; Pleural Effusion/therapy ; Practice Patterns, Physicians'/trends ; Retrospective Studies ; Tertiary Care Centers ; Thoracic Surgery, Video-Assisted/trends ; Thoracic Surgery, Video-Assisted/utilization ; Thoracotomy/statistics & numerical data ; Thoracotomy/utilization ; Thrombolytic Therapy/trends ; Thrombolytic Therapy/utilization ; United Kingdom
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2018-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2017.07.017
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Article ; Online: Objective assessment tools in laparoscopic or robotic-assisted gynecological surgery: A systematic review.

Tesfai, Freweini Martha / Nagi, Jasleen / Morrison, Iona / Boal, Matt / Olaitan, Adeola / Chandrasekaran, Dhivya / Stoyanov, Danail / Lanceley, Anne / Francis, Nader

Acta obstetricia et gynecologica Scandinavica

2024

Abstract: Introduction: There is a growing emphasis on proficiency-based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The ... ...

Abstract	Introduction: There is a growing emphasis on proficiency-based progression within surgical training. To enable this, clearly defined metrics for those newly acquired surgical skills are needed. These can be formulated in objective assessment tools. The aim of the present study was to systematically review the literature reporting on available tools for objective assessment of minimally invasive gynecological surgery (simulated) performance and evaluate their reliability and validity. Material and methods: A systematic search (1989-2022) was conducted in MEDLINE, Embase, PubMed, Web of Science in accordance with PRISMA. The trial was registered with the Prospective Register of Systematic Reviews (PROSPERO) ID: CRD42022376552. Randomized controlled trials, prospective comparative studies, prospective single-group (with pre- and post-training assessment) or consensus studies that reported on the development, validation or usage of assessment tools of surgical performance in minimally invasive gynecological surgery, were included. Three independent assessors assessed study setting and validity evidence according to a contemporary framework of validity, which was adapted from Messick's validity framework. Methodological quality of included studies was assessed using the modified medical education research study quality instrument (MERSQI) checklist. Heterogeneity in data reporting on types of tools, data collection, study design, definition of expertise (novice vs. experts) and statistical values prevented a meaningful meta-analysis. Results: A total of 19 746 titles and abstracts were screened of which 72 articles met the inclusion criteria. A total of 37 different assessment tools were identified of which 13 represented manual global assessment tools, 13 manual procedure-specific assessment tools and 11 automated performance metrices. Only two tools showed substantive evidence of validity. Reliability and validity per tool were provided. No assessment tools showed direct correlation between tool scores and patient related outcomes. Conclusions: Existing objective assessment tools lack evidence on predicting patient outcomes and suffer from limitations in transferability outside of the research environment, particularly for automated performance metrics. Future research should prioritize filling these gaps while integrating advanced technologies like kinematic data and AI for robust, objective surgical skill assessment within gynecological advanced surgical training programs.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.14840
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Article ; Online: Peritoneal encapsulation; a rare cause of bowel obstruction.

Griffith, Dgl / Boal, M / Rogers, T

Annals of the Royal College of Surgeons of England

2017 Volume 99, Issue 1, Page(s) e11–e12

Abstract: Peritoneal encapsulation is a rare congenital cause of bowel obstruction in children. We present the case of a 12-year-old male with severe dehydration and recurrent episodes of vomiting. This pathology should be considered in cases of bowel obstruction ... ...

Abstract	Peritoneal encapsulation is a rare congenital cause of bowel obstruction in children. We present the case of a 12-year-old male with severe dehydration and recurrent episodes of vomiting. This pathology should be considered in cases of bowel obstruction with a virgin abdomen.
MeSH term(s)	Acalculous Cholecystitis/etiology ; Acalculous Cholecystitis/surgery ; Child ; Cholecystectomy/methods ; Humans ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Intestine, Small/diagnostic imaging ; Intestine, Small/surgery ; Laparotomy/methods ; Male ; Peritoneal Fibrosis/etiology ; Peritoneum/abnormalities ; Peritoneum/surgery ; Tissue Adhesions/congenital ; Tissue Adhesions/surgery ; Vomiting/etiology
Language	English
Publishing date	2017-01
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2016.0264
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Article ; Online: Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy.

Pasquali, S / Boal, M / Griffiths, E A / Alderson, D / Vohra, R S

The British journal of surgery

2016 Volume 103, Issue 1, Page(s) 27–34; discussion 34

Abstract: Background: The effectiveness of perioperative antibiotics in reducing surgical-site infection (SSI) and overall nosocomial infections in patients undergoing laparoscopic cholecystectomy for biliary colic and low- and moderate-risk cholecystitis (Tokyo ... ...

Abstract	Background: The effectiveness of perioperative antibiotics in reducing surgical-site infection (SSI) and overall nosocomial infections in patients undergoing laparoscopic cholecystectomy for biliary colic and low- and moderate-risk cholecystitis (Tokyo classification) is unclear. A systematic review and meta-analysis was performed to assess this. Methods: Searches were conducted of the MEDLINE, Embase and Cochrane databases. Only randomized clinical trials (RCTs) were included. The analysis was performed using the random-effects method, and the risk ratio (RR) with 95 per cent c.i. was employed. Results: Nineteen RCTs, published between 1997 and 2015, with a total of 5259 participants, of whom 2709 (51·5 per cent) were treated with antibiotics, were included. SSI and overall nosocomial infections were detected in 2·4 and 4·2 per cent respectively of patients given perioperative antibiotics, and in 3·2 and 7·2 per cent of those who received no antibiotics. Antibiotics did not significantly reduce the risk of SSI (RR 0·81, 95 per cent c.i. 0·58 to 1·13; P = 0·21) or overall nosocomial infections (RR 0·64, 0·36 to 1·14; P = 0·13). There was no significant between-study heterogeneity for SSI, but significant between-study heterogeneity in the eight studies that reported nosocomial infections. Analysis of studies considered to be high quality, grouped according to the timing of antibiotics (preoperative only or perioperative) and reporting intention-to-treat analyses, again failed to show a significant reduction in SSI. Conclusion: Antibiotics should not be administered before laparoscopic cholecystectomy in patients with biliary colic and/or low- and moderate-risk cholecystitis.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Cholecystectomy, Laparoscopic ; Cholecystitis/surgery ; Cross Infection/prevention & control ; Humans ; Models, Statistical ; Surgical Wound Infection/prevention & control
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2016-01
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.9904
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Evaluation of a Microsurgery Training Curriculum.

Cuteanu, Anita / Hellich, Agathe / Cardinal, Alba Le / Thomas, Maeve / Valchanova, Anna / Vara, Sital / Horbury, Gwynn / Boal, Matt / Ghamrawi, Walaa / Slim, Naim / Francis, Nader

Journal of reconstructive microsurgery

2022 Volume 39, Issue 8, Page(s) 589–600

Abstract: Background: Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim ... ...

Abstract	Background: Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model. Methods: A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact. Results: In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for "good." All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, Conclusion: Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.
MeSH term(s)	Humans ; Microsurgery/education ; Clinical Competence ; Curriculum ; Internship and Residency ; Learning Curve
Language	English
Publishing date	2022-12-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	605983-1
ISSN	1098-8947 ; 0743-684X ; 0743-684X
ISSN (online)	1098-8947 ; 0743-684X
ISSN	0743-684X
DOI	10.1055/a-2003-7689
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The Impact of Decaffeinated Green Tea Extract on Fat Oxidation, Body Composition and Cardio-Metabolic Health in Overweight, Recreationally Active Individuals.

Roberts, Justin D / Willmott, Ashley G B / Beasley, Liam / Boal, Mariette / Davies, Rory / Martin, Laurence / Chichger, Havovi / Gautam, Lata / Del Coso, Juan

Nutrients

2021 Volume 13, Issue 3

Abstract: This study investigated the effect of decaffeinated green tea extract (dGTE), with or without antioxidant nutrients, on fat oxidation, body composition and cardio-metabolic health measures in overweight individuals engaged in regular exercise. Twenty- ... ...

Abstract	This study investigated the effect of decaffeinated green tea extract (dGTE), with or without antioxidant nutrients, on fat oxidation, body composition and cardio-metabolic health measures in overweight individuals engaged in regular exercise. Twenty-seven participants (20 females, 7 males; body mass: 77.5 ± 10.5 kg; body mass index: 27.4 ± 3.0 kg·m
MeSH term(s)	Adiponectin/blood ; Adipose Tissue/drug effects ; Adult ; Antioxidants/administration & dosage ; Bilirubin/blood ; Blood Glucose/drug effects ; Body Composition/drug effects ; Body Mass Index ; Cardiometabolic Risk Factors ; Cholesterol/blood ; Double-Blind Method ; Energy Metabolism/drug effects ; Enzymes/blood ; Exercise/physiology ; Fatty Acids, Nonesterified/blood ; Female ; Glycerol/blood ; Humans ; Insulin/blood ; Leptin/blood ; Male ; Middle Aged ; Overweight/physiopathology ; Overweight/therapy ; Oxidation-Reduction/drug effects ; Oxygen Consumption/drug effects ; Plant Extracts/administration & dosage ; Tea
Chemical Substances	Adiponectin ; Antioxidants ; Blood Glucose ; Enzymes ; Fatty Acids, Nonesterified ; Insulin ; Leptin ; Plant Extracts ; Tea ; Cholesterol (97C5T2UQ7J) ; Glycerol (PDC6A3C0OX) ; Bilirubin (RFM9X3LJ49)
Language	English
Publishing date	2021-02-26
Publishing country	Switzerland
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu13030764
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Article: Evaluation of a Microsurgery Training Curriculum

Cuteanu, Anita / Hellich, Agathe / Cardinal, Alba Le / Thomas, Maeve / Valchanova, Anna / Vara, Sital / Horbury, Gwynn / Boal, Matt / Ghamrawi, Walaa / Slim, Naim / Francis, Nader

Journal of Reconstructive Microsurgery

2022 Volume 39, Issue 08, Page(s) 589–600

Abstract	Background: Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model. Methods: A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact. Results: In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for “good.” All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (chi square = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring 11 attempts on average to reach proficiency. In total, 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation, and actions to address them were implemented in the following programs. Conclusion: Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.
Keywords	microsurgery ; curriculum ; evaluation
Language	English
Publishing date	2022-12-23
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	605983-1
ISSN	1098-8947 ; 0743-684X ; 0743-684X
ISSN (online)	1098-8947 ; 0743-684X
ISSN	0743-684X
DOI	10.1055/a-2003-7689
Database	Thieme publisher's database

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In stock of ZB MED Cologne/Königswinter

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