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Article ; Online: Simulation for Vascular Trainees.

Maguire, Seán C / Kavanagh, Dara O

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2021 Volume 61, Issue 6, Page(s) 1030–1031

MeSH term(s)	Computer Simulation ; Education, Medical, Graduate ; Humans ; Internship and Residency
Language	English
Publishing date	2021-05-02
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2021.03.025
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Article ; Online: End-of-shift surgical handover: mixed-methods, multicentre evaluation and recommendations for improvement.

Ryan, Jessica M / Simiceva, Anastasija / Eppich, Walter / Kavanagh, Dara O / McNamara, Deborah A

BJS open

2024 Volume 8, Issue 2

MeSH term(s)	Humans ; Patient Safety
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Multicenter Study ; Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrae023
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Article ; Online: Comment on: The impact of virtual-reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials.

Toale, Conor / Morris, Marie / Kavanagh, Dara O

BJS open

2022 Volume 6, Issue 6

MeSH term(s)	Humans ; Cholecystectomy, Laparoscopic ; Randomized Controlled Trials as Topic ; Simulation Training ; Virtual Reality
Language	English
Publishing date	2022-10-21
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac134
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Article ; Online: Perspectives on simulation-based assessment of operative skill in surgical training.

Toale, Conor / Morris, Marie / Kavanagh, Dara O

Medical teacher

2022 , Page(s) 1–8

Abstract: Introduction: The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to explore the factors associated with the acceptable use of SBA in surgical training, ... ...

Abstract	Introduction: The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to explore the factors associated with the acceptable use of SBA in surgical training, through the perceptions and experiences of a broad range of stakeholder representatives, building on findings from a review of the published literature. Materials and methods: Ten semi-structured interviews were conducted, using a sequential transformative qualitative methods approach, with representatives from identified key stakeholder groups; executive management, risk management, a practicing surgeon, an anaesthesiologist, a theatre-nursing representative, a representative from simulation industry, a patient, a medical student, a junior surgical trainee, and a senior surgical trainee. Interview transcripts underwent reflexive thematic analysis using an inductive and constructivist framework (NVIVO software, NVIVO 12, QSR International). Results: Four themes emerged: the 'need' for SBA, the concept of a 'minimum standard', the 'optimum design' of an SBA framework, and 'fairness'. SBA is a potential solution to challenges in the current training environment. It emerged that it should not replace trainer judgement, but could ensure that trainees meet a minimum operative competency standard. SBA should be used to identify underperforming trainees early in training to provide targeted remediation. The application of SBA in high-stakes settings such as trainee selection, autonomy granting, and end-of training certification has perceived benefits over current assessment methods. Conclusions: This study builds on findings from prior research to explore factors regarding the acceptable use of simulation as an assessment method in surgical training, including perspectives from a broad range of stakeholder representatives. Findings can inform the development of simulation-based assessment curricula in surgical training.
Language	English
Publishing date	2022-10-26
Publishing country	England
Document type	Journal Article
ZDB-ID	424426-6
ISSN	1466-187X ; 0142-159X
ISSN (online)	1466-187X
ISSN	0142-159X
DOI	10.1080/0142159X.2022.2134001
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Article ; Online: Training and assessment using the LapSim laparoscopic simulator: a scoping review of validity evidence.

Toale, Conor / Morris, Marie / Kavanagh, Dara O

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 1658–1671

Abstract: Introduction: The LapSim (Surgical Science, Sweden) laparoscopic simulator is a high-fidelity virtual reality simulator for use in endoscopic surgical training. This review critiques the current validity evidence for the LapSim laparoscopic simulator, ... ...

Abstract	Introduction: The LapSim (Surgical Science, Sweden) laparoscopic simulator is a high-fidelity virtual reality simulator for use in endoscopic surgical training. This review critiques the current validity evidence for the LapSim laparoscopic simulator, specifically with respect to its potential use as a tool and method of training and assessment in surgery. Methods: A scoping review of the MEDLINE (PubMed), EMBASE, Cochrane and Web of Science databases was conducted in accordance with PRISMA guidelines (2020)-scoping review extension. Articles were included if they presented validity evidence for the use of the LapSim in operative skill training or assessment, in accordance with Messick's validity framework. European Association of Endoscopic Surgeons (EAES) guidelines (2005) were used to provide recommendations for the use of the LapSim in operative performance training and assessments. Results: Forty-nine articles were included. An EAES level 2 recommendation was provided with regard to the internal consistency reliability of automated performance metrics in assessing performance. An EAES recommendation of 2 was awarded with respect to the ability of the LapSim to discriminate based on case volume and overall laparoscopic experience (relationships with other variables). Performance assessment metrics on the LapSim correlate with improved performance in the operating room (EAES level of recommendation 1-consequential validity). Conclusion: The LapSim has accumulated substantial evidence supporting the validity of its use in surgical training and assessment. Future studies should explore the relationship between the achievement of performance benchmarks on the LapSim and subsequent patient outcomes, and interrogate the benefits of implementing virtual reality simulation training and assessment curricula in post-graduate surgical training programmes.
MeSH term(s)	Humans ; Reproducibility of Results ; Computer Simulation ; Laparoscopy/education ; Education, Medical, Graduate/methods ; Internship and Residency ; Clinical Competence ; User-Computer Interface
Language	English
Publishing date	2022-09-19
Publishing country	Germany
Document type	Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09593-0
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Article ; Online: Assessing Operative Skill in the Competency-based Education Era: Lessons From the UK and Ireland.

Toale, Conor / Morris, Marie / Kavanagh, Dara O

Annals of surgery

2022 Volume 275, Issue 4, Page(s) e615–e625

Abstract: Introduction: Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to ... ...

Abstract	Introduction: Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods. Methods: A review of the MEDLINE (Pubmed), EMBASE and Cochrane Library databases was undertaken in accordance with the Joanna Briggs Institute Protocol for Scoping Reviews (2020). Articles were included if they provided evidence of the validity of procedure-based assessments, direct observation of procedural skills, or indicative operative number targets. The educational impact of each article was evaluated using a modified Kirkpatrick model. Results: Twenty-eight articles outlining validity evidence of WBAs and operative number targets were synthesised by narrative review. Five studies documented users' views on current assessment methods (Kirkpatrick level 1). Two articles recorded changes in attitudes towards current operative assessments (level 2a). Ten studies documented the ability of current assessments to record improvements in operative competence (level 2b). Ten studies measured a change in behaviour as a result of the introduction of these assessments (level 3). One article studied the ability of operative assessments to predict clinical outcomes (level 4b). Conclusions: Operative WBAs are reliable. Scores achieved correlate with both time spent in training and recorded operative experience. Trainers and residents have concerns regarding the subjectivity of these assessments and the opportunistic nature in which they are used. Operative number targets are not criterion-referenced, lack validity evidence, and may be set too low to ensure operative competence.
MeSH term(s)	Clinical Competence ; Competency-Based Education ; Educational Measurement/methods ; Humans ; Ireland ; Workplace
Language	English
Publishing date	2022-02-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005242
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Article ; Online: Training to proficiency in surgery using simulation: is there a moral obligation?

Toale, Conor / Morris, Marie / Kavanagh, Dara O

Journal of medical ethics

2022

Abstract: A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The 'learning curve' in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry ... ...

Abstract	A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The 'learning curve' in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.
Language	English
Publishing date	2022-01-06
Publishing country	England
Document type	Journal Article
ZDB-ID	194927-5
ISSN	1473-4257 ; 0306-6800
ISSN (online)	1473-4257
ISSN	0306-6800
DOI	10.1136/medethics-2021-107678
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Article ; Online: Defining operative experience targets in surgical training: A systematic review.

Toale, Conor / O'Byrne, Aisling / Morris, Marie / Kavanagh, Dara O

Surgery

2022 Volume 172, Issue 5, Page(s) 1364–1372

Abstract: Background: The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to ... ...

Abstract	Background: The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence. Methods: A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model. Results: Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b). Conclusion: Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.
MeSH term(s)	Clinical Competence ; General Surgery/education ; General Surgery/standards ; Humans ; Learning Curve ; Operative Time
Language	English
Publishing date	2022-08-26
Publishing country	United States
Document type	Journal Article ; Systematic Review ; Research Support, Non-U.S. Gov't
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2022.07.015
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Article ; Online: Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes.

Ryan, Jessica M / McHugh, Fiachra / Simiceva, Anastasija / Eppich, Walter / Kavanagh, Dara O / McNamara, Deborah A

BJS open

2024 Volume 8, Issue 2

Abstract: Background: Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical ... ...

Abstract	Background: Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and a modified quality assessment tool are also described. Methods: Ovid MEDLINE®, PubMed, Embase, and Cochrane databases were searched for articles up to April 2023. Comparative studies describing interventions for daily in-hospital surgical handovers between doctors were included. Studies were grouped according to their interventions and outcomes. Results: In total, 6139 citations were retrieved, and 41 studies met the inclusion criteria. The total patient sample sizes in the control and intervention groups were 11 946 and 11 563 patients, respectively. Most studies were pre-/post-intervention cohort studies (92.7%), and most (73.2%) represented level V evidence. The mean quality assessment score was 53.4% (17.1). A taxonomy of handover interventions and outcomes was developed, with interventions including handover tools, process standardization measures, staff education, and the use of mnemonics. More than 25% of studies used a document as the only intervention. Overall, 55 discrete outcomes were assessed in four categories including process (n = 27), staff (n = 14), patient (n = 12) and system-level (n = 2) outcomes. Significant improvements were seen in 51.8%, 78.5%, 58.3% (n = 9761 versus 9312 patients) and 100% of these outcomes, respectively. Conclusions: Most publications demonstrate that good-quality surgical handover improves outcomes and many interventions appear to be effective; however, studies are methodologically heterogeneous. These novel taxonomies and quality assessment tool will help standardize future studies.
MeSH term(s)	Humans ; Patient Handoff ; Hospitals
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Systematic Review ; Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrae011
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Article ; Online: A National Needs Assessment in Simulation Based Training in Vascular Surgery.

Maguire, Seán C / O'Callaghan, Adrian P / Traynor, Oscar / Strawbridge, Judith D / Kavanagh, Dara O

Journal of surgical education

2023 Volume 80, Issue 7, Page(s) 1039–1045

Abstract: Objectives: The aim of this research was to ascertain the highest need areas for vascular simulation, in order to tailor training for the highest impact.: Design, participants and setting: A needs assessment was conducted according to best practices ... ...

Abstract	Objectives: The aim of this research was to ascertain the highest need areas for vascular simulation, in order to tailor training for the highest impact. Design, participants and setting: A needs assessment was conducted according to best practices using the Delphi method. All consultant vascular surgeons/trainers in the training jurisdiction (n=33) were approached through an independent intermediary to contribute and generate a prioritized list of procedures for training. The research team were blinded to participant identities. Three rounds were conducted according to the Delphi process and scored according to the Copenhagen Needs Assessment Formula (CAMES-NAF). Results: A final list of 34 vascular procedures was selected and prioritized by surgical trainers. Principles of arterial repair and endarterectomy/patching were considered the highest priority. Complex major interventions such as open abdominal aortic aneurysm (AAA) repair, carotid endarterectomy, and endovascular aortic repair (EVAR) consistently ranked higher than rarer, such as first rib resection and more basic procedures, such as foam injection for varicose veins. Major lower limb amputations typically ranked lower overall compared to arterial interventions. Surgical trainers generally agreed with the ranking according to the CAMES-NAF. There was some disagreement for a select few procedures such as iliac stenting (which rose 13 places) and open radial artery exposure (which fell 6 places) on subsequent iterations. Conclusions: Core operative principles and common major operative cases should remain the priority for vascular technical skills training. Other procedures which may be less invasive, but have the potential for major complications should also not be overlooked. In designing simulators the main focus should center on specific skill acquisition for commonly performed major procedures and management of the recognized potential complications. Lower limb amputations are considered adequately taught in clinical practice, or are too challenging to simulate in simulator models apart from cadaveric models.
MeSH term(s)	Humans ; Needs Assessment ; Education, Medical, Graduate/methods ; Vascular Surgical Procedures/education ; Simulation Training ; Aortic Aneurysm, Abdominal/surgery ; Endovascular Procedures/education
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2023.05.005
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