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  1. Article ; Online: Telesimulation for remote simulation and assessment.

    Roach, Eileen / Okrainec, Allan

    Journal of surgical oncology

    2021  Volume 124, Issue 2, Page(s) 193–199

    Abstract: Telesimulation (TS), the process of using the internet to link educators and trainees at locations remote from one another, harnesses the powers of technology to enable access to high-quality simulation-based education and assessment to learners across ... ...

    Abstract Telesimulation (TS), the process of using the internet to link educators and trainees at locations remote from one another, harnesses the powers of technology to enable access to high-quality simulation-based education and assessment to learners across the globe. From its first uses in the teaching and assessment of laparoscopic skills to more recent interpretations during the current pandemic, TS has shown promise in helping educators to address pressing dilemmas in medical education.
    MeSH term(s) Education, Distance/methods ; Education, Medical, Graduate/methods ; Educational Measurement/methods ; Educational Technology ; Global Health ; Humans ; International Cooperation ; Internet ; Simulation Training/methods ; Specialties, Surgical/education
    Language English
    Publishing date 2021-07-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.26505
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    Zs.A 706: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Perceptions of the multidisciplinary operative team on intraoperative telecoaching among surgeons.

    Shafa, Golsa / Masino, Caterina / Madani, Amin / Okrainec, Allan

    Surgery open science

    2022  Volume 10, Page(s) 145–147

    Abstract: Telecoaching, intraoperative coaching through videoconference, has been suggested as a tool to overcome logistical barriers with in-person coaching. However, little is known about the operative team's perception of telecoaching and its unique set of ... ...

    Abstract Telecoaching, intraoperative coaching through videoconference, has been suggested as a tool to overcome logistical barriers with in-person coaching. However, little is known about the operative team's perception of telecoaching and its unique set of challenges. This qualitative study explores the perceptions of the multidisciplinary operative team on surgical telecoaching. A telecoaching program between peer surgeons was implemented using the Karl Storz Visitor1 remote presence system (Karl Storz, Germany). Semistructured interviews were conducted with the 12 operative team members present during 2 telecoaching sessions completed during the study period. Twelve participants were interviewed. The 4 central themes that emerged from the data were effective communication and collaboration, improving performance, operating room workflow, and culture and optics. Participating surgeon mentees reported that the session met expectations and learning goals and revealed concerns about negative perception of their autonomy and expertise by colleagues and patients. Conversely, team members unanimously reported a positive impression of surgeon mentees for taking additional measures to improve their performance and for patient outcomes. The operative team members reported that telecoaching was conducive to their own learning and relevant for complex cases. Considerations for future implementation of telecoaching include robust privacy standards for patients and staff, strong internet connectivity, coordinating with the operative team, and space constraints. Operative team participants viewed the intervention favorably and identified practical considerations for its continued use in an operating room environment. However, more work is needed on surgical culture as a contributor to low adoption and its impact on coaching programming activity.
    Language English
    Publishing date 2022-09-18
    Publishing country United States
    Document type Journal Article
    ISSN 2589-8450
    ISSN (online) 2589-8450
    DOI 10.1016/j.sopen.2022.09.003
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  3. Article ; Online: Virtual fundamentals of laparoscopic surgery (FLS) boot-camp using telesimulation: an educational solution during the COVID-19 pandemic.

    Ramadan, Khaled / Chaiton, Karen / Burke, Jaime / Labrakos, Dimitra / Maeda, Azusa / Okrainec, Allan

    Surgical endoscopy

    2023  Volume 37, Issue 5, Page(s) 3926–3933

    Abstract: Background: The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has ... ...

    Abstract Background: The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has organized an FLS boot-camp to teach PGY1 residents the FLS manual skills. During the COVID-19 pandemic, in-person sessions were not possible. The purpose of this study was to utilize telesimulation as an education solution for teaching FLS technical skills to PGY1 residents during the COVID-19 pandemic.
    Methods: A virtual FLS program was established. A complete, easily portable FLS kit was distributed to participants and instructors to set up an FLS box and connect remotely using telesimulation. The program was delivered by three senior residents using the Zoom™ platform. Participants were split into groups of 3-4 individuals, each receiving three 1-h sessions. Sessions were structured with initial demonstration of tasks followed by individual coaching of participants in 'break-out' rooms. The official FLS exam was administered in-person on the 4th week. Pre- and post-course surveys were administered to participants gauging self-reported proficiency with FLS tasks and overall course feedback. Anonymized FLS exam results were collected.
    Results: A total of 14 residents participated, and 11 responded to the survey. Participants reported that their overall FLS skills proficiency significantly improved on a 5-point likert scale from 1.5 ± 0.5 pre-course to 4.0 ± 0.5 post-course (mean ± SD). Participants unanimously stated that having the FLS box at home was valuable and enabled them to practice more. On the FLS exam, 13 of 14 participants passed the manual skills component.
    Conclusions: We developed a telesimulation hands-on FLS course as an alternative to in-person training. The course was practical and effective and was preferred to traditional methods by participants. With ever-expanding technological solutions, virtual telesimulation education is an attractive and underutilized tool, not only in the setting of COVID-19, but also more broadly across current educational programs.
    MeSH term(s) Humans ; Internship and Residency ; Pandemics ; Clinical Competence ; COVID-19/epidemiology ; Laparoscopy/education
    Language English
    Publishing date 2023-04-17
    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/s00464-023-09995-8
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  4. Article ; Online: An argument-based validation study of the fundamentals of laparoscopic surgery (FLS) program.

    Wagner, Maryam / Gomez-Garibello, Carlos / Seymour, Neal / Okrainec, Allan / Vassiliou, Melina

    Surgical endoscopy

    2023  Volume 37, Issue 7, Page(s) 5351–5357

    Abstract: Background: The Fundamentals of Laparoscopy Surgery (FLS) program was launched over 15 years ago. Since then, there has been an exponential rise in advancements of laparoscopy and its uses. In response, we conducted an argument-based validation study of ...

    Abstract Background: The Fundamentals of Laparoscopy Surgery (FLS) program was launched over 15 years ago. Since then, there has been an exponential rise in advancements of laparoscopy and its uses. In response, we conducted an argument-based validation study of FLS. The purpose of this paper is to exemplify this approach to validation for surgical education researchers using FLS as an illustrative case.
    Methods: The argument-based approach to validation involves three key actions: (1) developing interpretation and use arguments; (2) research; and (3) building a validity argument. Drawing from the validation study of FLS each step is exemplified.
    Results: Qualitative and quantitative data sources from the FLS validity examination study provided evidence that both supported claims, but also generated backing for rebuttals. Some of the key findings were synthesized in a validity argument to illustrate its structure.
    Discussion: The argument-based validation approach described numerous advantages over other validation approaches: (1) it is endorsed by the foundational documents in assessment and evaluation research; (2) its specific language of claims, inferences, warrants, assumptions and rebuttals provides a systematic and unified way to communicate both the processes and outcomes of validation; and (3) the use of logic reasoning in building the validity document clearly delineates the relationship between evidence and the inferences made to support desired uses and interpretations from assessments.
    MeSH term(s) Humans ; Clinical Competence ; Laparoscopy/education ; Educational Measurement
    Language English
    Publishing date 2023-03-30
    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/s00464-023-10020-1
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    Zs.A 2214: Show issues Location:
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  5. Article ; Online: The entrustable professional activities of laparoscopic surgery: moving toward an integrated training model.

    Gomez-Garibello, Carlos / Wagner, Maryam / Seymour, Neal / Okrainec, Allan / Vassiliou, Melina

    Surgical endoscopy

    2023  Volume 37, Issue 7, Page(s) 5335–5339

    Abstract: Background: Entrustable Professional Activities (EPAs) provide the opportunity to integrate multiple competencies into meaningful units that facilitate curriculum development and assessment design. As part of the process of reviewing and enhancing the ... ...

    Abstract Background: Entrustable Professional Activities (EPAs) provide the opportunity to integrate multiple competencies into meaningful units that facilitate curriculum development and assessment design. As part of the process of reviewing and enhancing the Fundamentals of Laparoscopic of Surgery (FLS) program, we used the concept of EPAs to create a framework of reference that articulates a contemporary definition of Laparoscopic Surgery (LS).
    Methods: The framework of reference of LS was created with data gathered from a literature review and during series of educational retreats with subject matter experts (SMEs). Various activities were implemented during these retreats to develop the LS EPAs, their constitutive competencies, and related observable behaviors.
    Results: Ten EPAs and associated competency descriptors (articulated as observable behaviors) specific to LS were identified. In addition, knowledge areas were associated to each EPA.
    Discussion: A comprehensive list of EPAs for LS were identified. These EPAs will be used in the development and update of the FLS program. Further, they can be used to guide the development of curriculum, clinical teaching, and assessment in any surgical program with a laparoscopic training component. They are applicable to any level of training by defining the expected observable behaviors associated with a given level of expertise. These fundamental aspects of LS provide a common framework of reference across different surgical specialties.
    MeSH term(s) Humans ; Competency-Based Education ; Curriculum ; Educational Measurement ; Clinical Competence ; Internship and Residency
    Language English
    Publishing date 2023-03-29
    Publishing country Germany
    Document type Review ; Journal Article ; 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/s00464-023-10022-z
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    Zs.A 2214: Show issues Location:
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  6. Article ; Online: Weight loss outcomes for patients undergoing conversion to Roux-en-Y-gastric bypass after sleeve gastrectomy.

    Roach, Eileen / Laplante, Simon / Stogryn, Shannon / Maeda, Azusa / Jackson, Timothy / Okrainec, Allan

    Surgical endoscopy

    2022  Volume 37, Issue 4, Page(s) 3208–3214

    Abstract: Background: Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes ... ...

    Abstract Background: Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes for patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) after previous LSG are variable. We sought to determine the weight-loss outcomes of patients undergoing LRYGB after LSG in the largest bariatric surgical network in Canada and to determine whether outcomes differ according to indications for conversion.
    Methods: The Bariatric Registry is a multi-center database with prospectively collected standardized data on patients undergoing bariatric surgery at ten Bariatric Centers of Excellence within the Ontario Bariatric Network in Ontario, Canada. A retrospective analysis was performed of patients who underwent LRYGB after previous LSG between 2012 and 2019. Weight loss outcomes were compared between patients who underwent LRYGB for insufficient weight loss/weight regain and those who underwent conversion to LRYGB for other reasons.
    Results: Excluding patients with multiple revisions and those without follow-up data, 48 patients were included in the analysis: 33 patients (69%) underwent conversion to LRGYB for insufficient weight loss/weight regain (Group 1) and 15 patients (31%) underwent conversion for other reasons (Group 2). Mean body mass index (BMI) measured pre-LSG, pre-LRYGB, and at mid-term follow-up after LRYGB was 61, 48, and 43 kg/m
    Conclusions: Conversion to LRYGB after previous LSG resulted in an additional loss of 4 kg/m
    MeSH term(s) Humans ; Gastric Bypass ; Retrospective Studies ; Gastrectomy ; Ontario ; Weight Loss ; Weight Gain
    Language English
    Publishing date 2022-08-18
    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/s00464-022-09506-1
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    Zs.A 2214: Show issues Location:
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  7. Article ; Online: Training for excellence: using a multimodal videoconferencing platform to coach surgeons and improve intraoperative performance.

    Shafa, Golsa / Kiani, Parmiss / Masino, Caterina / Okrainec, Allan / Pasternak, Jesse D / Alseidi, Adnan / Madani, Amin

    Surgical endoscopy

    2023  Volume 37, Issue 12, Page(s) 9406–9413

    Abstract: Introduction: Continuing Professional Development opportunities for lifelong learning are fundamental to the acquisition of surgical expertise. However, few opportunities exist for longitudinal and structured learning to support the educational needs of ...

    Abstract Introduction: Continuing Professional Development opportunities for lifelong learning are fundamental to the acquisition of surgical expertise. However, few opportunities exist for longitudinal and structured learning to support the educational needs of surgeons in practice. While peer-to-peer coaching has been proposed as a potential solution, there remains significant logistical constraints and a lack of evidence to support its effectiveness. The purpose of this study is to determine whether the use of remote videoconferencing for video-based coaching improves operative performance.
    Methods: Early career surgeon mentees participated in a remote coaching intervention with a surgeon coach of their choice and using a virtual telestration platform (Zoom Video Communications, San Jose, CA). Feedback was articulated through annotating videos. The coach evaluated mentee performance using a modified Intraoperative Performance Assessment Tool (IPAT). Participants completed a 5-point Likert scale on the educational value of the coaching program.
    Results: Eight surgeons were enrolled in the study, six of whom completed a total of two coaching sessions (baseline, 6-month). Subspecialties included endocrine, hepatopancreatobiliary, and surgical oncology. Mean age of participants was 39 (SD 3.3), with mean 5 (SD 4.1) years in independent practice. Total IPAT scores increased significantly from the first session (mean 47.0, SD 1.9) to the second session (mean 51.8, SD 2.1), p = 0.03. Sub-category analysis showed a significant improvement in the Advanced Cognitive Skills domain with a mean of 33.2 (SD 2.5) versus a mean of 37.0 (SD 2.4), p < 0.01. There was no improvement in the psychomotor skills category. Participants agreed or strongly agreed that the coaching programs can improve surgical performance and decision-making (coaches 85%; mentees 100%).
    Conclusion: Remote surgical coaching is feasible and has educational value using ubiquitous commercially available virtual platforms. Logistical issues with scheduling and finding cases aligned with learning objectives continue to challenge program adoption and widespread dissemination.
    MeSH term(s) Humans ; Surgeons/education ; Mentoring ; Learning ; Educational Status
    Language English
    Publishing date 2023-09-05
    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/s00464-023-10374-6
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  8. Article ; Online: Relationship between dietary intake components and hepatic fibrosis in those with obesity before and 1 year after bariatric surgery.

    Schwenger, Katherine J P / Ghorbani, Yasaman / Rezaei, Kuorosh / Fischer, Sandra E / Jackson, Timothy D / Okrainec, Allan / Allard, Johane P

    Nutrition (Burbank, Los Angeles County, Calif.)

    2023  Volume 114, Page(s) 112095

    Abstract: Objectives: Non-alcoholic fatty liver disease is highly prevalent in the bariatric population but not all patients develop liver fibrosis. Considering that fibrosis may affect clinical outcomes, it is important to assess and treat contributing factors. ... ...

    Abstract Objectives: Non-alcoholic fatty liver disease is highly prevalent in the bariatric population but not all patients develop liver fibrosis. Considering that fibrosis may affect clinical outcomes, it is important to assess and treat contributing factors. In this population, it is not clear whether dietary intake is a contributor. The objective was to determine the relationship between dietary intake components and liver fibrosis before and 1 y after Roux-en-Y gastric bypass (RYGB).
    Methods: This was a prospective cross-sectional (n = 133) study conducted between 2013 and 2022. In addition, a subgroup of 44 patients were followed for 1 y post-RYGB. Anthropometrics, biochemical measurements, and 3-d food records and liver biopsies were obtained presurgery and, in a subgroup of patients, as for the cohort, 1 y post-RYGB.
    Results: In the cross-sectional study, 78.2% were female, with a median age of 48 y and body mass index of 46.8 kg/m
    Conclusions: In bariatric patients before surgery, higher age, alanine transaminase, and total calorie and lower copper intakes were independent risk factors associated with liver fibrosis. These relationships were no longer observed after RYGB, likely due to the effect of surgery on weight and similar postsurgery diet among patients.
    MeSH term(s) Humans ; Female ; Male ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/etiology ; Alanine Transaminase ; Prospective Studies ; Copper ; Obesity/etiology ; Bariatric Surgery/adverse effects ; Gastric Bypass/adverse effects ; Liver Cirrhosis/etiology ; Liver Cirrhosis/surgery ; Eating ; Obesity, Morbid/complications ; Obesity, Morbid/surgery
    Chemical Substances Alanine Transaminase (EC 2.6.1.2) ; Copper (789U1901C5)
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639259-3
    ISSN 1873-1244 ; 0899-9007
    ISSN (online) 1873-1244
    ISSN 0899-9007
    DOI 10.1016/j.nut.2023.112095
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  9. Article: Adult-onset autoimmune-type enteropathy: potential relationship to an adverse drug reaction.

    Chetty, Runjan / Cino, Maria / Okrainec, Allan

    BMJ open gastroenterology

    2019  Volume 6, Issue 1, Page(s) e000319

    Abstract: Objective: To describe an example of adult-onset autoimmune enteropathy (AIE) that coincided with drug-induced reaction.: Design: A 54-year-old patient was presented with Stevens-Johnson syndrome after a course of quinolones. This was followed ... ...

    Abstract Objective: To describe an example of adult-onset autoimmune enteropathy (AIE) that coincided with drug-induced reaction.
    Design: A 54-year-old patient was presented with Stevens-Johnson syndrome after a course of quinolones. This was followed shortly thereafter by epigastric pain, diarrhoea and weight loss. She also developed an autoimmune neutropenia.
    Results: Several biopsies were performed from the upper and lower gastrointestinal tract (GIT). The duodenal biopsies showed intraepithelial lymphocytosis; therefore, coeliac disease was considered. However, confirmatory serology was negative and the patient did not respond to a gluten-free/gliadin-free diet. Both upper and lower GIT biopsies consistently showed an absence of goblet cells resembling the changes of an AIE.
    Conclusion: This is an unusual case of autoimmune-pattern enteropathy in an adult that was potentially drug-induced.
    Language English
    Publishing date 2019-12-02
    Publishing country England
    Document type Case Reports
    ISSN 2054-4774
    ISSN 2054-4774
    DOI 10.1136/bmjgast-2019-000319
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  10. Article ; Online: Feasibility of remote administration of the fundamentals of laparoscopic surgery (FLS) skills test using Google wearable device.

    Nikouline, Anton / Jimenez, M Carolina / Okrainec, Allan

    Surgical endoscopy

    2019  Volume 34, Issue 1, Page(s) 443–449

    Abstract: Background: The fundamentals of laparoscopic surgery (FLS) program is a simulation-based training program designed to teach and assess the basic skills necessary for laparoscopic surgery. Preliminary work has demonstrated the feasibility of using Skype™ ...

    Abstract Background: The fundamentals of laparoscopic surgery (FLS) program is a simulation-based training program designed to teach and assess the basic skills necessary for laparoscopic surgery. Preliminary work has demonstrated the feasibility of using Skype™ as a telesimulation modality in reliably scoring the exam for remote centers. Google Glass (GG) (Mountain View, California) is referred to as a wearable computer containing a heads-up display and front-facing camera allowing point-of-view video transmission. The objective of this study was to evaluate the feasibility of GG in scoring the technical skills component of the FLS exam.
    Methods: Twenty-eight participants were asked to complete the peg transfer and intracorporeal knot tasks of FLS using both GG and Skype™ setups. GG employed a third-party HIPAA-compliant video software (Pristine; Austin, TX) for video transmission. Participants were alternated between setups and evaluated by onsite and remote proctors. Times and errors were recorded by both proctors. Interrater reliability of their FLS scores was compared using Intraclass Correlation Coefficients (ICCs). GG experience was evaluated based on participant survey responses using a 5-point Likert scale.
    Results: Interrater reliability for GG demonstrated a statistically significant correlation between onsite (OP) and remote (RP) proctors with ICCs of 0.985 (95% Confidence Interval [CI], 0.969-0.993) and 0.997 (95% CI 0.993-0.998), respectively, for peg and suture tasks. Skype™ demonstrated ICCs of 1.0 (95% CI 1.0-1.0). Average Likert scale responses found GG to be distracting (2.71), obstructive of the view (2.79), and a limitation to task execution (2.75). Overall, there was no statistical difference in scores between GG and Skype™ setups for either the peg (t = 1.446, p = 0.154) or suture task (t = - 0.710, p = 0.480), only 1 participant found the use of GG superior to Skype™.
    Conclusions: Our findings suggest that although GG are feasible in remote assessment of FLS with strong interrater reliability (ICC > 0.95), Skype™ was the preferred modality.
    MeSH term(s) Adult ; Canada ; Clinical Competence ; Education, Distance ; Feasibility Studies ; Female ; Humans ; Laparoscopy/education ; Male ; Pilot Projects ; Reproducibility of Results ; Simulation Training/methods ; Wearable Electronic Devices
    Language English
    Publishing date 2019-04-29
    Publishing country Germany
    Document type Journal Article ; 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/s00464-019-06788-w
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