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IntroductionThere has been a constant increase in the number of published surgical videos with preference for open-access sources, but the proportion of videos undergoing peer-review prior to publication has markedly decreased, raising questions over quality of the educational content presented. The aim of this study was the development and validation of a standard framework for the appraisal of surgical videos submitted for presentation and publication, the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool.MethodsAn international committee identified items for inclusion in the LAP-VEGaS video assessment tool and finalised the marking score utilising Delphi methodology. The tool was finally validated by anonymous evaluation of selected videos by a group of validators not involved in the tool development.Results9 items were included in the LAP-VEGaS video assessment tool, with every item scoring from 0 (item not presented in the video) to 2 (item extensively presented in the video), with a total marking score ranging from 0 to 18. The LAP-VEGaS video assessment tool resulted highly accurate in identifying and selecting videos for acceptance for conference presentation and publication, with high level of internal consistency and generalisability.ConclusionsWe propose that peer review in adherence to the LAP-VEGaS video assessment tool could enhance the overall quality of published video outputs.Graphic Abstract

PurposeThe availability of children’s surgical care in lower middle-income countries is lacking. The authors describe a hub and spoke global training initiative in children’s surgery for adult teams from district hospitals (spokes) comprising general and orthopaedic surgeons, anaesthetists, and nurses and specialist children’s surgical trainers from tertiary centres (hubs) in delivering the course.MethodsThe training course developed in Vellore, trained several sets of district hospital adult teams and trainer teams in India. Six specialist children’s surgical trainer teams were invited from African countries to the course delivered in Vellore, India. The aim was to train them to deliver the course in their countries.ResultsParticipants underwent a precourse ‘train the trainer’ program, observed and assessed the suitability of the district hospital training course. The program received positive feedback, government supported planning of similar courses in some of the countries and discussions in others.ConclusionThe availability of children’s surgical care is similarly limited in the Asian and African continent, and the regions have shared challenges of disease burden, lack of access, poverty, deficient infrastructure, and trained human resources. They would benefit from this ‘South to South’ collaboration to impart training skills and modules to the children’s surgical trainers.

Background Paediatric surgery requires specialised skills, acquired through different traditional and newly applied training methods. However, there are several challenges in paediatric surgery training worldwide, especially among low- and middle-income countries (LMICs), due to limited resources and increased workload. Objectives This study introduces and evaluates a basic paediatric surgical skills course (BPSS), as a training model, in an attempt to standardise simulation-based training (SBT) in paediatric surgical education and evaluate its educational impact in an LMIC. Design A cross-sectional (observational) study was conducted on trainees who participated in two iterations of a paediatric surgical skills course. The course included a series of didactic lectures by consultants in paediatric surgery, followed each by a hands-on session, with a 1:2 instructor-to-trainee ratio. Data were collected through post-course structured assessment questionnaires distributed to the candidates directly after the course, regarding each surgical skill and the entire content of the course. Setting Data are presented from the first two delivered national workshops, held in October 2021 and May 2022, which took place at a specialised learning resource centre (comprising conference/lecture halls and dry/animal simulation training laboratories) of a university-based medical school campus and cluster of tertiary hospitals, hosting this training. A structured feedback system was used to assess the learning outcomes. Participants The study comprised 25 trainees in the early stages of surgical training, including aspiring paediatric surgeons (interns) and beginner/entry-level (junior) surgical residents. Results The evaluation showed a high level of satisfaction with the practical sessions among trainees, particularly in suturing and knotting, laparoscopic introduction, and ergonomics sessions. Overall, 96% of trainees found the practical training methods to be sufficient and effective, and the same percentage would recommend the course to their peers. Conclusion The structured training model of the BPSS course showed notable satisfaction levels and increased confidence in surgical open and laparoscopic skills gained. These results suggest that short, intensive training sessions can be highly effective in improving core paediatric surgical skills.

Background Surgical training curricula have changed little over the past decades. Current advances in surgical techniques, especially in minimally invasive surgery, as well as the rapidly changing socioeconomic environment pose a major challenge for the training of young surgeons. The aim of this survey was to provide a representative overview of the surgical training landscape in Switzerland focusing on laparoscopic surgical training: How do department chairs of teaching hospitals deal with the above challenges, and what should a future training curriculum look like? Methods This is a prospective, questionnaire-based, cross-sectional study among the heads of departments of all certified surgical teaching hospitals in Switzerland. Results The overall response rate was 56% (48/86) and 86% (19/22) for tertiary centers. Two-thirds of the centers (32) organize themselves in training networks. Laparoscopic training courses are offered in 25 (52%) hospitals, mainly in tertiary centers. Self-training opportunities exist in 40 (83%) hospitals. In addition to commercial (27) and self-built (7) box trainers, high-fidelity trainers are available in 16 (33%) hospitals. A mandatory training curriculum exists in 7 (15%) facilities, and a training assessment is performed in 15 (31%) institutions. Thirty-two (65%) heads of departments indicated that residents have sufficient practical exposure in the operating room, but the ability to work independently with obtaining the specialist title is seen critically (71%). They state that the surgical catalog does not adequately reflect the manual skills of the resident (64%). The desire is for training to be restructured from a numbers-based to a performance-based curriculum (53%) and for tools to assess residents' manual skills (56%) to be introduced. Conclusions Department chairs stated that the existing curriculum in Switzerland does not meet the requirements of a modern training curriculum. This study highlights the need to create an improved, competency-based curriculum that ensures the training of a new generation of surgeons, taking into account the growing evidence of the effectiveness of state-of-the-art training modalities such as simulation or proficiency-based training.

Background: Medical and surgical education is an expansive field fraught with many challenges. Technology such as virtual reality could be a new venue that can offer a solution to improve surgical training. Objective: The objective of this prospective, blinded study was to evaluate virtual reality as a training model for orthopedic surgery and surgical training at large. Methods: Fourth-year medical students with novice skills volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience in tibia intramedullary nail (IMN) surgery. They were randomized into traditional technique guide education and virtual reality. The participants were timed on their mock surgery, and a blinded observer was utilized to subjectively grade their performance throughout the procedure using the Global Assessment 5-point Rating Scale and Procedure-Specific Checklist. Results: Thirty-eight participants were recruited and randomized into virtual reality (19) and traditional (19) groups. There were trends in all categories favoring the virtual reality group. The VR group had improved time to completion (9.6 minutes vs 12.2 minutes, P = 0.034) and reduced need for corrections within the mock procedure (2.2 vs 2.5; P = 0.05). Conclusion: Virtual reality training was more effective than traditional training in learning and completing the steps of the tibia IMN surgery for novice medical students. Virtual reality training may be a useful method to augment orthopedic education and surgical training. Keywords: surgical training, virtual reality, traditional surgical training, operating room, mock procedures, comparative study

The human, financial, and infrastructural resources required to effectively treat invasive cancer of the cervix are grossly inadequate in the African region, inclusive of a paucity of surgeons capable of performing life-saving radical pelvic surgery for early-stage disease, and the requisite medical ecosystem (blood banking, anesthesia, laboratory, imaging, diagnostics, etc.) Death without treatment, therefore, is a common sequela of cervical cancer in Africa. As African American gynaecologic oncology sub-specialists working in Africa and its Diaspora, we set out to find a way to alter these circumstances. Herein, we provide an overview of our efforts and how they evolved into a novel method of training that rapidly builds surgical capacity for the treatment of early-stage cervical cancer in resource-constrained environments.

Telementoring studies found technical challenges in achieving accurate and stable annotations during live surgery using commercially available telestration software intraoperatively. To address the gap, a wireless handheld telestration device was developed to facilitate dynamic user interaction with live video streams. This study aims to find the perceived usability, ergonomics, and educational value of a first-generation handheld wireless telestration platform. A prototype was developed with four core hand-held functions: (1) free-hand annotation, (2) cursor navigation, (3) overlay and manipulation (rotation) of ghost (avatar) instrumentation, and (4) hand-held video feed navigation on a remote monitor. This device uses a proprietary augmented reality platform. Surgeons and trainees were invited to test the core functions of the platform by performing standardized tasks. Usability and ergonomics were evaluated with a validated system usability scale and a 5-point Likert scale survey, which also evaluated the perceived educational value of the device. In total, 10 people (9 surgeons and 1 senior resident; 5 male and 5 female) participated. Participants strongly agreed or agreed (SA/A) that it was easy to perform annotations (SA/A 9, 90% and neutral 0, 0%), video feed navigation (SA/A 8, 80% and neutral 1, 10%), and manipulation of ghost (avatar) instruments on the monitor (SA/A 6, 60% and neutral 3, 30%). Regarding ergonomics, 40% (4) of participants agreed or strongly agreed (neutral 4, 40%) that the device was physically comfortable to use and hold. These results are consistent with open-ended comments on the device's size and weight. The average system usability scale was 70 (SD 12.5; median 75, IQR 63-84) indicating an above average usability score. Participants responded favorably to the device's perceived educational value, particularly for postoperative coaching (agree 6, 60%, strongly agree 4, 40%). This study presents the preliminary usability results of a novel first-generation telestration tool customized for use in surgical coaching. Favorable usability and perceived educational value were reported. Future iterations of the device should focus on incorporating user feedback and additional studies should be conducted to evaluate its effectiveness for improving surgical education. Ultimately, such tools can be incorporated into pedagogical models of surgical coaching to optimize feedback and training.

Three-dimensional (3D) virtual modeling and printing advances individualized medicine and surgery. In congenital cardiac surgery, 3D virtual models and printed prototypes offer advantages of better understanding of complex anatomy, hands-on preoperative surgical planning and emulation, and improved communication within the multidisciplinary team and to patients. We report our single center team-learning experience about the realization and validation of possible clinical benefits of 3D-printed models in surgical planning of complex congenital cardiac surgery. CT-angiography raw data were segmented into 3D-virtual models of the heart-great vessels. Prototypes were 3D-printed as rigid “blood-volume” and flexible “hollow”. The accuracy of the models was evaluated intraoperatively. Production steps were realized in the framework of a clinical/research partnership. We produced 3D prototypes of the heart-great vessels for 15 case scenarios (nine males, median age: 11 months) undergoing complex intracardiac repairs. Parity between 3D models and intraoperative structures was within 1 mm range. Models refined diagnostics in 13/15, provided new anatomic information in 9/15. As a team-learning experience, all complex staged redo-operations (13/15; Aristotle-score mean: 10.64 ± 1.95) were rehearsed on the 3D models preoperatively. 3D-printed prototypes significantly contributed to an improved/alternative operative plan on the surgical approach, modification of intracardiac repair in 13/15. No operative morbidity/mortality occurred. Our clinical/research partnership provided coverage for the extra time/labor and material/machinery not financed by insurance. 3D-printed models provided a team-learning experience and contributed to the safety of complex congenital cardiac surgeries. A clinical/research partnership may open avenues for bioprinting of patient-specific implants.

The aim of this paper is to introduce readers to potential strategies available for teaching trabeculectomy surgery. Trainee surgical outcomes and various surgical simulation techniques are discussed, with suggestions on how to measure progress and consideration of relevant educational theories.

Background Evaluation tools for training programs vary, necessitating a standardized tool for assessing surgical clinical training quality to enhance program effectiveness, pinpoint improvement areas, and ensure resident readiness for independent practice. We present a new tool designed to provide a reliable and consistent framework for evaluating the effectiveness of surgical clinical training. Methods The Surgical Clinical Training Measurement (SCTM) was developed using the modified Delphi method to evaluate ten variables, including core competencies specific to surgical training. It employs a 5-point Likert scale, with scores ranging from 40 to 200. General surgery residents completed the SCTM twice to evaluate training levels. Results were categorized based on score ranges. Statistical analysis via SPSS included descriptive statistics, group comparisons, internal consistency assessments, correlations, and reliability tests to evaluate the SCTM scores, demographic characteristics, and language versions. ANOVA, Chi-Square, Cohen Kappa, and Spearman’s rho tests were employed for data analysis. Results 74 general surgery residents at Aleppo University Hospital have participated in this study. The SCTM scores indicated a mean total score of 131.42, with most residents falling into the good satisfactory category. Analysis showed no significant differences in total scores across specialty years, but post-hoc tests revealed differences between specific years. The SCTM demonstrated strong reliability, with a Kappa value of 0.884 indicating high agreement between English and Arabic versions ( p  < 0.05). Test-retest reliability was also high ( r  = 0.964, p  < 0.01). Internal consistency was excellent across various domains, reinforcing its validity in surgical education. The analysis of variables showed different levels of reliability and mean scores among the various factors. The Pre-Operative Clinical variable had the highest performance, while the Evidence-Based Quality Clinical Training variable indicated the most potential for improvement. The strong positive correlations between various domains of SCTM emphasize the interconnected nature of skill development, with proficiency in patient care closely linked to competency in other areas such as Medical Knowledge, Practice-based Learning and Improvement, and Evidence-Based Quality Clinical Training. Conclusion SCTM offers a standardized and cohesive method for evaluating the quality of surgical clinical training. It’s a valuable resource for program directors, educators, and residents to assess and enhance training programs, and identify specific areas for improvement. Additional research is required to validate the SCTM in different settings and explore its applicability in other fields. Clinical trial number Not applicable.