Poster Session III - Simulation
(P017) VISUALIZATION AND EVALUATION OF TRAINEE'S PSYCHOMOTOR DYNAMICS DURING LAPAROSCOPIC TRAINING USING EEG DEVICE: A PILOT STUDY
Yu Sugiyama1, Shutaro Hori, MD, PhD2, Yasue Mitsukura, PhD3, Taira Shiono2, Akina Masuda1, Haruka Suzuki, PhD1, Tetsuya Toma, PhD, PMP1; 1Graduate school of System Design and Management, Keio University, 2Keio University School of Medicine, 3Faculty of Science and Technology, Keio University
Background
To evaluate surgical technique training methods for trainees, it is necessary to assess not only the content of the training and performance after the training but also the psychomotor dynamics of trainees while receiving the training. However, there have been limited applications to measure the learner's psychological state in real-time, and thus the psychomotor dynamics of the trainees during training have not been adequately evaluated. In this study, we used a simple EEG device "Kansei Analyzer®" to observe the psychomotor dynamics of learners during laparoscopic technique training.
Objective
To evaluate the psychomotor dynamics of trainees during laparoscopic technique training using a simple EEG.
Methods
We conducted an experiment with eight trainees (medical students and residents) who performed a laparoscopic simulator task, continuously moving multiple beads for one minute, repeated four times. During the training, the trainees wore a simple EEG device, "Kansei Analyzer®," and five psychological performance metrics—Like, Interest, Concentration, Calmness, and Stress—were measured every second. In the first three training sessions, the instructor consistently provided supportive verbal cues, while in the fourth session, negative verbal feedback was given upon unsuccessful attempts. We examined emotional changes associated with the success or failure of bead movement, as well as the relationship with the number of successful bead movements.
Results
Comparing the number of training sessions with the number of successes, there was a significant increase in the number of successes as the training progressed. When bead movement was successful, Interest increased, and when bead movement failed, Stress decreased, and Like increased. Additionally, even during failures, simultaneous increases in Stress and Interest, which are associated with short-term memory responses, were observed. The Like metric remained high even during failures, suggesting a potential contribution to skill improvement.
Conclusion
The psychological dynamics of learners during procedural training were visualized using the simple EEG (Kansei Analyzer®). This suggests that the simple EEG can objectively compare and evaluate the changes in trainee's psychological dynamics in response to various instructional methods.
(P018) ENTRUSTMENT OF GENERAL SURGERY RESIDENTS IN ROBOTIC SURGERY AND UTILITY OF A ROBOTIC PORTFOLIO TO PROMOTE PROSPECTIVE ENTRUSTMENT
Laura Washburn, MD1, Bethany A Hileman, BS1, Daniel R Bacon, MD2, Sean Whelan, MD, FACS1, Emily Huang, MD, MEd2; 1University of Pittsburgh (SSO), 2The Ohio State University
Introduction: Operative entrustment decisions are influenced by resident and faculty characteristics faculty and contextual factors. However, entrustment in the context of robotic surgery has not been well studied. This study aimed to identify how faculty surgeons approach resident entrustment decisions in robotic surgery, and the perceived impact of a resident robotic portfolio on prospective entrustment.
Methods: We conducted semi-structured interviews with surgical faculty who work with general surgery residents in robotic surgery. Purposive sampling identified faculty with varied specialties and years of experience. The research team developed a sample resident portfolio containing case numbers by type, simulation experience, and a representative case to highlight the resident’s percent console time and parts of the procedure performed. The portfolio was introduced after participants shared their typical entrustment process and was refined iteratively based on feedback. Interviews were transcribed verbatim and deidentified. Thematic analysis was conducted iteratively in an inductive fashion. Authors met frequently to develop codes and establish consensus on themes.
Results: Preliminary results include analysis from 7 academic-affiliated faculty surgeons with 2-16 years of experience and specialties of bariatrics, colorectal, and general surgery. Six themes influence entrustment of surgical residents in robotic surgery: faculty characteristics and philosophy, resident characteristics, interpersonal dynamics and trust, robotic technical proficiency, case context and approach, and strategies for progressive entrustment. Strategies for entrustment decisions include a structured approach of graduated autonomy in common cases, closely monitoring the resident’s robotic proficiency (bedside, technical skill, tissue handling, maintaining exposure), and continually assessing risk and progression of the case. The robotic approach, compared to laparoscopic or open, both facilitates and hinders resident entrustment in different ways. Faculty value the portfolio's objective case information, but case quantity might not correlate with robotic proficiency. Most faculty (5/7) perceived the portfolio as strongly helpful to make more informed entrustment decisions and to potentially increase their initial entrustment.
Conclusion: Our findings highlight factors influencing entrustment and strategies faculty use to entrust general surgery residents in robotic surgery. A portfolio with objective data is informative of a resident’s robotic experiences and could promote prospective entrustment of surgical residents.
(P020) A RANDOMIZED CONTROLLED TRIAL ASSESSING THE IMPACT OF COMMUNICATION SIMULATION TRAINING ON SURGICAL HANDOVER SKILLS IN MEDICAL STUDENTS
Cathleen McCarrick, BA, MB, BAO, BCh, MCH, M, Phil, Philip D McEntee, MB, BAO, BCh, Patrick A. Boland, MB, BAO, BCh, Suzanne Donnelly, MB, BAO, BCh, PhD, Helen Heneghan, MB, BAO, BCh, PhD, FRCS, Ronan A Cahill, MB, BAO, BCh, MD, PhD, FRCS; University College Dublin/ Mater Misericordiae Hospital
Introduction
Effective communication skills are integral to a physician's practice, especially in high-stakes environments like surgical handover. This study investigates the innovative application of Communication Simulation Training (CST) using the ISBAR tool to enhance these critical skills among final-year medical students. While ISBAR is widely recognized for ensuring clear communication and patient safety, our approach uniquely integrates simulation-based learning with peer reenactment and discussion—an aspect not extensively studied in this context. By assessing the impact of CST on students' communication abilities, we aim to provide new insights into how structured training can improve surgical handover practices and contribute to developing competent future healthcare professionals.
Methodology
With institutional ethical approval, CST was integrated into our undergraduate clinical surgery module. Students were randomly divided into two groups, all of whom were already familiar with the ISBAR framework. Prior to the intervention, each student was assessed on their communication skills using the externally validated Global Communication Rating Scale (GCRS) and adherence to ISBAR during a mock surgical handover, evaluated by an independent blinded senior clinician. Control students continued with standard clinical experiential learning, while the intervention group participated in CST, which included observing effective and ineffective surgical handover roleplays using ISBAR, followed by peer reenactment and discussion. Both groups underwent repeat assessments in the same week. Additionally, intervention group students completed surveys to anonymously report their confidence levels in communication before and after CST.
Results
A total of 132 students participated, with 68 undergoing CST. Mean GCRS scores were similar (p > 0.05) at baseline but significantly higher for CST-trained students (p < 0.01). Improvements were notable in the GCRS domains of initiation, verbal communication, session structuring, and information relay. Self-reported confidence levels increased significantly (2.93 vs. 3.96; p < 0.05, >80% response rate).
Conclusion
Communication Simulation Training significantly enhances students' communication abilities, particularly in surgical handover. This study is unique, combining CST with peer reenactment, which effectively reinforces learning and skill retention. The skills developed are transferable to other communication contexts, ensuring that soon-to-be-qualified doctors can proficiently articulate surgical patient situations, ultimately leading to improved patient care and safety.
(P021) ASSESSING THE IMPACT OF RESIDENCY TRAINING YEAR AND SURGICAL EXPERIENCE ON PERFORMANCE IN ROBOTIC SIMULATION FOR GENERAL SURGERY RESIDENTS
Chelsea Spector, MD, Stephanie Massimilian, MD, Jianli Niu, Omar Llaguna, MD; Memorial Healthcare System
INTRODUCTION
The integration of robotic simulation into surgical training has become increasingly prevalent, yet its effectiveness in correlating with residents’ performance has not been well investigated. This study investigates the relationship between performance on robotic simulators and both level of residency training and the number of actual surgical cases performed by general surgery residents.
METHODS
A cohort of general surgery residents was evaluated after completing six simulation exercises and one simulated cholecystectomy. A one-way ANOVA with post hoc testing was conducted to compare performance skills across residency training levels. Pearson’s correlation was used to assess the relationship between total cholecystectomy volume and the robotic cholecystectomy variables. The simulation exercises and cholecystectomy were evaluated based on six and four different metrics, respectively.
RESULTS
A significant negative correlation was observed between number of cholecystectomies performed and time taken for extraction during cholecystectomy simulation. However, other performance metrics, including the number of clutches, instances of being out of view, and total movements, did not demonstrate any correlation. When stratified by postgraduate year (PGY), no differences in performance metrics were evident across the groups.
Notably, significant differences emerged between PGY1 and PGY5 across five of the six simulation exercises. Specifically, in the ring exercise, PGY1 residents scored lower in total scores, time, and number of penalties compared to PGY5 residents. In the knot tying exercise, PGY1 residents also lagged behind PGY4 and PGY5 in terms of scores, time, economy, and penalties. In the rail track exercise, a significant difference in total scores was noted only between PGY1 and PGY5. The puzzle exercise revealed significant discrepancies in scores and penalties between PGY1 and PGY5, while the vessel sealing exercise showed differences in time and economy between PGY1 and PGY2. For the 4th arm cutting exercise, significant score differences were identified between PGY1 and PGY2, PGY3, and PGY4; however, no differences were noted in time, economy, or penalties.
CONCLUSION
The results indicate that both the level of training and operative experience considerably influence performance on robotic simulators among general surgery residents. This study underscores the potential of robotic simulation as an assessment tool in surgical training.
(P022) EFFECTIVENESS OF ASYNCHRONOUS FEEDBACK ON LAPAROSCOPIC SKILLS IMPROVEMENT: RESULTS FROM AN INTERNATIONAL MULTICENTER STUDY
Maria Elena Vial, MD, Sofia Abedrapo, MD, Diego Sanhueza, Gabriel Escalona, MD, Pablo Achurra, Milenko Grimoldi, MD, Fernando Crovari, MD, Cristian Jarry, MD, MSc, Julian Varas, MD, MSc; Center for Simulation and Experimental Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago Chile
INTRODUCTION
Simulation-based training is validated for acquiring laparoscopic skills, demonstrating efficacy in shortening learning curves. Most evidence is from in-person training involving direct feedback. Asynchronous feedback has been validated experimentally; however, real-world evidence remains limited. Our institution developed a validated remote advanced laparoscopic course (ALC), delivered across multiple countries via the "Lapp" platform. This study aims to elucidate the learning curves of students in this remote ALC under real-world conditions.
METHODS
Students from 20 centers,established in 10 countries who completed standarized ALC training sessions using “Lapp” platform were included. The course aims to develop proficiency in hand-sewn entero-enterostomy with ex-vivo bovine bowel. It consists of 18 sessions, 9 of which are recorded and analyzed by experts using OSATS score (25 points), procedural time (minutes), and a specific rating scale score (SRS; 20 points). Remote, asynchronous feedback was provided. T-student for paired samples was used for pre-post assessment of each variable. Demographic data were collected.
RESULTS
168 students completed the course since 2018, 36.36% female, 63.64% male, with an average age of 33.9 (SD: 7.08). Participants did the course mainly from Mexico (49.44%) and Chile (26.79%), with 37.25% general surgeons and 33.33% gynecologists. Learning curves were achieved. Initially, participants exhibited an OSATS and SRS score of 16.31 (SD: 2.7) and 12.26 (SD: 2.61), respectively, which significantly growth to 22.04 (SD: 2.29) and 18 (SD: 1.56) by the end of the course (p < 0.0001). The average anastomosis completion time also demonstrated significant improvement, starting at 44.32 minutes (SD: 13.29), which significantly decreased to 27.22 minutes (SD: 6.49) (p < 0.0001).
CONCLUSION
The remote ALC via “Lapp” platform significantly improved participants' procedural skills. Remote, asynchronous feedback effectively supported learning, as shown by significant improvements in time, OSATS, and SRS. These findings validate that the remote training approach by Quezada et al. (2019) and Gaete et al. (2023) is effective in practice. This analysis of about 15% of "Lapp" students, demonstrates its value in expanding laparoscopic education while ensuring high-quality learning outcomes