Quick Shot III - Simulation / Teaching Methods
BUILDING A CURRICULUM FOR EMERGENCY ROBOT UNDOCKING: INITIAL FINDINGS OF INTERPROFESSIONAL TEAM TRAINING SIMULATION
Daniel P McGough, MD, Kalina Siehl, BS, Gabriella Plisko, BA, Michael A Deal, MD, Frances W Lee, DBA, CHSE, Ken R Catchpole, PhD, Kristie Wilson, BSN, RN, Betts Bishop, BSN, RN, Colleen A Donahue, MD, Catherine D Tobin, MD, CHSE, FASA, Douglas J Cassidy, MD; Medical University of South Carolina
PURPOSE: Robotic-assisted surgery is rapidly becoming more prevalent, and while emergency events are rare, there are no best practice guidelines or structured curricula for emergency robot undocking. This study aims to develop a comprehensive emergency undocking curriculum for robotic surgery teams through the thematic analysis of debriefing session transcripts following in situ simulation sessions.
METHODS: Interprofessional OR emergency robot undocking simulation scenarios were completed by 6 groups of general surgery attendings, general surgery residents, attending anesthesiologists, nurse anesthetists, and OR staff. Following each simulation, a debriefing session was held. These sessions focused on team interactions and overall performance. Debriefing sessions were audio-recorded, transcribed, deidentified, and independently, inductively coded by two members of the research team. Using the constant comparative method, a codebook was developed and refined until interrater reliability was confirmed with a kappa of >0.9. Codes were organized into higher-level themes.
RESULTS: There were 39 participants, including 6 attending surgeons, 7 general surgery residents, 5 attending anesthesiologists, 8 nurse anesthetists, and 13 OR staff. A total of 310 primary codes were collapsed into 24 coding categories. There were 6 emerging themes of the debriefing sessions: (1) Interprofessional Communication Strategies and Challenges with Robotic Surgery, (2) OR Setup, Infrastructure, Equipment, and Space Issues with Robotic Surgery, (3) Team Based Response and Collaboration, (4) Patient Acuity and Intraoperative Considerations, (5) Knowledge, Understanding, and Comfort with the Robotic Platform, (6) Benefits and Limitations of Interprofessional Simulation.
CONCLUSIONS: Interprofessional OR simulations and structured debriefing sessions provide insights into team dynamics and define the guidelines and roles essential for effective emergency undocking protocols. These sessions identified latent safety threats, inefficiencies, and team challenges, ultimately leading to the creation of an evidence-based, broadly applicable emergency undocking curriculum. This pilot curriculum will be trialed at a partner hospital with plans to repeat interprofessional simulations for evaluation and refinement of the curriculum.
PLAYBACK WITH A PURPOSE: IMPLEMENTING TRAUMA VIDEO REVIEW FOR LEADERSHIP DEVELOPMENT IN SURGICAL FELLOWSHIP TRAINING
Caitlin A Fitzgerald, MD, FACS1, Shawn Moore, EdD2, Mary Noory, MD3, Sejul A Chaudhary, MD, FACS2, Aaron Hudnall, DO2, David Trisler, DO2, Christina Regelsberger-Alvarez, DO2, Kenji Leonard, MD2, Nicole M Garcia, MD2, Michael R Bard, MD2, Mark A Newell2, Eric A Toschlog, MD2; 1Baylor College of Medicine, 2East Carolina University, 3Trinity Health of New England
Background: Leadership is a critical skill in trauma that is necessary to control the chaos of a resuscitation. However, leadership is a fluid and individualized concept that is not a routine part of fellowship training. Recently, trauma video review (TVR) has emerged as a powerful tool used to examine trauma resuscitations from performance improvement, quality improvement, research, and educational perspectives. To address the gap in leadership curriculum for trauma fellows, we examined whether an individualized approach utilizing TVR would improve fellows’ leadership skills and feelings of autonomy.
Methods: Trauma fellows at a level 1 trauma center participated in quarterly TVR sessions with pre-assigned trauma faculty. At the end of each session, three deliverables were created to track each fellow’s longitudinal progress throughout the year. Anonymous pre- and post-course surveys were completed by both the faculty and fellows utilizing a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). The survey assessed domains including comfort, autonomy, confidence, and the value of TVR. Descriptive statistics were used to summarize responses and thematic analysis of open-ended feedback was performed to identify recurring ideas.
Results: All participants (15) completed both the pre- and post-course surveys. When considering fellow comfort in leading a resuscitation, the mean comfort score increased from 3.75 ± 0.5 to 4.33 ± 0.6 post-intervention (p=0.21). Fellow satisfaction with autonomy also improved from 3.25 ± 0.5 to 4.0 ± 1.0 (p=0.24). Faculty confidence scores improved significantly when considering a 1st year fellow’s ability to lead a trauma in a stable patient (3.9 ± 0.7 vs. 4.78 ± 0.4, p=0.007), a 1st year fellow’s ability to lead a trauma in an unstable patient (2.7 ± 0.5 vs. 3.22 ± 0.4, p=0.03), and a 2nd year fellow’s ability to lead a trauma in an unstable patient (3.9 ± 0.6 vs. 4.45 + 0.7, p=0.04). 85% of participants agreed that the most effective part of the curriculum was the individualized approach.
Conclusion: Implementation of an individualized leadership curriculum using TVR improved fellow comfort and autonomy and also improved faculty confidence in fellow ability. TVR is a valuable educational tool that can enhance leadership training in graduate medical education.
MODELING SKILL ACQUISITION AND WORKLOAD REDUCTION ON A VIRTUAL LAPAROSCOPIC HIATAL HERNIA SIMULATOR
Sofia Garces Palacios, MD1, Bryanna Stukes1, Mark Ellis2, Apoorva Pise1, Alexis Desir, MD1, Kaustubh Gopal1, Doga Demirel, PhD3, Daniel J Scott, MD1, Carla Holcomb, MD4, Ganesh Sankaranarayanan, PhD1; 1UT Southwestern Medical Center, 2Florida Polytechnic University, 3University of Oklahoma, 4University of Utah Health Science Center
Introduction
The Virtual Laparoscopic Hiatal Hernia Simulator (VLaHHS) was developed as a high-fidelity, objective platform for training and assessment in laparoscopic crural repair, a technically demanding procedure. While building technical skill is a key goal in simulation-based training, managing cognitive workload equally important for effective learning. Tracking both skill improvement and workload reduction offers a more complete picture of learners’ progression and can inform curriculum design. This study examined how performance and perceived mental workload changed over time as participants trained on VLaHSS.
Methods
In this IRB approved randomized controlled trial, general surgery residents were randomly assigned to either a simulation or control group. All participants completed a pre-test, post-test, and retention-test on the simulator. The simulation group completed a three-week training on VLaHHS, while the control group received no additional training. Subjective workload was assessed using the NASA Task Load Index (NASA-TLX) at all test sessions and during training. Objective performance was automatically recorded by the simulator. A two-way mixed ANOVA was used to compare groups across test points. Generalized additive mixed models (GAMMs) were used to model non-linear changes in performance and workload over time, with trial as a smooth term and subject as a random effect.
Results
Six residents (n = 3 per group) completed the study. Mixed ANOVA analysis showed that the simulation group outperformed the control at post-test (p = 0.008) and retention (p < 0.001), with no difference at baseline (p = 0.82). GAMM analysis showed a progressive, non-linear reduction in perceived workload over trials (p < 0.001), with a significant individual variability (p = 0.013, R2=0.62). Simulator performance followed a U-shaped curve, with an initial performance decline during early trials (1-5), followed by steady improvement (p = 0.002, R² = .48).
Conclusion
Training on the VLaHHS revealed high initial technical and cognitive demands, followed by steady skill gains and continued workload reduction. These findings underscore the importance of assessing both performance and workload demand to better understand learning and guide simulation-based curriculum development.
