Quick Shot III - Simulation / Teaching Methods
(Q019) 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.
(Q020) DESCRIBING THE IMPACT OF A NON-TECHNICAL SKILLS TRAINING COURSE ON GENERAL AND PEDIATRIC SURGICAL TEAMS IN SOUTHERN MALAWI
Palesa Chisala-Chabunya, Dr1, Abahuje Egide, Dr2, Robert Riviello, PhD, MPH3, Barnabas Alayande, Dr4, Wendy Williams3, Wyness Gondwe, PhD, RN5, Steven Yule, PhD6; 1Queen Elizabeth Central Hospital, 2University of Michigan, 3Mass General Brigham, 4University of Global Health equity, Rwanda, 5Kamuzu Univesity of Health Sciences, 6University of Edinburgh
Background
Non-technical skills (NTS),defined as the cognitive and interpersonal skills that underpin medical knowledge and technical skills, characterize high-performing teams in the operating rooms. NTS are essential for the delivery of safe perioperative patient care. However, in Low and Middle Income Countries, operating room personnel have limited exposure to NTS education during their training. A NTS course was therefore conducted with the aim of improving NTS among general and pediatric surgical teams at a tertiary teaching hospital in Malawi.
Methods:
Two one-day contextualized NTS training courses were delivered to general and pediatric surgical teams. Pre- and post-course tests were administered to course participants to assess knowledge acquisition (January 2025). In-person interviews were conducted three months pre-course and post-course to identify perceptions of changes in surgical safety culture and practice. Descriptive statistics were used to report the average NTS knowledge before and after the course. Unpaired T-test was conducted to compare pre and post course scores. Interviews were audio recorded transcribed verbatim, de-identified, and thematically analyzed in Atlas.ti 9 software, using inductive coding techniques in a reflexive, iterative analytic process. Themes were co-developed and refined by a multiprofessional research team with regional operative experience.
Results:
Eighty-eight participants attended the course with 76 (86%) completing the pre-course knowledge assessment and 77 (88%) completing the post-course assessment. The mean test score increased from 60.7% pre-course to 74.3% post-course (p <0.001). Twenty-six participants participated in the post course interviews. When comparing their perceptions before taking the course, and after taking the NTS course, participants reported that there was : 1) improved perception of psychological safety and feelings of empowerment, especially among nurses and non-physicians; 2) improved team dynamics and communication (e.g. decreased stereotyping, increased use of closed loop communication); 3) more frequent and effective use of the WHO Surgical Safety Checklist (SSC); 4) improved preoperative preparation including more strategic and cadre-inclusive resource planning.
Conclusion:
This adapted and contextualized NTS training course improved participants’ knowledge of NTS. The Non-technical skills course was perceived to improve psychological safety and team empowerment, and the effective use of the SSC.
Disclosure: This study was funded by the Johnson & Johnson Foundation
(Q021) WHO IS GOING TO STRUGGLE?: RELATIONSHIP BETWEEN AMERICAN COLLEGE OF SURGEONS OBJECTIVE STRUCTURED CLINICAL EXAM SCORE AND OTHER MARKERS OF INTERN PERFORMANCE
Brielle Warnock, MD, Nathan Behrens, MD, Noosha Deravi, MD, MiMi Arrington, MS, Amy Holmstrom, MD, Dimitrios Stefanidis, MD, PhD, E. Matthew Ritter, MD, MHPE; Indiana University School of Medicine
Background
The American College of Surgeons (ACS) developed an Objective Structured Clinical Exam (OSCE) in 2008 to assess the clinical knowledge and skills of entering surgical interns. There is little information regarding the relationship between OSCE performance and other measures of performance in residency. We sought to determine the relationship of OSCE scores with intern clinical knowledge and communication skills later in the year.
Methods
Data from categorical and preliminary general surgery interns on five of the ten available OSCE stations were retrospectively analyzed from 2020-2024 at a single academic center. The relationship of OSCE performance scores and intern year American Board of Surgery In training Exam (ABSITE) scores, communication scores on end-of-rotation evaluations (scale from 1-5), and need for a performance improvement plan was analyzed. OSCE scores are reported as a percentage correct based on checklist scoring.
Results
A total of 49 interns were included, 67% female and 79% categorical. There was no difference in mean OSCE performance among the six interns who were later placed on an improvement plan and those who were not (68.2+/-5.2 vs 68.5+/-5.1, respectively; p=0.9). There was no meaningful association between overall OSCE score and ABSITE score (r=0.04) or between a combined diagnosis and management OSCE score and ABSITE score (r= -0.08). Mean OSCE communication scores did not differ discernably between interns with rotation evaluation communication scores below 2 compared to 2 or above (90.1+/-7.2 vs 92.6+/-6.7, respectively; p=0.25).
Conclusion
Performance on the ACS OSCE for entering surgical interns did not show a meaningful relationship with other measures of performance during intern year, including the need for a performance improvement plan. The role of the ACS OSCE for entering surgical interns needs further evaluation.
(Q022) 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.
(Q024) FROM LOW-COST PROTOTYPES TO HIGH-FIDELITY MODELS: A THREE-YEAR ITERATIVE DEVELOPMENT FOR TAPP HERNIA TRAINING
Bernardita Becker, MD1, Jose Rui-Wamba, MD1, Noelia Salgado, MD1, Enzo Castiglioni, MD1, Michelle Grunauer, MD1, Sofia Abedrapo, MD2, Urusla Figueroa, MD1, Maria Ines Gaete, MD1, Pablo Achurra, MD1, Julian Varas, MD, MSc1; 1Pontificia Universidad Católica de Chile, 2Universidad de Chile
Introduction
Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernioplasty is an anatomy-dependent technique that requires precise anatomical orientation and safe execution of three steps: opening and dissection of the peritoneal flap, mesh placement, and flap closure. Although several simulators have been described, most lack realistic anatomy, standardized 30° laparoscopic geometry, or a structured stepwise design. Furthermore, the ergonomics required for TAPP hernia repair differ significantly from those practiced in most traditional laparoscopic training boxes, representing an essential but often overlooked element of TAPP simulation training. Evidence of effective skill transfer to the operating room (OR) remains limited, underscoring the need for complementary, low-cost, and high-fidelity models that bridge the gap between technical training and anatomical realism.
Methods
Between 2022-2025, multiple design–build–test cycles were conducted at our simulation center and during international meetings. A total of 20 surgeons and residents participated in structured Likert-scale (1–5) evaluations assessing anatomical accuracy, ergonomics, and educational value. Early feedback identified missing landmarks, such as the anterior superior iliac spine, bladder dome, rectus abdominis, psoas, and Cooper’s ligament, as well as suboptimal trocar alignment and viewing angles. Later iterations refined geometry, optical orientation, and the color, transparency, and viscoelastic consistency of the peritoneum and preperitoneal fat to improve dissection realism. In parallel, a set of low-cost submodels was created to allow step-by-step practice of flap creation, mesh positioning, and peritoneal closure.
Results
The final high-fidelity simulator accurately reproduces the myopectineal orifice, the triangle of doom, the triangle of pain, and Hesselbach’s triangle, as well as realistic peritoneal and preperitoneal planes. Experts rated anatomical fidelity (median = 4.8), tissue realism (4.7), and educational usefulness (4.9) as high or very high. Ergonomics, particularly camera orientation and instrument triangulation, received a median score of 4.6. The low-cost models were also favorably rated (mean = 4.5) for design feasibility and training relevance.
Conclusion
After several design iterations incorporating expert feedback, we developed anatomically realistic, complementary models; one high-fidelity and two low-cost prototypes, that enabled focused practice of each TAPP step under authentic ergonomic and optical conditions, establishing the groundwork for a future structured hernia training course.
(Q025) WHEN FEEDBACK HITS EARLY: VIDEO REVIEW ACCELERATES STABILIZATION AND AMPLIFIES TRAINING GAINS IN RESIDENT CHOLECYSTECTOMY
Matias Aguilera, MD1, Diego Sanhueza, MD2, Enzo Castiglioni, MD1, Bernardita Becker, MD1, María Inés Gaete, MD1, Julian Varas, MD, MSc1; 1Pontificia Universidad Católica de Chile, 2Universidad de Los Andes
Introduction
Asynchronous video feedback is expanding in competency-based surgical education, yet effects likely vary by training phase and simulation exposure. We evaluated whether video feedback improves early laparoscopic cholecystectomy performance and how prior simulation moderates these effects.
Methods
Comparative observational study of general surgery residents from seven programs across five cities. Laparoscopic cholecystectomies were blindly scored with OSATS (5 items; range 5–25). Residents were allocated to Feedback or No-Feedback arms. Predefined milestones (3rd, 5th, 10th case) were analyzed with Welch’s t-test, Mann–Whitney U, and Levene’s test (α=0.05). Intra-resident improvement was ΔOSATS = mean(cases 8–10) − mean(cases 1–3). Simulation exposure was examined as a moderator (binary ≥1 course completed vs none; sensitivity across five levels).
Results
Fifty-one residents contributed 436 recordings (252 Feedback; 184 No-Feedback). At the 3rd case (n=23), median OSATS was 18 (Feedback) vs 17 (No-Feedback) (p>0.5); at the 5th (n=29), 18 vs 19 (p>0.7); and at the 10th (n=15), 20 vs 20.5 (p>0.6). Despite similar medians, dispersion was significantly lower with Feedback at the 10th case (Levene p=0.046), indicating a more homogeneous group with fewer extreme outliers and early stabilization around the central tendency rather than a shift in it. Intra-resident improvement was positive in both arms (mean ΔOSATS 4.22 vs 2.44; ns). Pairing Feedback with completed simulation yielded larger gains (ΔOSATS 5.61 vs 0.75), suggesting a synergistic pattern; however, the Feedback×Simulation interaction was not statistically significant (p=0.217). Simulation alone did not confer clear advantages without Feedback.
Conclusions
Video-based feedback did not increase mean OSATS but narrowed variability by the 10th case, consistent with compressed dispersion—stabilizing the median/average and yielding a more homogeneous (and plausibly more symmetric) cohort. Both groups improved over time, and combining feedback with completed simulation trended toward larger early-to-late gains, suggesting a training-dependent benefit. Limitations include small samples at key milestones, limited power for interaction testing, and potential confounding inherent to observational designs. Larger, adequately powered (ideally randomized) studies using variance-sensitive and distributional metrics (e.g., IQR/SD, skewness) are needed to confirm and quantify these signals. Meanwhile, programs may emphasize early video feedback, ensure simulation completion before or alongside initial clinical exposure, and transition to targeted coaching as trainees advance.
(Q026) DEVELOPING AND VALIDATING IMAGE-BASED METRICS FOR OPEN SURGICAL SUTURING SKILL ASSESSMENT
Jianxin Gao, Amir Mehdi Shayan, Simar P. Singh, Joe Bible, Ravikiran Singapogu, Richard E. Groff; Clemson University
Purpose: Open surgery training is vital in vascular surgery education. Traditionally, trainees’ open surgical suturing skills are evaluated by educators, which is a subjective and time-consuming process. This paper proposes using image-based metrics for skill assessment of open surgical suturing technique.
Method: A simulator, named SutureCoach, is developed to simulate a radial suturing task, performed either at "depth," representing a cavity, or at "surface." Among other sensors, the simulator includes cameras and computer vision software to track the motion of the needle and thread under the membrane being sutured. A set of image-based metrics are calculated for each suture based on video data. The set of metrics includes four previously proposed metrics inspired by surgeons’ recommended best practice, to “follow the curvature of the needle,” as well as four new metrics inspired by a refined suturing phase segmentation scheme. The performance of the image-based metrics is evaluated through a study with 97 participants, divided almost evenly between attending surgeons, resident surgeons, and novices. Data was collected at several events over a 5-month period.
Results: The statistical analysis shows that all metrics have significantly different means when comparing performance between novices and surgeons at both conditions, surface and depth. Furthermore, seven out of eight metrics have significantly different means when comparing resident surgeons' and attending surgeons' performance at the depth condition. ROC curves show that the Tip Path Length and Swept Area metrics perform best for classifying performance of novices versus surgeons. Classifying resident surgeons versus attending surgeons is much more challenging, though Swept Area and several other metrics perform similarly. Though the Tip Path Length metric works well for classifying novices versus surgeons, it is ineffective for classifying resident surgeons vs attending surgeons.
Conclusion: Image-based metrics are capable of suturing skill assessment, especially for distinguishing novices from surgeons. Depth constraints allow higher skill levels to be better differentiated.
(Q027) 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.
