Visuospatial and technical ability in the selection and assessment of higher surgical trainees in the London deanery

INTRODUCTION

Despite awareness of the limitations of current selection and competency assessments, there is little consensus and alternatives have not been readily accepted. Essential surgical skills include visuospatial and technical ability. The aim of this study was to survey current methods of higher surgical trainee selection and assessment. We suggest ways to improve the process.

MATERIALS AND METHODS

Nine surgical training programmes in the London deanery were surveyed through questionnaires to programme directors, existing trainees and examination of deanery publications.

RESULTS

Testing of visuospatial and technical ability was piloted at selection only in a single general surgical department. Practical skills were assessed in 3/9 (33%) specialties (ENT, plastic and general surgery). Once selected, no specialty tested visuospatial and technical ability. Practical skills were tested in only 1/9 (11%) specialties (plastic surgery). The remaining 8/9 (89%) were ‘assessed’ by interview.

CONCLUSIONS

Lack of visuospatial and technical ability assessment was identified at selection and during higher surgical training. Airlines have long recognised early identification of these qualities as critical for efficient training. There is a need for more objective methods in this area prior to selection as time to assess surgical trainees during long apprenticeships is no longer available. We advocate a suitably validated competency-based model during and at completion of training.     

The development of postgraduate surgical training in Guyana

Background

Like many developing countries, Guyana has a severe shortage of surgeons. Rather than rely on overseas training, Guyana developed its own Diploma in Surgery and asked for assistance from the Canadian Association of General Surgeons (CAGS). This paper reviews the initial results of Guyana’s first postgraduate training program.

Methods

We assisted with program prerequisites, including needs assessment, proposed curriculum, University of Guyana and Ministry of Health approval, external partnership and funding. We determined the outputs and outcomes of the program after 2 years, and we evaluated the impact of the program through a quantitative/qualitative questionnaire administered to all program participants.

Results

Five residents successfully completed the 2-year program and are working in regional hospitals. Another 9 residents are in the training program. Twenty-four modules or short courses have been facilitated, alternating Guyanese with visiting Canadian surgical faculty members coordinated through CAGS. A postgraduate structure, including an Institute for Health Sciences Education and Surgical Postgraduate Education Committee, has been developed at the Georgetown Public Hospital Corporation (GPHC). An examination structure similar to Canada’s has been established. Hospital staff morale is greater, surgical care is more standardized and academic opportunities have been enhanced at GPHC. Four regional hospitals have welcomed the new graduates, and surgical services have already improved. Canadian surgeons have a greater understanding of and commitment to surgical development in low-income countries.

Conclusion

Guyana has proven that, with visiting faculty assistance, it can mount its own postgraduate training suitable to national needs and will provide a career path to encourage its own doctors to remain and serve their country.     

Self-directed practice schedule enhances learning of suturing skills

Background

Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills.

Methods

Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments.

Results

Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice.

Conclusion

Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.     

Retained surgical sponges,needles and instruments

Introduction

Retained sponges and instruments (RSI) due to surgery are a recognised medical ‘never event’ and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies.

Methods

A comprehensive literature search was performed on MEDLINE^®, Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved.

Results

The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success.

Conclusions

Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.     

Military General Surgical Training Opportunities on Operations in Afghanistan

INTRODUCTION

In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees.

PATIENTS AND METHODS

A retrospective theatre log-book review of all surgical cases performed at the Role 2 (Enhanced) treatment facility at Camp Bastion, Helmand Province on Operation HERRICK between October 2006 and October 2007, inclusive. Operative cases were analysed for general surgical trauma, laparotomy, thoracotomy, vascular trauma and specific organ injury management where available.

RESULTS

A total of 968 operative cases were performed during the study period. General surgical procedures included 51 laparotomies, 17 thoracotomies and 11 vascular repairs. There were a further 70 debridements of general surgical wounds. Specific organ management included five cases of liver packing for trauma, five trauma splenectomies and four nephrectomies.

CONCLUSIONS

A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.     

Amputation and the assessment of limb viability: perceptions of two hundred and thirty two orthopaedic trainees

INTRODUCTION

The management of complex extremity injury, which may require assessment of limb viability and performance of amputation, is a challenge to those involved in its emergent and definitive care. Concern exists regarding the exposure of orthopaedic trainees to such cases due both to changes in training and centralisation of trauma services.

SUBJECTS AND METHODS

This is a web-based observational study by survey, investigating the confidence and perceived adequacy of training of UK orthopaedic specialist trainees in the assessment of limb viability and amputation surgery. 222 responses from 888 trainees were required to achieve a < 5% error rate with 90% confidence; 232 surveys were completed.

RESULTS

Trainee confidence in dealing with the assessment of limb viability is high despite infrequent exposure to cases. The majority of trainees perceive their training in limb viability assessment as adequate. For performance of amputation, exposure is minimal, confidence is lower and 36% of trainees regard their training as inadequate.

CONCLUSIONS

Limb viability assessment is an area in which trainees feel confident and well trained. There is, however, a perceived training inadequacy in amputation surgery and a corresponding lack of confidence for many trainees, irrespective of training year. This is the first study to offer an insight into specific training experiences of junior orthopaedic surgeons at a national level and it should drive the development of opportunities for trainees to develop skills in amputation surgery.     

Health Education England,Local Education and Training Boards (LETBs) and reform of healthcare education: implications for surgical training

Background

National Health Service (NHS) reforms have changed the structure of postgraduate healthcare education and training. With a Government mandate that promotes multi-professional education and training aligned with policy driven initiatives, this article highlights concerns over the impact that these changes may have on surgical training.

Discussion

The creation of Health Education England (HEE) and its local education and training boards (LETBs), which are dominated by NHS healthcare providers, should result in greater accountability of employers in workforce planning, enhanced local responsibility and increased transparency of funding allocation. However, these changes may also create a potential poacher-turned-gamekeeper role of employers, who now have responsibility for junior doctors’ training. Analysis of LETB membership reveals a dearth of representation of surgeons, who comprise only 2% of board members, with the input of trainees also seemingly overlooked. A lack of engagement with the LETBs by the independent sector is a concern with increasing numbers of training opportunities potentially being lost as a result.The new system also needs to recognise the specific training needs required by the craft specialties given the demands of technical skill acquisition, in particular regarding the provision of simulation training facilities and trainer recognition. However, training budget cuts may result in a disproportionate reduction of funding for surgical training. Surgical training posts will also be endangered, opportunities for out-of-programme experience and research may also decline and further costs are likely to be passed onto the trainee.

Summary

Although there are several facets to the recent reforms of the healthcare education and training system that have potential to improve surgical training, concerns need to be addressed. Engagement from the independent sector and further clarification on how the LETBs will be aligned with commissioning services are also required. Surgical training is in danger of taking a back seat to Government mandated priorities. Representation of trainees and surgeons on LETB committees is essential to ensure a surgical viewpoint so that the training needs of the future consultant workforce meet the demands of a 21^st century health service.     

Fact or Infection: Do Surgical Trainees Know Enough About Infection Control?

INTRODUCTION

There exists a high level of non-compliance with basic infection control measures by medical staff. One explanation may be a lack of familiarity with contemporary infection control guidelines. As surgical trainees represent a key group of stakeholders responsible for the delivery of recommended infection control practice, we assessed knowledge of infection control guidelines amongst current UK surgical trainees.

MATERIALS AND METHODS

Without warning, during the annual meeting of the UK Association of Surgeons in Training (ASiT), participating surgical trainees were asked to complete a questionnaire examining their basic knowledge of infection control and methicillin-resistant Staphylococcus aureus (MRSA) based on recently published guidelines.

RESULTS

A total of 52 trainees (13 higher surgical trainees [HSTs]; 39 basic surgical trainees [BSTs]) returned completed questionnaires in the study. BSTs demonstrated a higher level of knowledge of infection control, outperforming the HSTs in 7 out of 11 questions. Of surgical trainees, 61.5% were misinformed regarding the prevalence of MRSA blood-stream infections and 69% were unaware of policies for transfer of MRSA-positive patients. Analysis revealed areas of concern in regards to an adequate general level of knowledge of infection control in surgical trainees, particularly in some key areas.

CONCLUSIONS

To ensure patient safety and reduce hospital-acquired infections, it is vital that focused, co-ordinated programmes of education, in this rapidly changing field, are prioritised and formalised into surgical training, selection and assessment.     

Training in the practical application of damage control and early total care operative philosophy �C perceptions of UK orthopaedic specialist trainees

INTRODUCTION

Despite improvements in the outcome of individuals sustaining significant injury, the optimum management of fractures in traumatised patients remains an area of debate and publication. There is, however, a paucity of studies regarding the specifics of acquired experience and training of junior orthopaedic surgeons in the practical application of these skills. Our null hypothesis is that, despite alteration in surgical training, the perceived confidence and adequacy of training of UK orthopaedic specialist trainees in the application of damage control orthopaedics (DCO) and early total care (ETC) philosophy is unaffected.

PATIENTS AND METHODS

A web-based survey was sent to a sample of orthopaedic trainees. From 888 trainees, 222 responses were required to achieve a 5% error rate with 90% confidence.

RESULTS

A total of 232 responses were received. Trainees reported a high level of perceived confidence with both external fixation and intramedullary devices. Exposure to cases was sporadic although perceived training adequacy was high. A similar pattern was seen in perceived operative role with the majority of trainees expecting to be performing such operations, albeit under varying levels of supervision. In a more complicated case of spanning external fixation for a ‘floating knee, trainees reported a decreased level of perceived confidence and limited exposure. One-third of trainees reported never having been involved in such a case. In contrast to nationally collated logbook data, exposure to and perceived confidence in managing cases involving ETC and DCO were similar.

CONCLUSIONS

Despite changes in the training of junior orthopaedic surgeons, trainee-reported confidence and adequacy of training in the practical application of DCO and ETC was high. Exposure to cases overall was, however, seen to be limited and there was a suggestion of disparity between current operative experiences of trainees and that recorded in the national trainee logbook.     

Are general surgeons able to accurately self-assess their level of technical skills?

Introduction

Self-assessment is a way of improving technical capabilities without the need for trainer feedback. It can identify areas for improvement and promote professional medical development. The aim of this review was to identify whether selfassessment is an accurate form of technical skills appraisal in general surgery.

Methods

The PubMed, MEDLINE^®, Embase^™ and Cochrane databases were searched for studies assessing the reliability of self-assessment of technical skills in general surgery. For each study, we recorded the skills assessed and the evaluation methods used. Common endpoints between studies were compared to provide recommendations based on the levels of evidence.

Results

Twelve studies met the inclusion criteria from 22,292 initial papers. There was no level 1 evidence published. All papers compared the correlation between self-appraisal versus an expert score but differed in the technical skills assessment and the evaluation tools used. The accuracy of self-assessment improved with increasing experience (level 2 recommendation), age (level 3 recommendation) and the use of video playback (level 3 recommendation). Accuracy was reduced by stressful learning environments (level 2 recommendation), lack of familiarity with assessment tools (level 3 recommendation) and in advanced surgical procedures (level 3 recommendation).

Conclusions

Evidence exists to support the reliability of self-assessment of technical skills in general surgery. Several variables have been shown to affect the accuracy of self-assessment of technical skills. Future work should focus on evaluating the reliability of self-assessment during live operating procedures.     

Whose Appendicectomy? – Do Laparoscopic Appendicectomies Impair SHO Training?

INTRODUCTION

Open appendicectomy is an ideal procedure for junior surgical trainees to develop operative skills. However, in recent years, we have noticed a decline in the number of appendicectomies performed by basic surgical trainees and a shift towards increasing use of laparoscopic appendicectomy. The aim of this study was to determine whether the growing popularity of laparoscopic appendicectomy is having a detrimental impact on the training experience of SHOs.

PATIENTS AND METHODS

We undertook a retrospective review of all cases of appendicectomies performed in one district hospital over a 7-year period (August 1999 to August 2006.) A standard performa was used to extract data from the original case notes of these patients relating to the operating surgeon and technique.

RESULTS

Data were obtained for 857 appendicectomies. Between February 2002 and July 2003, there was asignificant decline in the proportion of appendicectomies performed by SHOs from 78.7% to 29.3% (P < 0.001). Either side of this decline there were no significant changes in the proportion of SHO appendicectomies. The number of appendicectomies performed laparoscopically only began to rise after February 2004, with ayear-on-year increase. The number of appendicectomies performed by SHOs remained stable during this time. No laparoscopic appendicectomy was performed by an SHO.

CONCLUSIONS

We found no evidence that the popularisation of laparoscopic appendicectomy has contributedtothe decline of appendicectomies performed by SHOs. Nevertheless, with the continual rise in popularity of this procedure, it is important to balance training opportunities for both junior and higher surgical trainees.     

Endoscopic anatomy of the ulnar nerve: a useful adjunct to teaching anatomy

INTRODUCTION

There has been a shift away from gross anatomy teaching and hands-on cadaveric dissection. This has been replaced by a variety of teaching modalities including problem-based learning, models and prosections, and computer-assisted learning. We aim to pilot a technique of endoscopic visualisation of upper limb anatomy, to produce a video that can be incorporated into anatomy teaching and to assess the video qualitatively as an adjunct to anatomy teaching.

MATERIALS AND METHODS

A single, previously undissected, formalin preserved cadaver was used and views were obtained of the left arm. The video was shown to 10 surgical trainees who were then asked to complete appraisal forms anonymously.

RESULTS

The endoscopic views were thought to be useful and helped the trainees to appreciate the in situ anatomy and potential sites of nerve compression. 70% of respondents would recommend the system to others.

CONCLUSIONS

We feel this represents another method to help in the understanding of a complex area of anatomy in a way that is unique to endoscopy.     

A retrospective review of general surgery training outcomes at the University of Toronto

Background

Surgical educators have struggled with achieving an optimal balance between the service workload and education of surgical residents. In Ontario, a variety of factors during the past 12 years have had the net impact of reducing the clinical training experience of general surgery residents. We questioned what impact the reductions in trainee workload have had on general surgery graduates at the University of Toronto.

Methods

We evaluated graduates from the University of Toronto general surgery training program from 1995 to 2006. We compared final-year In-Training Evaluation Reports (ITERs) of trainees during this interval. For purposes of comparison, we subdivided residents into 4 groups according to year of graduation (1995–1997, 1998–2000, 2001–2003 and 2004–2006). We evaluated postgraduate “performance” by categorizing residents into 1 of 4 groups: first, residents who entered directly into general surgery practice after graduation; second, residents who entered into a certification subspecialty program of the Royal College of Physicians and Surgeons of Canada (RCPSC); third, residents who entered into a noncertification program of the RCPSC; and fourth, residents who entered into a variety of nonregulated “clinical fellowships.”

Results

We assessed and evaluated 118 of 134 surgical trainees (88%) in this study. We included in the study graduates for whom completed ITER records were available and postgraduate training records were known and validated. The mean scores for each of the 5 evaluated residency training parameters included in the ITER (technical skills, professional attitudes, application of knowledge, teaching performance and overall performance) were not statistically different for each of the 4 graduating groups from 1995 to 2006. However, we determined that there were statistically fewer general surgery graduates (p < 0.05) who entered directly into general surgery practice in the 2004–2006 group compared with the 1998–2000 and 2001–2003 groups. The graduates from 2004 to 2006 who did not enter into general surgery practice appeared to choose a clinical fellowship.

Conclusion

These observations may indicate that recent surgical graduates possess an acceptable skill set but may lack the clinical confidence and experience to enter directly into general surgery practice. Evidence seems to indicate that the clinical fellowship has become an unregulated surrogate extension of the training program whereby surgeons can gain additional clinical experience and surgical expertise.     

Feasibility and fidelity of practising surgical fixation on a virtual ulna bone

Background

Surgical simulators provide a safe environment to learn and practise psychomotor skills. A goal for these simulators is to achieve high levels of fidelity. The purpose of this study was to develop a reliable surgical simulator fidelity questionnaire and to assess whether a newly developed virtual haptic simulator for fixation of an ulna has comparable levels of fidelity as Sawbones.

Methods

Simulator fidelity questionnaires were developed. We performed a stratified randomized study with surgical trainees. They performed fixation of the ulna using a virtual simulator and Sawbones. They completed the fidelity questionnaires after each procedure.

Results

Twenty-two trainees participated in the study. The reliability of the fidelity questionnaire for each separate domain (environment, equipment, psychological) was Cronbach α greater than 0.70, except for virtual environment. The Sawbones had significantly higher levels of fidelity than the virtual simulator (p < 0.001) with a large effect size difference (Cohen d < 1.3).

Conclusion

The newly developed fidelity questionnaire is a reliable tool that can potentially be used to determine the fidelity of other surgical simulators. Increasing the fidelity of this virtual simulator is required before its use as a training tool for surgical fixation. The virtual simulator brings with it the added benefits of repeated, independent safe use with immediate, objective feedback and the potential to alter the complexity of the skill.     

Assessing the Value of the SimPraxis? Laparoscopic Cholecystectomy Trainer

Background and Objectives:

Our aim was to determine whether the SimPraxis™ Laparoscopic Cholecystectomy Trainer is an effective adjunct for training both junior and senior surgical residents.

Methods:

During the 2009–2010 academic year, 20 of 27 surgical residents at our institution completed training with the SimPraxis Laparoscopic Cholecystectomy Trainer. These 20 residents took an identical 25-question pre- and posttest prepared in-house by a senior laparoscopic surgeon, based on the SimPraxis Laparoscopic Cholecystectomy program content. Included within the SimPraxis program is a multiple data point scoring system. For our reporting purposes, we divided the residents into 2 groups, junior (PGY 1-2; n=11) and senior (PGY 3-5; n=9).

Results:

The junior residents demonstrated a statistically significant improvement in their post-test scores (P=.001). On the contrary, the senior residents showed nonstatistically significant minor improvement in their examination scores (P=.09). While, the pretest scores were significantly higher for the senior residents compared with the junior residents (P=.003), the post-test scores were nonsignificantly different between the senior vs. the junior residents (P=.07). There was no significant difference between the time it took junior and senior residents to complete the SimPraxis program.

Conclusion:

Our data demonstrate that junior residents benefitted the most from the SimPraxis training program. Requiring junior surgical residents to complete both skills and cognitive training programs may be an effective adjunct in preparation for participation in laparoscopic cholecystectomy procedures.     

Robotic Surgical Skills: Acquisition, Maintenance, and Degradation

Background and Objectives:

The degradation in robotic skills that occurs during periods of robotic surgical inactivity in newly trained surgeons was measured. The role of animate training in robotic skill was also assessed.

Methods:

Robotically naïve resident and attending surgeons underwent training with the da Vinci® robot on needle passage (DN), rocking ring transfer peg board (RPB), and running suture pod tasks (SP). Errors were established to convert actual time to adjusted time. Participants were deemed “proficient” once their adjusted times were within 80% of those set by experienced surgeons through repeated trials. Participants did not use the robot except for repeating the tasks once at 4, 8, and 12 weeks (tests). Participants then underwent animate training and completed a final test within 7 days.

Results:

Twenty-five attending and 29 resident surgeons enrolled; 3 withdrew. There were significant increases in time to complete each of the tasks, and in errors, by 4 weeks (Adjusted times: DN: 122.9 ± 2.2 to 204.2 ± 11.7, t=6.9, P<.001; RPB: 262.4 ± 2.5 to 364.7 ± 8.0, t=12.4, P<.001; SP: 91.4 ± 1.4 to 169.9 ± 6.8, t=11.3, P<.001). Times decreased following animate training, but not to levels observed after proficiency training for the RPB and SP modules.

Conclusions:

Robotic surgical skills degrade significantly within 4 weeks of inactivity in newly trained surgeons. Animate training may provide different skills than those acquired in the dry lab.     

Comparison of the cheese-wiring effects among three sutures used in rotator cuff repair

Purpose:

The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction.

Materials and Methods:

Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord^™ suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire^® suture (FiberWire^®, Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper.

Results:

The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord^™ suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire^® suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student''s t-test, which showed significance between Orthocord^™ and FiberWire^® sutures (P = 0.026), but not significant between Orthocord^™ and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire^® sutures (P = 0.103).

Conclusion:

The cheese-wiring effect is less in the Orthocord^™ suture than in the FiberWire^® suture in human cadaveric supraspinatus tendons.

Clinical Relevance:

Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.     

Assessing the impact of a 2-day laparoscopic intestinal workshop

Background

Surgical educators have responded to the demand for increased skills in minimally invasive surgery by offering short technique-focused workshops at academic centres. The purpose of this study was to determine the impact of a comprehensive laparoscopic intestinal workshop for the adoption of laparoscopic colonic surgery.

Methods

A 2-day comprehensive laparoscopic intestinal surgery workshop included didactic teaching and supervised hands-on practice of numerous laparoscopic colon resections on a cadaveric model. Participants completed pre-, post- and 6-month postcourse questionnaires.

Results

The participants (n = 39) had been in practice for a mean of 10 (interquartile range 3–18) years. Fifty-one percent (n = 20) were already performing laparoscopic colectomies as part of their practices prior to the course. Regardless of whether they were performing laparoscopic colectomies prior to the course or not, attending the 2-day workshop improved their self-assessed preparedness to perform laparoscopic colectomies. Six months after the intestinal workshop, 10 of 16 respondents who were not performing laparoscopic colectomies prior to the course had performed at least 1 since the course. Seven of these individuals had a preceptor for their first case. Reasons cited for not performing a laparoscopic colectomy since the workshop included perceived inadequate surgical skill set, a lack of preceptor and the lack of an appropriate patient.

Conclusion

A comprehensive laparoscopic intestinal workshop contributed to the perceived acquisition of advanced laparoscopic surgical skills. Local laparoscopic preceptorship was an important adjunct to the workshop for the incorporation of laparoscopic colorectal surgery into practice.     

Treatment of posttraumatic arthrofibrosis of the radioulnar joint with vibration therapy (VMTX Vibromax Therapeutics): a case report and narrative review of literature

Objective

To present the clinical features of post traumatic arthrofibrosis and response to treatment with Vibromax Therapeutics™ (VMTX™) in 28 year old male soccer player.

Rationale

Many studies have reported an increase in muscle performance after whole-body vibration, but to date none have evaluated the possibility of vibration application as a therapy for functional restoration after injury.

Conclusions

Vibration training is being utilized in, strength training, performance enhancement and rehabilitation. Despite the lack of research in this area, the literature that is currently available and the results of this case study imply that vibration therapy has the potential to aid in the management of acute soft tissue injury and the sequela of disuse and immobilization.