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      Teaching impact in pediatric minimal access surgery: Personal perspective from “Fellow”

      research-article
      Journal of Minimal Access Surgery
      Medknow Publications
      MAS, pediatric, teaching

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          Abstract

          The global objective of this paper is to review from the “Fellow” perspective, the current status of pediatric minimal access surgery (MAS) in terms of teaching feasibility, safety and impact on standard practice paradigms. In the pediatric general surgery field, surgeons are dealing with a wide range of pathology that includes thoracic, abdominal, urological and gynecological procedures. The learning curve is slow because of a relatively small volume of patients. However, gradually but steadily, a significant proportion of the procedures traditionally performed, with major open exposures at present, are preferentially performed by minimal access. Currently, minimal access surgery training is incorporated into adult general surgery residency/fellowship programs and teaching techniques of pediatric MAS are available only as seldom international workshops. Pediatric surgery fellowship programs with incorporated guidelines for MAS training are just recently feasible in select centers, mostly as “self” established programs. In many other pediatric surgery centers, teaching the “glamour” of MAS is quite dependent on a program director’s vision. Integration of MAS training into the secondary residency/fellowship curriculum of pediatric surgeons is the inevitable goal. MAS- minded education and research through adequate training will pay dividends and “manufacture” competent, contemporary trainees. National Pediatric Surgery Associations should be responsible for setting criteria that consider the MAS for accreditation with maintaining the international standards of these teaching programs.

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          Most cited references12

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          Randomized clinical trial of virtual reality simulation for laparoscopic skills training.

          This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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            Objective assessment of technical skills in surgery.

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              Laparoscopic skills training and assessment.

              The introduction of laparoscopic techniques to general surgery was associated with many unnecessary complications, which led to the development of skills laboratories to train novice laparoscopic surgeons. This article reviews the tools currently available for training and assessment in laparoscopic surgery. Medline searches were performed to identify articles with combinations of the following key words: laparoscopy, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. Current training involves the use of box trainers with either innate models or animal tissues; it lacks objective assessment of skill acquisition. Virtual reality simulators have the ability to teach laparoscopic psychomotor skills, and objective assessment is now possible using dexterity-based and video analysis systems. The tools are now available for the development of a structured, competency-based, laparoscopic surgical training programme. Copyright 2004 British Journal of Surgery Society Ltd.
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                Author and article information

                Journal
                J Minim Access Surg
                JMAS
                Journal of Minimal Access Surgery
                Medknow Publications (India )
                0972-9941
                1998-3921
                December 2006
                : 2
                : 4
                : 216-219
                Affiliations
                Alberta Children’s Hospital, Calgary, Alberta, Canada
                Author notes
                Address for correspondence: Dragan Kravarusic, Alberta Children’s Hospital, 1820 Richmond Road, SW, Calgary, Alberta, Canada T2T 5C7. E-mail: dkravarusic@ 123456yahoo.com
                Article
                JMAS-2-216
                10.4103/0972-9941.28183
                3016483
                21234149
                1f8c77c5-cc9a-4a16-8f1f-c6014cf2f19d
                © Journal of Minimal Access Surgery

                This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 June 2006
                : 19 July 2006
                Categories
                Original Article

                Surgery
                mas,pediatric,teaching
                Surgery
                mas, pediatric, teaching

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