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      Der „Surgical Track“ – innovative Ansätze gegen den Nachwuchsmangel in der Chirurgie Translated title: The “surgical track”—Innovative approaches to counteract the shortage of young recruits in surgery

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          Abstract

          Die Chirurgie steht vor bedeutenden Herausforderungen, die sowohl aus Veränderungen in der medizinischen Ausbildung als auch aus der sinkenden Attraktivität des chirurgischen Berufswegs für angehende Ärzt:innen in der westlichen Welt resultieren. So haben sich die Erwartungen der Studierenden an ihren zukünftigen Arbeitsplatz geändert, wobei Themen wie Unsicherheiten in der beruflichen Planung, eine unausgewogene Work-Life-Balance sowie eine fehlende Vereinbarkeit von Familie und Beruf zunehmend relevant sind. Auch der Eintritt der Generation Z in das Berufsleben wird Auswirkungen auf die Chirurgie haben. Obwohl Frauen den größten Anteil der Absolvent:innen ausmachen, entscheiden sich nur wenige von ihnen für eine chirurgische Laufbahn. Der daraus resultierende Nachwuchsmangel wird die medizinische Versorgung in deutschen chirurgischen Kliniken negativ beeinflussen. Ein intensiver Wettbewerb um Talente zeichnet sich bereits in allen medizinischen Fachgebieten ab. So ergreifen Kliniken verschiedene Maßnahmen gegen den bevorstehenden Personalmangel, wie z. B. „Summer Schools“ oder Stipendien mit Arbeitsverpflichtungen. Darüber hinaus werden regionale Fördergesetze etabliert. Da insbesondere ein abnehmendes Interesse an chirurgischer Weiterbildung im Studienverlauf zu verzeichnen ist, ist zudem eine frühe Integration chirurgischer Fähigkeiten ins Medizinstudium entscheidend, um diesem Trend entgegenzuwirken. Aus diesem Grund haben wir den „Surgical Track“ entwickelt, der gezielt innovative Lehrkonzepte anbieten soll, um Studierende frühzeitig für das Fach Chirurgie zu begeistern. Dieser basiert auf den Säulen der Virtual Reality (VR) und der Robotik. Studierende können durch VR-Simulationen Operationen und Notfallszenarien trainieren sowie praktische Übungen mit Robotersystemen absolvieren. Qualitativ hochwertige Ausbildungskonzepte wie der „Surgical Track“ können dazu beitragen, Begeisterung für die Chirurgie zu fördern und gleichzeitig Wissen zu vermitteln, auch wenn ihr langfristiger Nutzen noch evaluiert werden muss. Durch virtuelle Simulationen, robotische Chirurgie und innovative Lehre erhalten Studierende Einblicke in die Viszeralchirurgie, die theoretisches Verständnis und praktische Erfahrung miteinander vereinen.

          Translated abstract

          Surgery faces significant challenges resulting from changes in medical education and the declining attractiveness of the surgical career path for aspiring doctors in the western world. For example, students’ expectations of their future workplace have changed, with issues such as career planning uncertainties, an unbalanced work-life balance, and a lack of compatibility of family and occupation becoming increasingly more relevant. The entry of Generation Z into the workforce will also impact surgery. Although women comprise the largest proportion of graduates only a few opt for a career in surgery. The resulting shortage of young surgeons will negatively impact medical care in German surgical units. Intense competition for talents is already emerging in all medical specialties. Thus, hospitals and academic centers are taking various measures to counteract the impending staff shortage, such as summer schools or scholarships with work commitments. Furthermore, regional funding laws are being established. In addition, as there is a declining interest in surgical training, particularly during the course of medical studies, early integration of surgical skills is crucial to counteract this trend. For this reason, we have developed the “surgical track”, designed to offer targeted innovative teaching concepts to get students attracted to surgery at an early stage. The “surgical track” is based on virtual reality (VR) and robotics. Students can practice operations and emergency scenarios through VR simulations and complete practical exercises with robotic systems. High-quality training concepts such as the “surgical track” can help to promote enthusiasm for surgery and impart knowledge at the same time, even if the long-term benefits still need to be evaluated. Through virtual simulations, robotic surgery and innovative teaching, students gain insights into visceral surgery that combine theoretical understanding and practical experience.

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          The utility of simulation in medical education: what is the evidence?

          Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes.
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            Training and simulation for patient safety.

            Simulation-based medical education enables knowledge, skills and attitudes to be acquired for all healthcare professionals in a safe, educationally orientated and efficient manner. Procedure-based skills, communication, leadership and team working can be learnt, be measured and have the potential to be used as a mode of certification to become an independent practitioner. Simulation-based training initially began with life-like manikins and now encompasses an entire range of systems, from synthetic models through to high fidelity simulation suites. These models can also be used for training in new technologies, for the application of existing technologies to new environments and in prototype testing. The level of simulation must be appropriate to the learners' needs and can range from focused tuition to mass trauma scenarios. The development of simulation centres is a global phenomenon which should be encouraged, although the facilities should be used within appropriate curricula that are methodologically sound and cost-effective. A review of current techniques reveals that simulation can successfully promote the competencies of medical expert, communicator and collaborator. Further work is required to develop the exact role of simulation as a training mechanism for scholarly skills, professionalism, management and health advocacy.
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              Well prepared for work? Junior doctors' self-assessment after medical education

              Background Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. Methods A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. Results All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. Conclusions Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates.
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                Author and article information

                Contributors
                rabi.datta@uk-koeln.de
                Journal
                Chirurgie (Heidelb)
                Chirurgie (Heidelb)
                Chirurgie (Heidelberg, Germany)
                Springer Medizin (Heidelberg )
                2731-6971
                2731-698X
                25 January 2024
                25 January 2024
                2024
                : 95
                : 4
                : 315-323
                Affiliations
                GRID grid.411097.a, ISNI 0000 0000 8852 305X, Klinik für Allgemein‑, Viszeral-, Tumor- und Transplantationschirurgie, , Universitätsklinik Köln, ; Kerpener Str. 62, 50937 Köln, Deutschland
                Article
                2029
                10.1007/s00104-023-02029-y
                10954953
                38273036
                304cf38d-10e0-489d-8436-bce328e7fa42
                © The Author(s) 2024

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                History
                : 20 December 2023
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2024

                frauen in der chirurgie,junge chirurgie,virtual reality,robotische chirurgie,chirurgische lehre,female surgeons,young surgery,robotic surgery,surgical education

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