Biomedical subjects

Avril Chang

Publications and source records attributed to Avril Chang.

8 recordsLinked to original sources

PubMed2006

Development of assessing generic and specific technical skills in laparoscopic surgery.

BACKGROUND: Assessing live laparoscopic surgery using structured methodology is still in its infancy; however, it removes bias and subjectivity. We critique a new assessment tool for technical skills in laparoscopic surgery. METHODS: A hierarchical task analysis was done for laparoscopic cholecystectomy (LC), and a global assessment for generic and specific technical skills for LC was developed. Two experienced surgeons with >12 years of postgraduate experience assessed 50 full-length LC operations blindly and independently. RESULTS: Five consultant/attending and 4 registrar/resident surgeons were recruited. Interrater reliability was k = 0.86 and k = 0.84 (P < .05) for generic and specific technical skills, respectively. Mean time for consultants was 32 minutes (range 15 to 70) and for registrars was 53 minutes (range 20 to 90). Parametric Student t test analysis was significant for time between the 2 groups, P < .05. Nonparametric analysis of variance between the 2 groups for generic and specific technical skills was significant at P < .05. CONCLUSIONS: This assessment tool for live laparoscopic surgery may have face, content, concurrent, construct, and predictive validities for generic and specific technical skills. We aim to continue the study and expand assessment to other surgical techniques.

Cholecystectomy, Laparoscopic↗

PubMed2006

Training junior operative residents in laparoscopic suturing skills is feasible and efficacious.

BACKGROUND: Laparoscopic suturing has been regarded as an advanced operative task, and courses to develop this skill are aimed at senior trainees and consultants. This study evaluates the role of laparoscopic suturing courses in the modern operative training curriculum. METHODS: The performance of 9 senior operative trainees (course A) was compared to that of 14 junior operative trainees (course B) at identical, 2-day laparoscopic suturing courses. Pre- and post-course assessments measured time taken, dexterity, and quality for the placement of 1 intracorporeal suture on synthetic bowel. Post-course data was compared to the performance of a group of 6 experts. RESULTS: The median number of laparoscopic procedures carried out unassisted was 130 for surgeons on course A, and 0 for those on course B. At the pre-course assessment, senior trainees (course A) were significantly faster, more dexterous, and had higher checklist scores then those on course B. Both groups had improved significantly by the end of each the course. Post-course comparison between the 2 groups showed equivalent path length and checklist scores, although group A remained faster (P = .003) and made fewer movements (P = .033). Senior trainees had similar performance data to the group of expert surgeons, although this was not the case for junior trainees. CONCLUSIONS: Endoscopic suturing is a task that can be learned by operative trainees during short skills courses, regardless of baseline laparoscopic experience. Skills training in laparoscopic suturing should thus not be reserved only for those contemplating advanced laparoscopic operation.

General Surgery↗

PubMed2006

Laparoscopic resection of mucinous cystadenoma of appendix: a careful decision.

Appendiceal mucoceles are mainly due to cystadenoma or cystadenocarcinoma. Definite diagnosis is difficult preoperatively and is usually peroperatively. Surgical excision, either by laparoscopy or by laparotomy, is the mainstay of treatment. Rupture of the lesion causes pseudomyxoma peritonei. We present a case to highlight this point and especially deplore the use of laparoscopy if the tumor clearly extends beyond the appendix.

Aged, 80 and over↗

PubMed2004

Systems approaches to surgical quality and safety: from concept to measurement.

OBJECTIVE: This approach provides the basis of our research program, which aims to expand operative assessment beyond patient factors and the technical skills of the surgeon; to extend assessment of surgical skills beyond bench models to the operating theater; to provide a basis for assessing interventions; and to provide a deeper understanding of surgical outcomes. SUMMARY BACKGROUND DATA: Research into surgical outcomes has primarily focused on the role of patient pathophysiological risk factors and on the skills of the individual surgeon. However, this approach neglects a wide range of factors that have been found to be of important in achieving safe, high-quality performance in other high-risk environments. The outcome of surgery is also dependent on the quality of care received throughout the patient's stay in hospital and the performance of a considerable number of health professionals, all of whom are influenced by the environment in which they work. METHODS: Drawing on the wider literature on safety and quality in healthcare, and recent papers on surgery, this article argues for a much wider assessment of factors that may be relevant to surgical outcome. In particular, we suggest the development of an "operation profile" to capture all the salient features of a surgical operation, including such factors as equipment design and use, communication, team coordination, factors affecting individual performance, and the working environment. Methods of assessing such factors are outlined, and ethical issues and other potential concerns are discussed.

General Surgery↗

PubMed2003

Multiple Objective Measures of Skill (MOMS): a new approach to the assessment of technical ability in surgical trainees.

OBJECTIVE: The assessment of surgical technical skills has become an important topic in recent years. This study presents the validation of a 6-task skills examination for junior surgical trainees (at the level of the Membership of the Royal College of Surgeons). SUMMARY BACKGROUND DATA: Six tasks were evaluated in a project that also examined the feasibility of this method of assessment. The tasks were knowledge of sutures and instruments; knowledge of surgical devices; knot formation; skin-pad suturing, closure of an enterotomy; excision of a skin lesion; and laparoscopic manipulation. Comparisons were made between a group of junior trainees (n = 13), and a group of seniors (n = 8). RESULTS: Each of the 6 tasks was able to be used to discriminate between the 2 groups. In all, there were 19 primary analyses across the 6 tasks, and 17 of these showed significant differences between the groups (P values ranging from 0.037 to < 0.001). There was generally a strong correlation between the analyses, and when a mean rank was calculated, the difference between groups was significant (P = 0.005 on Mann-Whitney U test; mean ranks 13.9 and 6.3 [of 21], for juniors and seniors respectively). Reliability of the 6-task assessment was very good at 0.70 (Cronbach's Alpha). CONCLUSIONS: A skills examination is a feasible and effective method of assessing the technical ability of basic surgical trainees.

Computer Graphics↗

PubMed2002

The relationship between motion analysis and surgical technical assessments.

BACKGROUND: Recent attempts to gain a more objective measure of surgical technical skill include the use of structured checklists and motion analysis of surgeons' hand movements. We aim to show whether a correlation exists between these two methods of assessment. METHODS: Fifty subjects were recruited from four experience groups in general surgery, ranging from basic surgical trainees to consultants and were assessed performing a standardized laboratory-based task. Motion analysis using the Imperial College Surgical Assessment Device (ICSAD), which measures hand movements and time taken, and the Objective Structured Assessment of Technical Skill (OSATS) technique were used to measure skill. RESULTS: Number of movements made, time taken, and global rating score discriminated between performance and experience group (Kruskal-Wallis, P <0.001, P <0.01, P <0.001, respectively). There was a significant correlation between movements made and global rating score (Spearman coefficient 0.53, P <0.01). Checklist scoring was not an accurate predictor of experience. CONCLUSIONS: There is a strong correlation between hand motion analysis using ICSAD and OSATS global rating assessments in this model.

Clinical Competence↗

PubMed2002

Relationship between skill and outcome in the laboratory-based model.

BACKGROUND: Recent attention has been directed at developing quantitative assessments of surgical skill. This study aims to demonstrate whether objectively measuring differences in manual dexterity has an impact on a simulated surgical procedure. METHODS: Six general surgical trainees performed 5 polytetrafluoroethylene graft to artery anastomoses on a vascular model by using a standardized technique. Manual dexterity was objectively measured with (1) electromagnetic motion analysis: trackers applied to the backs of hands recorded and analyzed both hand movements and procedural time and (2) 4-parameter evaluation of the final product. Outcome parameters were assessed by (1) rate of anastomotic leakage and (2) smallest cross-sectional area of the anastomosis. RESULTS: The 2 objective measures of manual dexterity correlated closely (Pearson coefficient, 0.423; P <.02). Trainees with better manual dexterity scores produced better outcome measures. Those with better motion analysis scores produced anastomoses that leaked less (Pearson coefficient, 0.514; P <.01) and those with higher global evaluation scores had a larger anastomotic cross-sectional area (Pearson coefficient, 0.495; P <.01). Time taken for the procedure did not appear to influence either outcome measure. CONCLUSIONS: There is a significant correlation between objective measures of manual dexterity and the outcome measures in this model. This suggests that the outcome of a procedure can be predicted by measuring surgical skill.

Blood Vessel Prosthesis↗

PubMedDate not supplied

Technical and technological skills assessment in laparoscopic surgery.

OBJECTIVES: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. METHODS: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. RESULTS: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05. CONCLUSIONS: Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.

Adult↗