Biomedical subjects

Stanley J Hamstra

Publications and source records attributed to Stanley J Hamstra.

At least 19 recordsLinked to original sources

PubMed2006

Needs assessment of neurosurgery trainees: a survey study of two large training programs in the developing and developed worlds.

BACKGROUND: There are challenges facing surgical education in both the developing and the developed worlds. Few studies have examined trainee perceptions of their educational needs in a systematic way. We undertook a study to examine this issue, focusing on two large training programs, one in the developed world and one in the developing world. METHODS: Neurosurgical trainees at the University of Toronto, Toronto, Canada, and at Hasan Sadikin Hospital in Bandung, Indonesia, were surveyed with a comprehensive questionnaire assessing both the content and the methods of their training. The questionnaire had 37 quantitative questions requesting responses on a 7-point Likert scale and three open-ended questions to give more qualitative data. RESULTS: Sixty-four percent of all trainees responded. A number of interesting findings about the strengths and weaknesses of training emerged. For example, Bandung trainees felt they had excellent training in trauma but not in specialty areas, especially spine and vascular, with ample opportunity to operate as the primary surgeon. Toronto trainees felt that the volume and the variety of cases were excellent but they did not have enough ambulatory experience, and that they had suboptimal experience as the primary surgeon. Trainees in both centers agree that they will feel competent to practice neurosurgery upon completion of their training. CONCLUSION: This study defined different educational needs for neurosurgical trainees in two centers that reflect both their individual training environments and the local culture of medicine. As such, trainees' perceptions of these needs represent an important adjunct to program evaluation.

Attitude of Health Personnel↗

PubMed2006

Evaluation of patient simulator performance as an adjunct to the oral examination for senior anesthesia residents.

BACKGROUND: Patient simulators possess features for performance assessment. However, the concurrent validity and the "added value" of simulator-based examinations over traditional examinations have not been adequately addressed. The current study compared a simulator-based examination with an oral examination for assessing the management skills of senior anesthesia residents. METHODS: Twenty senior anesthesia residents were assessed sequentially in resuscitation and trauma scenarios using two assessment modalities: an oral examination, followed by a simulator-based examination. Two independent examiners scored the performances with a previously validated global rating scale developed by the Anesthesia Oral Examination Board of the Royal College of Physicians and Surgeons of Canada. Different examiners were used to rate the oral and simulation performances. RESULTS: Interrater reliability was good to excellent across scenarios and modalities: intraclass correlation coefficients ranged from 0.77 to 0.87. The within-scenario between-modality score correlations (concurrent validity) were moderate: r = 0.52 (resuscitation) and r = 0.53 (trauma) (P < 0.05). Forty percent of the average score variance was accounted for by the participants, and 30% was accounted for by the participant-by-modality interaction. CONCLUSIONS: Variance in participant scores suggests that the examination is able to perform as expected in terms of discriminating among test takers. The rather large participant-by-modality interaction, along with the pattern of correlations, suggests that an examinee's performance varies based on the testing modality and a trainee who "knows how" in an oral examination may not necessarily be able to "show how" in a simulation laboratory. Simulation may therefore be considered a useful adjunct to the oral examination.

Adult↗

PubMed2006

Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.

BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). METHODS: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. RESULTS: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. CONCLUSIONS: Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.

Adult↗

PubMed2006

Teaching medical education principles and methods to faculty using an active learning approach: the University of Michigan Medical Education Scholars Program.

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School was established in 1998 to develop educational leadership, improve teaching skills, and promote educational scholarship among medical school faculty. The Department of Medical Education designed and implemented the program. Eighty-one scholars have completed the MESP, with 15 more currently enrolled. While most scholars have been clinical faculty, some have been basic science faculty or from other allied health fields. The selection process emphasizes potential for contributing to the educational mission of the medical school. Each cohort is limited to two participants per department. The curriculum of the MESP is designed to provide an overview of a wide range of topics in education. It is divided into five broad domains: principles and theories of education, teaching methods, educational research methods, assessment and evaluation, and educational leadership. During the sessions, active learning of content is expected and encouraged. For instance, scholars share responsibility with the session presenters for planning and evaluating individual program sessions. To graduate, scholars are expected to attend the sessions regularly, and to make a final presentation of their project, which demonstrates near-completion or substantial progress toward that goal. Over its eight years, the MESP has evolved in response to environmental changes and ongoing evaluation of the program. Overall, the Medical Education Scholars Program has proven effective in developing faculty skills and educational leadership locally at the University of Michigan Medical School and nationally.

Adult↗

PubMed2006

Duty hours reforms in the United States, France, and Canada: is it time to refocus our attention on education?

Resident duty hours restrictions have now been instituted in many countries worldwide. Such policies have resulted in a broad-based discussion in the medical literature concerning their effects on patient care, resident education, and resident well-being. To better understand the impetuses behind these changes, the authors examine not only the duty hours mandates currently in effect in the United States, Canada, and France, but also the events influencing their independent development in these three countries. In the United States, an 80-hour resident workweek was mandated by the Accreditation Council for Graduate Medical Education out of concern for patient safety. In France, a 52.5-hour workweek was decreed by the government, reflecting the broader European Working Time Directive initiated out of concern for the negative impact of extended work hours on its population. In Canada, resident unions, whose primary interest has been one of resident well-being, have negotiated a series of reduced resident duty hours that approach those mandated in the United States. At the core of these changes are unique differences in these countries' health care and medical education systems. The resulting diversity in the origin and nature of such regulations serves to highlight the lack of evidence that has guided their development and the need to refocus on the educational elements of postgraduate training.

Canada↗

PubMed2006

Teaching technical skills to surgical residents: a survey of empirical research.

We review a series of empirical studies on the use of simulators and bench models in training technical skills and subsequent retention of those skills. We discuss recent research on the transfer of training from bench models and simulators to the clinical setting and provide a theoretical structure to organize the findings. The transfer of training from inanimate bench models and simulators to live patients has recently been demonstrated in a number of areas. The effectiveness of this training is enhanced if focus is placed on the operative, or process-oriented, aspects of the procedure, with suspension of disbelief regarding the physical structure of the training platform. The retention of trained skills is an area of research only beginning to evolve, with recent results suggesting that effective retention can be demonstrated if training is tightly focused and involves an entire procedure. An emerging area of research involves the use of simulators as assessment instruments for high-stakes testing, and recent results involving simulated trauma management support this novel application. Based on these findings, we encourage the use of a wide variety of high- and low-fidelity platforms, with emphasis on training procedural knowledge involving an entire procedure.

Clinical Competence↗

PubMed2006

Predicting the technical competence of surgical residents.

I describe an approach to predicting competence in technical skills for the purposes of resident selection. To demonstrate a predictive relationship, it is necessary to use measures that exhibit variation, reliability, and validity. There is little evidence that such measures are routinely used in the process of selecting residents. I argue that the selection of assessment instruments in the predictor domain must be guided by relevant theoretical considerations, while assessment in the surgical domain must make use of more objective and reliable instruments than is currently the practice. I present a brief summary of research on predicting operative technical competence.

Clinical Competence↗

PubMed2006

Effect of age on detection of gaps in speech and nonspeech markers varying in duration and spectral symmetry.

Gap detection thresholds for speech and analogous nonspeech stimuli were determined in younger and older adults with clinically normal hearing in the speech range. Gap detection thresholds were larger for older than for younger listeners in all conditions, with the size of the age difference increasing with stimulus complexity. For both ages, gap detection thresholds were far smaller when the markers before and after the gap were the same (spectrally symmetrical) compared to when they were different (spectrally asymmetrical) for both speech and nonspeech stimuli. Moreover, gap detection thresholds were smaller for nonspeech than for speech stimuli when the markers were spectrally symmetrical but the opposite was observed when the markers were spectrally asymmetrical. This pattern of results may reflect the benefit of activating well-learned gap-dependent phonemic contrasts. The stimulus-dependent age effects were interpreted as reflecting the differential effects of age-dependent losses in temporal processing ability on within- and between-channel gap detection.

Adult↗

PubMed2005

Barriers to use of simulation-based education.

PURPOSE: Barriers to simulation-based education in postgraduate and continuing education for anesthesiologists have not been well studied. We hypothesized that the level of training may influence attitudes towards simulation-based education and impact on the use of simulation. This study investigated this issue at the University of Toronto which possesses two sites equipped with high-fidelity patient simulators. METHODS: A 40-question survey of experiences, perceptions, motivations and perceived barriers to simulation-based education, was distributed to 154 anesthesiologists attending a departmental conference. Data were analyzed using descriptive statistics and associations between responses were assessed using either the Chi-Square statistic or a one-way analysis of variance. RESULTS: The rate of response was 58%. Residents had experienced simulation-based education (96%) more often than staff (58%) and fellows (36%), (P < 0.001 respectively). Residents had also attended more simulation sessions than staff and fellows (mean 2.8 vs 1.05 and 1.04, P < 0.001 respectively). Residents and fellows found simulation-based education more relevant for their training than staff (88% vs 65%, P < 0.05). Eighty-one percent of the respondents identified at least one significant barrier that prevents or limits them from attending simulator sessions. Staff anesthesiologists perceived multiple barriers and identified 'time' and 'financial issues' as significant barriers. CONCLUSION: Anesthesiologists' level of training influences their attitudes towards and their perceptions of simulation-based education. This survey has identified perceived barriers that may limit a wider utilization of simulation. These results may be used to implement targeted actions such as course design, incentives, and information strategies, which could improve access and future use of simulation.

Anesthesiology↗

PubMed2005

Nontechnical skills in anesthesia crisis management with repeated exposure to simulation-based education.

BACKGROUND: Critical incident reporting and observational studies have identified nontechnical skills that are vital to successful anesthesia crisis management. Examples of such skills include task management, team working, situation awareness, and decision making. These skills are not necessarily acquired through clinical experience and may need to be specifically taught. This study uses a high-fidelity patient simulator to assess the effect of repeated exposure to simulated anesthesia crises on the nontechnical skills of anesthesia residents. METHODS: After institutional research board approval and informed consent, 20 anesthesia residents were recruited. Each resident was randomized to participate as the primary anesthesiologist in the management of three different simulated anesthesia crises using a high-fidelity patient simulator. After each session, videotaped footage was used to facilitate debriefing of their nontechnical skills. The videotapes were later reviewed by two expert blinded independent assessors who rated each resident's nontechnical skills by using a previously validated and reliable marking system. RESULTS: : A significant improvement in the nontechnical skills of residents was demonstrated from their first to second session and from their first to third session (both P < 0.005). However from their second to third session, no significant improvement was observed. Interrater reliability between assessors was modest (single rater intraclass correlation = 0.53). CONCLUSION: A single exposure to anesthesia crises using a high-fidelity patient simulator can improve the nontechnical skills of anesthesia residents. However, an additional simulation session may confer little or no additional benefit.

Adult↗

PubMed2005

Effective training and assessment of surgical skills, and the correlates of performance.

This report briefly describes the University of Toronto Surgical Skills Centre and summarizes research in technical skills conducted at that site. This includes work on curriculum evaluation, the development and validation of assessment instruments, the retention of technical skills after training, and the prediction of success in surgery. These studies benefited from the large number of participants made available by the Surgical Skills Centre, allowing for randomized controlled studies or correlation studies where larger numbers are necessary for adequate statistical power. Recent emphasis has been on the further development of objective means of assessment and the exploration of correlates of surgical performance. Ongoing research is also aimed at simulator validation.

Clinical Competence↗

PubMed2004

The benefit of the operating microscope for access cavity preparation by undergraduate students.

Although studies show the operating microscope (OM) provides benefits for endodontists, the benefit to undergraduates has not been evaluated as completely as for specialists. The purpose of this study was to determine whether using the OM would improve students' performance in endodontic access cavity preparation and canal identification. Thirty-six dental students prepared access cavities and located canals in extracted maxillary molars, before and after training, which varied according to group. The standard group received a lecture and practice in preparation of access cavities. The microscope group received identical instruction using the OM. The control group received lectures only. All groups received equal content and instruction time (2 hr 20 min). Faculty graded preparations according to a multidimensional 5-point rating scale. Using the OM, the microscope group improved significantly in access cavity preparation (p <0.05) and significantly outperformed both standard and control groups in accuracy of identifying canals (p <0.05).

Analysis of Variance↗

PubMed2004

Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.

PURPOSE: We evaluated the durability of laboratory based technical skills training in urological microsurgery using bench model simulators. METHODS AND MATERIALS: A total of 50 junior surgery residents (post-graduate years 1 to 3) were recruited to participate in a focused training program in urological microsurgery. Prior to training subjects were randomized to receive hands-on training with bench model simulators (silicone tubing or live rat vas deferens, 40) or didactic training alone (10). Four months following the original training program the technical performance of 18 returning subjects (13 from the bench model and 5 from the didactic training group) was reevaluated using a high fidelity, live animal model (vasovasostomy and rat vas deferens). Outcome measures included blinded, expert assessment of videotaped performance using checklists and global rating scores, and evaluation of anastomotic patency. RESULTS: The retention test checklist (p <0.001), global rating scores (p <0.001) and anastomotic patency rates (p = 0.05) in the live animal model remained significantly higher for subjects who originally received hands-on bench model training compared with those who received didactic training alone. The number of interim practice opportunities with microsurgery correlated significantly with expert global ratings of surgical performance irrespective of the nature of training (r = 0.54, p = 0.02). CONCLUSIONS: Laboratory based technical skills training with bench models can lead to a significant retention of technical skill by novice surgeons. Measured performance improvements appear to be durable with time. However, the opportunity for repeat hands-on practice appears to maximize the retention of technical skill.

Adult↗

PubMed2004

The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures.

OBJECTIVE: To evaluate the impact of bench model fidelity on the acquisition of technical skill using clinically relevant outcome measures. METHODS: Fifty junior surgery residents participated in a 1-day microsurgical training course. Participants were randomized to 1 of 3 groups: 1) high-fidelity model training (live rat vas deferens; n = 21); 2) low-fidelity model training (silicone tubing; n = 19); or 3) didactic training alone (n = 10). Following training, all participants were assessed on the high- and low-fidelity bench models. Immediate outcome measures included procedure times, blinded, expert assessment of videotaped performance using checklists and global rating scales, anastomotic patency, suture placement precision, and final product ratings. Delayed outcome measures (obtained from the live rat vas deferens 30 days following training) included anastomotic patency, presence of a sperm granuloma, and the presence of sperm on microscopy. RESULTS: Following training, checklist (P < 0.001) and global rating scores (P < 0.001) on the bench model simulators were higher among subjects who received hands-on training, irrespective of model fidelity. Immediate anastomotic patency rates of the rat vas deferens were higher with increasing model fidelity training (P = 0.048). Delayed anastomotic patency rates were higher among subjects who received bench model training, irrespective of model fidelity (P = 0.02). Rates of sperm presence on microscopy were higher among subjects who received high-fidelity model training compared with subjects who received didactic training (P = 0.039) but did not differ among subjects in the high- and low-fidelity groups. CONCLUSIONS: Surgical skills training on low-fidelity bench models appears to be as effective as high-fidelity model training for the acquisition of technical skill among novice surgeons.

Adult↗

PubMed2003

Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity.

Our purposes were: 1) to establish the predictive validity of stereoscopic visual acuity and microsurgical performance, and 2) to establish the construct and concurrent validity of hand-motion analysis as an objective and sensitive measure of microsurgical performance. Using a surgical microscope, 50 surgical residents completed a standardized microsurgical suturing task at baseline and following microsurgical training. Microsurgical performance was evaluated by blinded, expert microsurgeons using global rating scales. Measures of stereoscopic visual acuity and hand-motion analysis were correlated with expert global rating scores. Global rating scores correlated significantly with number of hand movements (r = -0.47, P = 0.001) and hand-travel distance (r = -0.37, P = 0.008). Economy of hand-motion improved significantly following microsurgical training (number of hand movements, P = 0.046; hand-travel distance, P = 0.04). Measures of stereoscopic visual acuity did not correlate significantly with global rating scores. Hand-motion analysis appears to be an objective and sensitive instrument for assessing microsurgical performance, with evidence of both concurrent and construct validity. The predictive validity of stereoscopic visual acuity and microsurgical performance remains unclear.

Adult↗

PubMed2003

Evaluating the effectiveness of a 2-year curriculum in a surgical skills center.

BACKGROUND: This study was a formative evaluation of a 2-year Surgical Skills Center Curriculum (SSCC) using objective measures of surgical performance and self-reported process-oriented evaluations. METHODS: Fifty postgraduate third-year (PGY-3) residents participated in an Objective Structured Assessment of Technical Skills (OSATS) examination. Nineteen residents underwent the SSCC and 31 residents did not. During the SSCC, self-reported student and faculty evaluations were completed after each session. RESULTS: For the OSATS examination, scores were not significantly different between treatment and control groups, on either the checklist (66.4 +/- 6.1 versus 64.1 +/- 10.8) or global rating scale scores (66.9 +/- 6.9 versus 68.0 +/- 9.6). Further comparisons between groups on individual OSATS stations revealed no significant differences between groups. The majority of student and faculty evaluation remarks were highly positive. CONCLUSIONS: The OSATS results failed to support our hypothesis that training on a core procedure in a single session during a SSCC would have an appreciable and sustained effect after 2 years. Self-reported process-oriented evaluations support the utility of our SSCC.

Clinical Competence↗

PubMed2003

Visual-spatial ability correlates with efficiency of hand motion and successful surgical performance.

BACKGROUND: This study examines the influence of visual-spatial ability and manual dexterity on surgical performance across 3 levels of expertise. METHODS: Dental students, surgical residents, and staff surgeons completed standardized tests of manual dexterity and visual-spatial ability and were assessed objectively while performing the rigid fixation of an anterior mandible on bench model simulations. Outcome variables included expert assessment of technical performance and efficiency of hand motion during the procedure (recorded using electromagnetic sensors). RESULTS: Visual-spatial scores correlated significantly with surgical performance scores within the group of dental students (r=.40 to.73), but this was not the case for residents or staff surgeons. For all groups, manual dexterity did not correlate with hand motion parameters. There were no differences between groups in visual-spatial ability or manual dexterity, but highly significant differences were seen in surgical performance scores (P<.001), in that surgeons outperformed residents, who in turn outperformed students. CONCLUSIONS: Among novices, visual-spatial ability is associated with skilled performance on a spatially complex surgical procedure. However, advanced trainees and experts do not score any higher on carefully selected visual-spatial tests, suggesting that practice and surgical experience may supplant the influence of visual-spatial ability over time. Thus, the use of these tests for the selection of residents is not currently recommended; they may be of more use in identifying those novice trainees (ie, those with lower test scores) who might benefit most from brief supplementary instruction on specific technical tasks.

Clinical Competence↗

PubMed2002

Effect of visual-spatial ability on learning of spatially-complex surgical skills.

Visual-spatial ability is thought to be important in competency in specific surgical procedures. To test this hypothesis, 37 surgical residents completed six tests of visual-spatial ability, ranging from low-level to high-level visual processing. Using previously validated and objective instruments, we then assessed their ability to complete and learn a spatially-complex surgical procedure. Residents with higher visual-spatial scores in the form-board test and the mental-rotations test did significantly better in the procedure than did those with lower scores. After practice and feedback, residents with lower scores achieved a comparable level of competency. Our results suggest that visual-spatial ability is related to competency and quality of results in complex surgery, and could potentially be used in resident selection, career counselling, and training.

Animals↗