Review Article
Medical Education
Malcolm Cox, M.D., Editor, David M. Irby, Ph.D., Editor
Teaching Surgical Skills — Changes in the Wind
N Engl J Med 2006; 355:2664-2669December 21, 2006
- Article
Video
Training Model for Microvascular Anastomosis.
Video
Vascular Anastomosis: Graft to Femoral Artery.
Sir William Halsted introduced a German-style residency training system with an emphasis on graded responsibility at Johns Hopkins Hospital in 1889.1 This system remains the cornerstone of surgical training in North America more than a century later. However, advances in educational theory, as well as mounting pressures in the clinical environment, have led to questions about the reliance on this approach to teaching technical skills.
Those pressures include a move toward a shorter workweek for residents2,3 and an emphasis on operating room efficiency, both of which diminish teaching time. Yet the patients in our teaching hospitals are generally much sicker and have more complex problems than in times past. The increasing complexity of cases and a greater emphasis on mitigating medical error limit a faculty's latitude in assisting residents with technical procedures.
Sheer volume of exposure, rather than specifically designed curricula, is the hallmark of current surgical training.4 But as opportunities for learning through work with “real” patients have diminished, interest in laboratories with formal curricula, specifically designed to teach surgical skills, has increased dramatically. In this new model of surgical education, basic surgical skills are learned and practiced on models and simulators, with the aim of better preparing trainees for the operating room experience.5-10
These new training techniques are based on established theories of the ways in which motor skills are acquired and expertise is developed. Fitts and Posner's three-stage theory of motor skill acquisition is widely accepted in both the motor skills literature and the surgical literature (Table 1Table 1
The Fitts–Posner Three-Stage Theory of Motor Skill Acquisition.).11,12 In the cognitive stage, the learner intellectualizes the task; performance is erratic, and the procedure is carried out in distinct steps. For example, with a surgical skill as simple as tying a knot, in the cognitive stage the learner must understand the mechanics of the skill — how to hold the tie, how to place the throws, and how to move the hands. With practice and feedback, the learner reaches the integrative stage, in which knowledge is translated into appropriate motor behavior. The learner is still thinking about how to move the hands and hold the tie but is able to execute the task more fluidly, with fewer interruptions. In the autonomous stage, practice gradually results in smooth performance. The learner no longer needs to think about how to execute this particular task and can concentrate on other aspects of the procedure.This model has obvious implications for surgical training. The earlier stages of teaching technical skills should take place outside the operating room; practice is the rule until automaticity in basic skills is achieved. This mastery of basic skills allows trainees to focus on more complex issues, both technical and nontechnical, in the operating room. To return to the example of knot tying, the learner who still has to think about how to tie a square knot is much less likely to pick up on other teaching that transpires in the operating room than is the learner who has mastered this simple skill.
Ericsson has helped to elucidate the acquisition of expertise.13,14 Expert performance represents the highest level of skill acquisition and the final result of a gradual improvement in performance through extended experience in a given domain. According to Ericsson, most professionals reach a stable, average level of performance and maintain this status for the rest of their careers. In surgery, “experts” have been defined by Ericsson as experienced surgeons with consistently better outcomes than nonexperts. An extensive literature on the relationship of operative volume to clinical outcomes supports the hypothesis that practice is an important determinant of outcome15; the literature also provides support for Ericsson's contention that many professionals probably do not attain true expertise. However, volume alone does not account for the skill level among practitioners, since variations in performance have been shown among surgeons with high and very high volumes. Deliberate practice is a critical process for the development of mastery or expertise. Ericsson argues that the number of hours spent in deliberate practice, rather than just hours spent in surgery, is an important determinant of the level of expertise.13
Deliberate practice calls for the individual to focus on a defined task, typically identified by a teacher, to improve particular aspects of performance; it involves repeated practice along with coaching and immediate feedback on performance. The attained level of expertise has been shown to be closely related to time devoted to deliberate practice in the performance of expert musicians, chess players, and athletes. In the current model of surgical training, based primarily on apprenticeship, the opportunities for deliberate practice are rare. Operations are complex, and it is difficult to focus on one small component of the procedure.
In our opinion, in order to better plan instruction and assess the efficacy of curricular interventions, valid and reliable assessments of technical skills are needed. Evaluating performance in the operating room is difficult,16 and most efforts have focused on techniques that standardize the assessment process outside the operating room. One such method is the Objective Structured Assessment of Technical Skills (OSATS),17,18 in which candidates perform a series of standardized surgical tasks on inanimate models under the direct observation of an expert. Examiners score candidates using two methods. The first is a task-specific checklist consisting of 10 to 30 specific surgical maneuvers that have been deemed essential elements of the procedure. The second is a global rating form, which includes five to eight surgical behaviors, such as respect for tissues, economy of motion, and appropriate use of assistants. The validity and reliability of the OSATS are similar to those of the more traditional Objective Structured Clinical Examination (OSCE) and are acceptable for summative high-stakes evaluation purposes.19-21 To date, we have created more than 40 OSATS stations; some examples are shown in Figure 1Figure 1
Examples of OSATS Stations..Other methods of assessment include the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS)22 and the Imperial College Surgical Assessment Device (ICSAD).23,24 Developed at McGill University in Montreal, the MISTELS uses an inanimate box to simulate the generic skills needed in the performance of laparoscopic surgery. It has been shown to be a valid and reliable instrument for assessing laparoscopic skills.22 The ICSAD, developed at Imperial College in London, tracks hand motion using sensors placed on the trainee's hands during the performance of a task. The sensors translate movement into a computerized tracing of hand motion, which provides an effective index of technical skill in both laparoscopic23 and open24,25 procedures. This index has been shown to have good concordance with OSATS scores.
Most surgical training programs make use of a variety of models, including inanimate models, virtual reality, live animals, and human cadavers, to simulate living human tissue and anatomy, as well as high-performance patient simulators for critical-incident and team training. Although human cadavers most closely approximate reality, their cost and limited availability, as well as the poor compliance of cadaveric tissue, limit their use. The use of live animals is also problematic because of ethical concerns, high costs, and the need for specialized facilities. In contrast, inanimate models are safe, reproducible, portable, readily available, and generally more cost-effective than animals or cadavers. Some of the advantages and disadvantages of various models are summarized in Table 2Table 2
Types of Simulations Available..Recent advances in virtual reality technology have demonstrated its potential for enhancing surgical skills training, and many virtual reality systems are now commercially available. Virtual reality provides the opportunity for very detailed feedback and may allow for more subtle measurement of trainee performance than is possible in the real world.25 Measures of precision and accuracy as well as error rates can be calculated easily.23,25,26
Two prospective trials have demonstrated that residents who have been trained on low-fidelity (not very lifelike) virtual reality models (laparoscopic box trainers) make fewer intraoperative errors when performing a laparoscopic cholecystectomy than do residents who have not had the benefit of simulation training.27,28 High-fidelity (lifelike) virtual reality models are also available for training in procedures such as colonoscopy and carotid artery stenting.29 A Food and Drug Administration panel recently recommended the use of virtual reality simulation as an integral component of a training package for carotid artery stenting.30
However, high-fidelity virtual reality comes at a price. As a general rule, the higher the fidelity and the more realistic the model, the more expensive the training tool. Further investigation will be required to determine whether such an investment is worthwhile. A large carotid artery stenting trial that is currently under way will help assess the effectiveness of high-fidelity virtual reality models in training experienced practitioners.31
Fidelity may be less important at relatively junior levels of training. For example, when one group of medical students was trained with the use of a high-fidelity-video endoscopic urology system and another with the use of a simple bench model, the two groups showed the same improvement in performance and showed more improvement than the control group (given didactic training).32 Likewise, among first-year surgical residents, improvement in performance for a variety of open procedures has been shown to be the same whether low-fidelity bench models or cadavers are used,33 and residents working with a simple Silastic tubing model performed similarly to those working with the vas deferens of a live rat.34
What about the overall effectiveness of ex vivo surgical skills training? To date, the evidence for transfer to the operating room is stronger for minimally invasive surgery than for more traditional open procedures. In a series of experiments involving more than 200 surgeons and trainees, practice on a physical laparoscopic simulator led to the acquisition of skills that were transferable to complex laparoscopic tasks such as suturing.22 Similarly, second- and third-year residents who received formal training on a physical laparoscopic simulator had a significantly greater improvement in video-trainer scores and global assessments of performance of a laparoscopic cholecystectomy than did residents who had no simulator training.35
The transfer of skills learned on virtual reality laparoscopic simulators has also been encouraging. Residents who received virtual reality training performed the dissection more quickly, made fewer errors, and had higher economy-of-movement scores during a laparoscopic cholecystectomy than did residents without such training.27,28 Taken together, these studies strongly suggest that ex vivo laparoscopic training leads to detectable benefits for learners in clinical settings.
However, it remains unclear whether the improvement in performance after ex vivo training is durable. One study, by Grober and colleagues,36 showed a durable positive effect of bench-model training in the task of microvascular anastomosis. In contrast, Sedlack and Kolars37 found an initial positive effect of virtual reality training in colonoscopy. However, in this high-volume unit, where fellows were performing approximately 15 colonoscopies per week, fellows who were trained with virtual reality models performed similarly to those who were not after a threshold of 30 procedures. Nonetheless, one could argue that whereas the advantages of training on a simulator may be limited to early procedural experience, the enhanced early learning curve may allow educators to be more efficient with their time.
Virtual reality has the potential to enhance surgical-team training as well as technical skills training. In aviation, teamwork training with simulation has been instrumental in reducing errors.38,39 The importance of teamwork in preventing medical error is well recognized, and simulator-based team training has been advocated as a possible preventive approach. Early research results have been promising. Simulator-based trauma-team training has been associated with enhanced performance.40 Task completion and simulated survival rates have improved after emergency-team training on a simulator.41 Simulator-based training for crisis management in anesthesia, both for individuals and for teams, has been shown to be effective,42 and simulated operating room environments are being assessed for training in both technical skills and teamwork.43
In summary, the report card on simulation, while not definitively positive, does suggest that it is an important addition to the training arsenal. The effectiveness of simulation training has been demonstrated primarily for lower-level learners,27,28,32-34 with a positive effect demonstrated for both laparoscopic27,28,35 and open33,34 procedures. Results to date have not been validated in large-scale studies, however, and additional research demonstrating the generalizability of findings across institutions is required. Additional research on simulation training for more senior learners, and for surgeons in practice, is needed. Further work is also needed to address important motor-learning issues, such as whether it is preferable to practice whole operations or to practice segments of operations and then build the whole from the segments, what practice schedules are optimal, and how to optimize the transfer of skills to the operating room. Simulator-based skills training is a relatively new area of research, and we are only beginning to build our knowledge in this domain.
As computing power expands and the cost of simulation equipment falls, it is likely that most, if not all, surgical training programs will be devoting substantial curricular time to simulator-based training. Increasing evidence of the efficacy of ex vivo training, coupled with societal pressure, will probably mean that future residents will need to demonstrate proficiency in basic techniques before being allowed to operate on patients.
With these and other changes in the wind, surgical educators will need to incorporate meaningful assessment into residency programs, using rigorous, reliable, and regular means of assessment for all relevant surgical skills. Tools with the requisite levels of reliability and validity for summative assessment include the OSATS and MISTELS programs. For example, the MISTELS program might be used to assess a resident's performance of basic laparoscopic skills. A requisite level of performance would be required before the resident would be allowed to perform a laparoscopic cholecystectomy. Similarly, OSATS stations could be used for open surgery. Residents would thus be trained in the laboratory until preset criteria had been met and would only then be allowed to participate in the graduated performance of procedures in patients. Competence-based advancement, rather than time served, would become standard in surgical training.
One of the challenges of a competence-based system of education and assessment that has received little attention is how to establish pass or fail standards for the performance of technical skills. This is a major deficit in the assessment literature that will require attention if a criterion-based system is implemented or if certification of technical ability is required before licensure. Given the advances in technology and the accruing evidence of their effectiveness, now is the time to take stock of the changes we can and must make to improve the assessment and training of surgeons in the future.
Videos showing training models for microvascular and vascular anastomosis are available with the full text of this article at www.nejm.org.
No potential conflict of interest relevant to this article was reported.
Source Information
From the Department of Surgery, University of Toronto, University Health Network (R.K.R.); and the University of Toronto Surgical Skills Centre at Mount Sinai Hospital (H.M.) — both in Toronto.
Address reprint requests to Dr. Reznick at the Department of Surgery, University of Toronto, Suite 311, 100 College St., Toronto, ON M5G 1L5, Canada, or at richard.reznick@utoronto.ca.
- References
References
1
Carter BN . The fruition of Halsted's concept of surgical training. Surgery 1952;32:518-527
Web of Science | Medline2
Council Directive 93/104/EC. Official Journal of the European Communities 1993;307:18-24
3
Leach DC . A model for GME: shifting from process to outcomes -- a progress report from the Accreditation Council for Graduate Medical Education. Med Educ 2004;38:12-14
CrossRef | Web of Science | Medline4
Haluck RS ,Krummel TM . Computers and virtual reality for surgical education in the 21st century. Arch Surg 2000;135:786-792
CrossRef | Web of Science | Medline5
Scallon SE ,Fairholm DJ ,Cochrane DD ,Taylor DC . Evaluation of the operating room as a surgical teaching venue. Can J Surg 1992;35:173-176
Web of Science | Medline6
Hutchison C ,Hamstra S ,Leadbetter W . The University of Toronto Surgical Skills Centre opens. Focus Surg Educ 1998;16:22-247
Heppell J ,Beauchamp G ,Chollet A . Ten-year experience with a basic technical skills and perioperative management workshop for first-year residents. Can J Surg 1995;38:27-32
Web of Science | Medline8
Lossing AG ,Hatswell EM ,Gilas T ,Reznick RK ,Smith LC . A technical-skills course for 1st-year residents in general surgery: a descriptive study. Can J Surg 1992;35:536-540
Web of Science | Medline9
Cauraugh JH ,Martin M ,Martin KK . Modeling surgical expertise for motor skill acquisition. Am J Surg 1999;177:331-336
CrossRef | Web of Science | Medline10
Reznick RK . Teaching and testing technical skills. Am J Surg 1993;165:358-361
CrossRef | Web of Science | Medline11
Fitts PM, Posner MI. Human performance. Belmont, CA: Brooks/Cole, 1967.
12
Kopta JA . The development of motor skills in orthopaedic education. Clin Orthop 1971;75:80-85
CrossRef | Medline13
Ericsson KA. The acquisition of expert performance: an introduction to some of the issues. In: Ericsson KA, ed. The road to excellence: the acquisition of expert performance in the arts and sciences, sports, and games. Mahwah, NJ: Lawrence Erlbaum Associates, 1996:1-50.
14
Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004;79:Suppl 10:S70-S81
Web of Science | Medline15
Halm EA ,Lee C ,Chassin MR . Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511-520
Web of Science | Medline16
Winckel CP ,Reznick RK ,Cohen R ,Taylor B . Reliability and construct validity of a structured technical skills assessment form. Am J Surg 1994;167:423-427
CrossRef | Web of Science | Medline17
Martin JA ,Regehr G ,Reznick R , et al. Objective Structured Assessment of Technical Skill (OSATS) for surgical residents. Br J Surg 1997;84:273-278
CrossRef | Web of Science | Medline18
Reznick R ,Regehr G ,MacRae H ,Martin J ,McCulloch W . Testing technical skill via an innovative “bench station” examination. Am J Surg 1997;173:226-230
CrossRef | Web of Science | Medline19
Regehr G ,MacRae H ,Reznick RK ,Szalay D . Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 1998;73:993-997
CrossRef | Web of Science | Medline20
Jansen JJ ,Tan LH ,van der Vleuten CP ,van Luijk SJ ,Rethans JJ ,Grol RP . Assessment of competence in technical clinical skills of general practitioners. Med Educ 1995;29:247-253
CrossRef | Web of Science | Medline21
Szalay D ,MacRae H ,Regehr G ,Reznick R . Using operative outcome to assess technical skill. Am J Surg 2000;180:234-237
CrossRef | Web of Science | Medline22
Fried GM ,Feldman LS ,Vassiliou MC , et al. Proving the value of simulation in laparoscopic surgery. Ann Surg 2004;240:518-528
CrossRef | Web of Science | Medline23
Taffinder N ,Sutton C ,Fishwick RJ ,McManus IC ,Darzi A . Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator. Stud Health Technol Inform 1998;50:124-130
Medline24
Datta V ,Mackay SD ,Mandalia M ,Darzi A . The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 2001;193:479-485
CrossRef | Web of Science | Medline25
Darzi A ,Mackay S . Assessment of surgical competence. Qual Health Care 2001;10:Suppl 2:ii64-ii69
CrossRef | Medline26
Risucci D ,Cohen JA ,Garbus JE ,Goldstein M ,Cohen MG . The effects of practice and instruction on speed and accuracy during resident acquisition of simulated laparoscopic skills. Curr Surg 2001;58:230-235
CrossRef | Medline27
Seymour NE ,Gallagher AG ,Roman SA , et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002;236:458-463
CrossRef | Web of Science | Medline28
Grantcharov TP ,Kristiansen VB ,Bendix J ,Bardram L ,Rosenberg J ,Funch-Jensen P . Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004;91:146-150
CrossRef | Web of Science | Medline29
Cotin S, Dawson SL, Meglan D, et al. ICTS, an interventional cardiology training system. In: Westwood JD, Hoffman HM, Mogel GT, Robb RA, Stredney D, eds. Medicine meets virtual reality 2000. Washington, DC: IOS Press, 2000:59-65.
30
Gallagher AG ,Cates CU . Approval of virtual reality training for carotid stenting: what this means for procedural-based medicine. JAMA 2004;292:3024-3026
CrossRef | Web of Science | Medline31
Yadav JS ,Wholey MH ,Kuntz RE , et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-1500
Full Text | Web of Science | Medline32
Matsumoto ED ,Hamstra SJ ,Radomski SB ,Cusimano MD . The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002;167:1243-1247
CrossRef | Web of Science | Medline33
Anastakis DJ ,Regehr G ,Reznick RK , et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 1999;177:167-170
CrossRef | Web of Science | Medline34
Grober ED ,Hamstra SJ ,Wanzel KR , et al. The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg 2004;240:374-381
CrossRef | Web of Science | Medline35
Scott DJ ,Bergen PC ,Rege RV , et al. Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 2000;191:272-283
CrossRef | Web of Science | Medline36
Grober ED ,Hamstra SJ ,Wanzel KR , et al. Laboratory based training in urologic microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. J Urol 2004;172:378-381
CrossRef | Web of Science | Medline37
Sedlack RE ,Kolars JC . Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study. Am J Gastroenterol 2004;99:33-37
CrossRef | Web of Science | Medline38
Helmreich RL . Managing human error in aviation. Sci Am 1997;276:62-67
CrossRef | Web of Science | Medline39
Leedom D ,Dimon R . Improving team coordination: a case for behavior-based training. Mil Psych 1995;7:109-122
CrossRef | Web of Science40
Holcomb JB ,Dumire RD ,Crommett JW , et al. Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. J Trauma 2002;52:1078-1085
CrossRef | Web of Science | Medline41
DeVita MA ,Schaefer J ,Lutz J ,Wang H ,Dongilli T . Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care 2005;14:326-331
CrossRef | Web of Science | Medline42
Wong AK . Full scale computer simulators in anesthesia training and evaluation. Can J Anaesth 2004;51:455-464
CrossRef | Web of Science | Medline43
Moorthy K ,Munz Y ,Adams S ,Pandey V ,Darzi A . A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann Surg 2005;242:631-639
CrossRef | Web of Science | Medline
- Citing Articles (177)
Citing Articles
1
Adam Dubrowski, Ryan Brydges, Lisa Satterthwaite, George Xeroulis, Roger Classen. (2012) Do not teach me while I am working!. The American Journal of Surgery 203:2, 253-257
CrossRef2
Ann VanHeest, Bradley Kuzel, Julie Agel, Matthew Putnam, Loree Kalliainen, James Fletcher. (2012) Objective Structured Assessment of Technical Skill in Upper Extremity Surgery. The Journal of Hand Surgery 37:2, 332-337.e4
CrossRef3
Karen Woo, Vincent L. Rowe, Fred A. Weaver, Maura E. Sullivan. (2012) The Results of a Needs Assessment to Guide a Vascular Surgery Skills Simulation Curriculum. Annals of Vascular Surgery 26:2, 198-204
CrossRef4
Yue-Yung Hu, Sarah E. Peyre, Alexander F. Arriaga, Robert T. Osteen, Katherine A. Corso, Thomas G. Weiser, Richard S. Swanson, Stanley W. Ashley, Chandrajit P. Raut, Michael J. Zinner, Atul A. Gawande, Caprice C. Greenberg. (2012) Postgame Analysis: Using Video-Based Coaching for Continuous Professional Development. Journal of the American College of Surgeons 214:1, 115-124
CrossRef5
Nicole K. Roberts, Michael J. Brenner, Reed G. Williams, Michael J. Kim, Gary L. Dunnington. (2012) Capturing the teachable moment: A grounded theory study of verbal teaching interactions in the operating room. Surgery
CrossRef6
Revaz Botchorishvili, Benoit Rabischong, Demetrio Larraín, Chong Kiat Khoo, Georgia Gaia, Kris Jardon, Jean-Luc Pouly, Patricia Jaffeux, Bruno Aublet-Cuvelier, Michel Canis, Gerard Mage. (2012) Educational Value of an Intensive and Structured Interval Practice Laparoscopic Training Course for Residents in Obstetrics and Gynecology: A Four-Year Prospective, Multi-Institutional Recruitment Study. Journal of Surgical Education
CrossRef7
Andrew M Schimel, M Gilbert Grand, Harry W Flynn. (2012) Surgery for Retinal Detachment: Does Experience Matter?. Retina 32:1, 1-3
CrossRef8
Lars Konge, Paul Clementsen, Klaus Richter Larsen, Henrik Arendrup, Christian Buchwald, Charlotte Ringsted. (2012) Establishing Pass/Fail Criteria for Bronchoscopy Performance. Respiration 83:2, 140-146
CrossRef9
Lars Konge, Per Lehnert, Henrik Jessen Hansen, René Horsleben Petersen, Charlotte Ringsted. (2011) Reliable and valid assessment of performance in thoracoscopy. Surgical Endoscopy
CrossRef10
Govind J. Oliver, Mahiben Maruthappu, Joseph Shalhoub. (2011) How do we continue to attract the best candidates to the surgical profession?. International Journal of Surgery
CrossRef11
Michael Ujiki, Jin-cheng Zhao. (2011) Simulation Training in Surgery. Disease-a-Month 57:12, 789-801
CrossRef12
Kamran Ahmed, Tarik Amer, Ben Challacombe, Peter Jaye, Prokar Dasgupta, Mohammad Shamim Khan. (2011) How to develop a simulation programme in urology. BJU International 108:11, 1698-1702
CrossRef13
Ajit K. Sachdeva, Jo Buyske, Gary L. Dunnington, Hilary A. Sanfey, John D. Mellinger, Daniel J. Scott, Richard Satava, Gerald M. Fried, Lenworth M. Jacobs, Karyl J. Burns. (2011) A New Paradigm for Surgical Procedural Training. Current Problems in Surgery 48:12, 854-968
CrossRef14
Benjie Tang, Iain Tait, Gillian Ross, Patrick Chien. (2011) Development and Use of a Restructured Animal Tissue Model for Training in Laparoscopic Salpingostomy and Salpingectomy. Journal of Minimally Invasive Gynecology 18:6, 785-791
CrossRef15
Matthew Schill, Debbie Tiemann, Mary E. Klingensmith, L. Michael Brunt. (2011) Year One Outcomes Assessment of a Masters Suturing and Knot-Tying Program for Surgical Interns. Journal of Surgical Education 68:6, 526-533
CrossRef16
Susan Steinemann, Benjamin Berg, Alisha Skinner, Alexandra DiTulio, Kathleen Anzelon, Kara Terada, Catherine Oliver, Hao Chih Ho, Cora Speck. (2011) In Situ, Multidisciplinary, Simulation-Based Teamwork Training Improves Early Trauma Care. Journal of Surgical Education 68:6, 472-477
CrossRef17
James I. Fann, Richard H. Feins, George L. Hicks, Jonathan C. Nesbitt, John W. Hammon, Fred A. Crawford. (2011) Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective. The Journal of Thoracic and Cardiovascular Surgery
CrossRef18
Lucian Panait, Jose M. Larios, Robert A. Brenes, Tiffany T. Fancher, Michael S. Ajemian, Stanley J. Dudrick, Juan A. Sanchez. (2011) Surgical Skills Assessment of Applicants to General Surgery Residency. Journal of Surgical Research 170:2, 189-194
CrossRef19
Henk W.R. Schreuder, S Guid Oei, Mario Maas, Jan C.C. Borleffs, Marlies P. Schijven. (2011) Implementation of simulation for training minimally invasive surgery*. Tijdschrift voor Medisch Onderwijs 30:5, 206-220
CrossRef20
Sarah E. Peyre, Stanley W. Ashley. (2011) Teaching Uncommon and Highly Complex Operations: Maximizing The Teaching and Learning. Journal of Gastrointestinal Surgery 15:10, 1724-1725
CrossRef21
Li Jing, Mary X. Wu, Heather Carnahan. (2011) Acupuncture skills and its evidence-based assessment. Journal of Acupuncture and Tuina Science 9:5, 269-272
CrossRef22
T.M. Lewis, R. Aggarwal, N. Rajaretnam, T.P. Grantcharov, A. Darzi. (2011) Training in surgical oncology – The role of VR simulation. Surgical Oncology 20:3, 134-139
CrossRef23
Stuart H. Shippey, Tiffany L. Chen, Betty Chou, Leise R. Knoepp, Craig W. Bowen, Victoria L. Handa. (2011) Teaching Subcuticular Suturing to Medical Students: Video versus Expert Instructor Feedback. Journal of Surgical Education 68:5, 397-402
CrossRef24
Alia Qureshi, Ashley Vergis, Carolina Jimenez, Jessica Green, Aurora Pryor, Christopher M. Schlachta, Allan Okrainec. (2011) MIS training in Canada: a national survey of general surgery residents. Surgical Endoscopy 25:9, 3057-3065
CrossRef25
David A. Edelman, Mark A. Mattos, David L. Bouwman. (2011) Impact of Fundamentals of Laparoscopic Surgery Training During Medical School on Performance by First Year Surgical Residents. Journal of Surgical Research 170:1, 6-9
CrossRef26
Joel Price, Viren Naik, Munir Boodhwani, Tim Brandys, Paul Hendry, Buu-Khanh Lam. (2011) A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: The role of deliberate practice. The Journal of Thoracic and Cardiovascular Surgery 142:3, 496-503
CrossRef27
Ryan Engebretson Hofer, O. Brant Nikolaus, Wojciech Pawlina. (2011) Using checklists in a gross anatomy laboratory improves learning outcomes and dissection quality. Anatomical Sciences Education 4:5, 249-255
CrossRef28
S.S. Brar, F. Wright, A. Okrainec, A.J. Smith. (2011) A structured strategy to combine education for advanced MIS training in surgical oncology training programs. Surgical Oncology 20:3, 129-133
CrossRef29
Jacob Moalem, Seymour I. Schwartz. (2011) Three-Phase Model for Surgical Training: A Proposal for Improved Resident Training, Assessment, and Satisfaction. Journal of Surgical Education
CrossRef30
Laura Beyer, Jérémie De Troyer, Julien Mancini, Franck Bladou, Stéphane V. Berdah, Gilles Karsenty. (2011) Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study. The American Journal of Surgery 202:3, 265-272
CrossRef31
Nicoleta O. Kolozsvari, Liane S. Feldman, Melina C. Vassiliou, Sebastian Demyttenaere, Michael L. Hoover. (2011) Sim One, Do One, Teach One: Considerations in Designing Training Curricula for Surgical Simulation. Journal of Surgical Education 68:5, 421-427
CrossRef32
Sayra M. Cristancho, Fuad Moussa, Adam Dubrowski. (2011) A framework-based approach to designing simulation-augmented surgical education and training programs. The American Journal of Surgery 202:3, 344-351
CrossRef33
Alexander Laird, Grant D. Stewart, Sichuan Hou, Benjie Tang, Marguerite E. McLornan, Antony C.P. Riddick, S. Alan McNeill. (2011) A Novel Bovine Model for Training Urological Surgeons in Laparoscopic Radical Nephrectomy. Journal of Endourology 25:8, 1377-1383
CrossRef34
Trystan Lewis, Rajesh Aggarwal, Colin Sugden, Ara Darzi. (2011) The adoption of advanced surgical techniques: are surgical masterclasses enough?. The American Journal of Surgery
CrossRef35
Carla M. Pugh, Matthew G. Bevan, Rebecca J. Duve, Heather L. White, J. Harvey Magee, Gene B. Wiehagen. (2011) A Retrospective Review of TATRC Funding for Medical Modeling and Simulation Technologies. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 6:4, 218-225
CrossRef36
Kamran Ahmed, Muhammed Jawad, May Abboudi, Andrea Gavazzi, Ara Darzi, Thanos Athanasiou, Justin Vale, Mohammad Shamim Khan, Prokar Dasgupta. (2011) Effectiveness of Procedural Simulation in Urology: A Systematic Review. The Journal of Urology 186:1, 26-34
CrossRef37
Sonya Malekzadeh, Glenn Hanna, Brette Wilson, Marieta Pehlivanova, Gregory Milmoe. (2011) A model for training and evaluation of myringotomy and tube placement skills. The Laryngoscope 121:7, 1410-1415
CrossRef38
D. BREEN, L. BOGAR, P. HEIGL, J. RITTBERGER, G. D. SHORTEN. (2011) Validation of a clinical assessment tool for spinal anaesthesia. Acta Anaesthesiologica Scandinavica 55:6, 653-657
CrossRef39
Ranil R. Sonnadara, Aaron Van Vliet, Oleg Safir, Benjamin Alman, Peter Ferguson, William Kraemer, Richard Reznick. (2011) Orthopedic boot camp: Examining the effectiveness of an intensive surgical skills course. Surgery 149:6, 745-749
CrossRef40
Dimitrios Stefanidis, Mark W Scerbo, Paul N. Montero, Christina E. Acker, Warren D. Smith. (2011) Simulator Training to Automaticity Leads to Improved Skill Transfer Compared With Traditional Proficiency-Based Training. Annals of Surgery1
CrossRef41
Robert E. Sedlack. 2011. Colonoscopy. , 42-72.
CrossRef42
Georges Azzie, J. Ted Gerstle, Ahmed Nasr, David Lasko, Jessica Green, Oscar Henao, Monica Farcas, Allan Okrainec. (2011) Development and validation of a pediatric laparoscopic surgery simulator. Journal of Pediatric Surgery 46:5, 897-903
CrossRef43
Sandra L. Kopp. (2011) That Bow Is Perfect, But Your Shoes Are on the Wrong Feet. Regional Anesthesia and Pain Medicine 36:3, 207-208
CrossRef44
Zubair Amin, John R. Boulet, David A. Cook, Rachel Ellaway, Ahmad Fahal, Roger Kneebone, Moira Maley, Doris Ostergaard, Gominda Ponnamperuma, Andy Wearn, Amitai Ziv. (2011) Technology-enabled assessment of health professions education: Consensus statement and recommendations from the Ottawa 2010 conference. Medical Teacher 33:5, 364-369
CrossRef45
Chad M. Thorson, Jason P. Kelly, R. Armour Forse, Kiran K. Turaga. (2011) Can We Continue to Ignore Gender Differences in Performance on Simulation Trainers?. Journal of Laparoendoscopic & Advanced Surgical Techniques 21:4, 329-333
CrossRef46
Antoine Duclos, Jean-Christophe Lifante, Simon Ducarroz, Pietro Soardo, Cyrille Colin, Jean-Louis Peix. (2011) Influence of Intraoperative Neuromonitoring on Surgeons’ Technique During Thyroidectomy. World Journal of Surgery 35:4, 773-778
CrossRef47
Cordula M. Wetzel, Akram George, George B. Hanna, Thanos Athanasiou, Stephen A. Black, Roger L. Kneebone, Debra Nestel, Maria Woloshynowych. (2011) Stress Management Training for Surgeons—A Randomized, Controlled, Intervention Study. Annals of Surgery 253:3, 488-494
CrossRef48
Carol E. Reiley, Henry C. Lin, David D. Yuh, Gregory D. Hager. (2011) Review of methods for objective surgical skill evaluation. Surgical Endoscopy 25:2, 356-366
CrossRef49
Henk W. R. Schreuder, Guid Oei, Mario Maas, Jan C. C. Borleffs, Marlies P. Schijven. (2011) Implementation of simulation in surgical practice: Minimally invasive surgery has taken the lead: The Dutch experience. Medical Teacher 33:2, 105-115
CrossRef50
Naoki Iwata, Michitaka Fujiwara, Yasuhiro Kodera, Chie Tanaka, Norifumi Ohashi, Goro Nakayama, Masahiko Koike, Akimasa Nakao. (2011) Construct validity of the LapVR virtual-reality surgical simulator. Surgical Endoscopy 25:2, 423-428
CrossRef51
Irene WY Ma, Elise Teteris, James M Roberts, Maria Bacchus. (2011) Who is teaching and supervising our junior residents' central venous catheterizations?. BMC Medical Education 11:1, 16
CrossRef52
Erica L. Mitchell, Dae Y. Lee, Nick Sevdalis, Aaron W. Partsafas, Gregory J. Landry, Timothy K. Liem, Gregory L. Moneta. (2011) Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: a randomized trial. The American Journal of Surgery 201:1, 31-39
CrossRef53
George L. Hicks, James Gangemi, Ronald E. Angona, Paul S. Ramphal, Richard H. Feins, James I. Fann. (2011) Cardiopulmonary bypass simulation at the Boot Camp. The Journal of Thoracic and Cardiovascular Surgery 141:1, 284-292
CrossRef54
David L. Joyce, Tanvir S. Dhillon, Anthony D. Caffarelli, Daniel D. Joyce, Dimitrios N. Tsirigotis, Thomas A. Burdon, James I. Fann. (2011) Simulation and skills training in mitral valve surgery. The Journal of Thoracic and Cardiovascular Surgery 141:1, 107-112
CrossRef55
Lars Konge, Henrik Arendrup, Christian von Buchwald, Charlotte Ringsted. (2011) Using Performance in Multiple Simulated Scenarios to Assess Bronchoscopy Skills. Respiration 81:6, 483-490
CrossRef56
Debra Nestel, Diana Tabak, Tanya Tierney, Carine Layat-Burn, Anja Robb, Susan Clark, Tracy Morrison, Norma Jones, Rachel Ellis, Cathy Smith, Nancy McNaughton, Kerry Knickle, Jenny Higham, Roger Kneebone. (2011) Key challenges in simulated patient programs: An international comparative case study. BMC Medical Education 11:1, 69
CrossRef57
Henri G. Colt, Mohsen Davoudi, Septimiu Murgu, Nazanin Zamanian Rohani. (2011) Measuring learning gain during a one-day introductory bronchoscopy course. Surgical Endoscopy 25:1, 207-216
CrossRef58
Dorothy Breen, George Shorten, Lajos Bogar, Annette Aboulafia. (2010) Teaching and learning spinal anaesthesia: anaesthetists‘ attitudes. The Clinical Teacher 7:4, 251-256
CrossRef59
Laurent Riffaud, Thomas Neumuth, Xavier Morandi, Christos Trantakis, Jürgen Meixensberger, Oliver Burgert, Brivael Trelhu, Pierre Jannin. (2010) Recording of Surgical Processes: A Study Comparing Senior and Junior Neurosurgeons During Lumbar Disc Herniation Surgery. Neurosurgery 67, ons325-ons332
CrossRef60
Roberto L. Flores, Nicholette Deluccia, Aaron Oliker, Joseph G. McCarthy. (2010) Creating a Virtual Surgical Atlas of Craniofacial Procedures: Part II. Surgical Animations. Plastic and Reconstructive Surgery 126:6, 2093-2101
CrossRef61
Kulsoom Laeeq, Raafeh Waseem, Robert A. Weatherly, Douglas D. Reh, Sandra Y. Lin, Andrew P. Lane, Masaru Ishii, Charles W. Cummings, Nasir I. Bhatti. (2010) In-training assessment and predictors of competency in endoscopic sinus surgery. The Laryngoscope 120:12, 2540-2545
CrossRef62
Alessandro Barelli, Andrea Scapigliati. (2010) The four-stage approach to teaching skills: The end of a dogma?. Resuscitation 81:12, 1607-1608
CrossRef63
Indran Balasundaram, Rajesh Aggarwal, Lord Ara Darzi. (2010) Development of a training curriculum for microsurgery. British Journal of Oral and Maxillofacial Surgery 48:8, 598-606
CrossRef64
Ashlesha K. Dayal, Nelli Fisher, Diane Magrane, Dena Goffman, Peter S. Bernstein, Nadine T. Katz. (2010) Simulation Training Improves Medical Students’ Learning Experiences When Performing Real Vaginal Deliveries. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 4:3, 155-159
CrossRef65
James A. Gordon, Erik K. Alexander, Steven W. Lockley, Erin Flynn-Evans, Suresh K. Venkatan, Christopher P. Landrigan, Charles A. Czeisler. (2010) Does Simulator-Based Clinical Performance Correlate With Actual Hospital Behavior? The Effect of Extended Work Hours on Patient Care Provided by Medical Interns. Academic Medicine 85:10, 1583-1588
CrossRef66
B. Bech, L. Lönn, T.V. Schroeder, S.B.E.W. Räder, C. Ringsted. (2010) Capturing the Essence of Developing Endovascular Expertise for the Construction of a Global Assessment Instrument. European Journal of Vascular and Endovascular Surgery 40:3, 292-302
CrossRef67
Brian David Hodges. (2010) A Tea-Steeping or i-Doc Model for Medical Education?. Academic Medicine 85, S34-S44
CrossRef68
Ryan Brydges, Heather Carnahan, Don Rose, Adam Dubrowski. (2010) Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training. Journal of Advanced Nursing 66:8, 1832-1844
CrossRef69
J Sándor, B Lengyel, T Haidegger, G Saftics, G Papp, Á Nagy, G Wéber. (2010) Minimally invasive surgical technologies: Challenges in education and training. Asian Journal of Endoscopic Surgery 3:3, 101-108
CrossRef70
Jameel Ali, Julie Dunn, Martin Eason, Jacob Drumm. (2010) Comparing the Standardized Live Trauma Patient and the Mechanical Simulator Models in the ATLS Initial Assessment Station. Journal of Surgical Research 162:1, 7-10
CrossRef71
Kamran Ahmed, Muhammed Jawad, Prokar Dasgupta, Ara Darzi, Thanos Athanasiou, Mohammad Shamim Khan. (2010) Assessment and maintenance of competence in urology. Nature Reviews Urology 7:7, 403-413
CrossRef72
Simon Browning. (2010) Teaching osteopathic students technique; using research to identify good teaching practice. International Journal of Osteopathic Medicine 13:2, 70-73
CrossRef73
Hilary Sanfey, Gary Dunnington. (2010) Verification of Proficiency: A Prerequisite for Clinical Experience. Surgical Clinics of North America 90:3, 559-567
CrossRef74
Dimitrios Stefanidis. (2010) Optimal Acquisition and Assessment of Proficiency on Simulators in Surgery. Surgical Clinics of North America 90:3, 475-489
CrossRef75
Eng H. Ooi, Ian J. Witterick. (2010) Rhinologic Surgical Training. Otolaryngologic Clinics of North America 43:3, 673-689
CrossRef76
Ian Choy, Allan Okrainec. (2010) Simulation in Surgery: Perfecting the Practice. Surgical Clinics of North America 90:3, 457-473
CrossRef77
Ryan Brydges, Heather Carnahan, Don Rose, Louise Rose, Adam Dubrowski. (2010) Coordinating Progressive Levels of Simulation Fidelity to Maximize Educational Benefit. Academic Medicine 85:5, 806-812
CrossRef78
Deborah Rooney, Carla Pugh, Edward Auyang, Eric Hungness, Debra DaRosa. (2010) Administrative considerations when implementing ACS/APDS Skills Curriculum. Surgery 147:5, 614-621
CrossRef79
L. Beyer, G. Karsenty, S. Berdah. (2010) Implication et intérêt du training hors du bloc opératoire dans l’apprentissage chirurgical. Côlon & Rectum 4:2, 124-128
CrossRef80
James I. Fann, John H. Calhoon, Andrea J. Carpenter, Walter H. Merrill, John W. Brown, Robert S. Poston, Maziyar Kalani, Gordon F. Murray, George L. Hicks, Richard H. Feins. (2010) Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: The Boot Camp experience. The Journal of Thoracic and Cardiovascular Surgery 139:5, 1275-1281
CrossRef81
John S. OʼShea. (2010) Individual and Social Concerns in American Surgical Education: Paying Patients, Prepaid Health Insurance, Medicare and Medicaid. Academic Medicine 85:5, 854-862
CrossRef82
John R. Boulet, David J. Murray. (2010) Simulation-based Assessment in Anesthesiology. Anesthesiology 112:4, 1041-1052
CrossRef83
Isabelle Van Herzeele, Kevin G.L. O'Donoghue, Rajesh Aggarwal, Frank Vermassen, Ara Darzi, Nicholas J.W. Cheshire. (2010) Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator. Journal of Vascular Surgery 51:4, 1035-1042
CrossRef84
María Eugenia Aponte-Rueda, Ramón A. Saade-Cárdenas, Salvador Navarrete-Aulestia. (2010) Experimental model as training tool in endoscopic axillary dissection. Minimally Invasive Therapy & Allied Technologies 19:2, 61-68
CrossRef85
M. P. Schijven, R. K. Reznick, O. Th. J. ten Cate, T. P. Grantcharov, G. Regehr, L. Satterthwaite, A. S. Thijssen, H. M. MacRae. (2010) Transatlantic comparison of the competence of surgeons at the start of their professional career. British Journal of Surgery 97:3, 443-449
CrossRef86
B. M. A. Schout, A. J. M. Hendrikx, F. Scheele, B. L. H. Bemelmans, A. J. J. A. Scherpbier. (2010) Validation and implementation of surgical simulators: a critical review of present, past, and future. Surgical Endoscopy 24:3, 536-546
CrossRef87
Kamran Ahmed, Aoife N. Keeling, Reenam S. Khan, Hutan Ashrafian, Sonal Arora, Kamal Nagpal, Joshua Burrill, Ara Darzi, Thanos Athanasiou, Mohamad Hamady. (2010) What Does Competence Entail in Interventional Radiology?. CardioVascular and Interventional Radiology 33:1, 3-10
CrossRef88
A P George, R De. (2010) Review of temporal bone dissection teaching: how it was, is and will be. The Journal of Laryngology & Otology 124:02, 119
CrossRef89
Rebekah A. Naylor, Lisa A. Hollett, Antonio Castellvi, R. James Valentine, Daniel J. Scott. (2010) Preparing medical students to enter surgery residencies. The American Journal of Surgery 199:1, 105-109
CrossRef90
Kamran Ahmed, Aoife N. Keeling, Morkos Fakhry, Hutan Ashrafian, Rajesh Aggarwal, Peter A. Naughton, Ara Darzi, Nicholas Cheshire, Thanos Athanasiou, Mohammed Hamady. (2010) Role of Virtual Reality Simulation in Teaching and Assessing Technical Skills in Endovascular Intervention. Journal of Vascular and Interventional Radiology 21:1, 55-66
CrossRef91
W. I. M. Willaert, R. Aggarwal, D. F. Nestel, P. A. Gaines, F. E. Vermassen, A. W. Darzi, N. J. Cheshire. (2010) Patient-specific simulation for endovascular procedures: qualitative evaluation of the development process. The International Journal of Medical Robotics and Computer Assisted Surgeryn/a-n/a
CrossRef92
Oleg Safir, Adam Dubrowski, Yvonne Hui, David Backstein, Heather Carnahan. (2010) Self-directed practice scheduling is equivalent to instructor guided practice when learning a complex surgical skill. Procedia - Social and Behavioral Sciences 2:2, 792-796
CrossRef93
Michael C. Wadman, Carol S. Lomneth, Lance H. Hoffman, Wesley G. Zeger, Lina Lander, Richard A. Walker. (2010) Assessment of a New Model for Femoral Ultrasound-guided Central Venous Access Procedural Training: A Pilot Study. Academic Emergency Medicine 17:1, 88-92
CrossRef94
Ryan Brydges, Heather Carnahan, Adam Dubrowski. (2009) Assessing suturing skills in a self-guided learning setting: absolute symmetry error. Advances in Health Sciences Education 14:5, 685-695
CrossRef95
Kulsoom Laeeq, Nasir I. Bhatti, John P. Carey, Charles C. Della Santina, Charles J. Limb, John K. Niparko, Lloyd B. Minor, Howard W. Francis. (2009) Pilot testing of an assessment tool for competency in mastoidectomy. The Laryngoscope 119:12, 2402-2410
CrossRef96
John L. Tarpley, Margaret J. Tarpley. (2009) Presidential address: what business are we in?. The American Journal of Surgery 198:5, 583-587
CrossRef97
Allan Okrainec, Lloyd Smith, Georges Azzie. (2009) Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course. Surgical Endoscopy 23:11, 2493-2498
CrossRef98
Stephanie G.C. Kroeze, Erik K. Mayer, Samarth Chopra, Rajesh Aggarwal, Ara Darzi, Anup Patel. (2009) Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study. European Urology 56:5, 865-873
CrossRef99
Chad G. Ball, Elijah Dixon, Andrew W. Kirkpatrick. (2009) The Utility of Organ Procurement Procedures for Operative Trauma Training. The Journal of Trauma: Injury, Infection, and Critical Care 67:5, 1128
CrossRef100
Edgar J.B. Furnée, Pieter J. van Empel, Babak Mahdavian Delavary, Donald L. van der Peet, Miguel A. Cuesta, Wilhelmus J.H.J. Meijerink. (2009) Evaluation of a Technical Skills Training Program in Surgical Residents. Journal of Laparoendoscopic & Advanced Surgical Techniques 19:5, 615-621
CrossRef101
M. D. Bould, N. A. Crabtree, V. N. Naik. (2009) Assessment of procedural skills in anaesthesia. British Journal of Anaesthesia 103:4, 472-483
CrossRef102
Michael E. Halkos, John D. Puskas. (2009) Teaching Off-Pump Coronary Artery Bypass Surgery. Seminars in Thoracic and Cardiovascular Surgery 21:3, 224-228
CrossRef103
Brian P. Lucas, Joseph K. Asbury, Ricardo Franco-Sadud. (2009) Training future hospitalists with simulators: A needed step toward accessible, expertly performed bedside procedures. Journal of Hospital Medicine 4:7, 395-396
CrossRef104
Elspeth M. McDougall, Surendra B. Kolla, Rosanne T. Santos, Jennifer M. Gan, Geoffrey N. Box, Michael K. Louie, Aldrin J.R. Gamboa, Adam G. Kaplan, Ross M. Moskowitz, Lorena A. Andrade, Douglas W. Skarecky, Kathryn E. Osann, Ralph V. Clayman. (2009) Preliminary Study of Virtual Reality and Model Simulation for Learning Laparoscopic Suturing Skills. The Journal of Urology 182:3, 1018-1025
CrossRef105
Scott J. Millington, Roger Y. Wong, Barry O. Kassen, James M. Roberts, Irene W.Y. Ma. (2009) Improving internal medicine residents' performance, knowledge, and confidence in central venous catheterization using simulators. Journal of Hospital Medicine 4:7, 410-416
CrossRef106
Jeffrey G. Chipman, Constance C. Schmitz. (2009) Using Objective Structured Assessment of Technical Skills to Evaluate a Basic Skills Simulation Curriculum for First-Year Surgical Residents. Journal of the American College of Surgeons 209:3, 364-370.e2
CrossRef107
Grace C. Huang, Lori R. Newman, Richard M. Schwartzstein, Peter F. Clardy, David Feller-Kopman, Julie T. Irish, C Christopher Smith. (2009) Procedural Competence in Internal Medicine Residents: Validity of a Central Venous Catheter Insertion Assessment Instrument. Academic Medicine 84:8, 1127-1134
CrossRef108
Katie Dorman, Lisa Satterthwaite, Andrew Howard, Sarah Woodrow, Miliard Derbew, Richard Reznick, Adam Dubrowski. (2009) Addressing the severe shortage of health care providers in Ethiopia: bench model teaching of technical skills. Medical Education 43:7, 621-627
CrossRef109
Roger Kneebone. (2009) Perspective: Simulation and Transformational Change: The Paradox of Expertise. Academic Medicine 84:7, 954-957
CrossRef110
Bruce L. Wilkoff, Charles J. Love, Charles L. Byrd, Maria Grazia Bongiorni, Roger G. Carrillo, George H. Crossley, Laurence M. Epstein, Richard A. Friedman, Charles E.H. Kennergren, Przemyslaw Mitkowski, Raymond H.M. Schaerf, Oussama M. Wazni. (2009) Transvenous Lead Extraction: Heart Rhythm Society Expert Consensus on Facilities, Training, Indications, and Patient Management. Heart Rhythm 6:7, 1085-1104
CrossRef111
Ryan Brydges, Heather Carnahan, Oleg Safir, Adam Dubrowski. (2009) How effective is self-guided learning of clinical technical skills? It’s all about process. Medical Education 43:6, 507-515
CrossRef112
Paul B. Roach, Kevin K. Roggin, Eugene Selkov, Mitchell C. Posner, Jonathan C. Silverstein. (2009) Use of a Novel, Web-Based Educational Platform Facilitates Intraoperative Training in a Surgical Oncology Fellowship Program. Annals of Surgical Oncology 16:5, 1100-1107
CrossRef113
Shawn Tsuda, Daniel Scott, Jennifer Doyle, Daniel B. Jones. (2009) Surgical Skills Training and Simulation. Current Problems in Surgery 46:4, 271-370
CrossRef114
Bert M. Glaser. (2009) Surgical Simulation: Why Now?. Retina 29:3, 289-291
CrossRef115
Akira Nishisaki, Roberta Hales, Katherine Biagas, Ira Cheifetz, Christine Corriveau, Nan Garber, Elizabeth Hunt, Rima Jarrah, John McCloskey, Wynne Morrison, Kristen Nelson, Dana Niles, Sophia Smith, Samuel Thomas, Stephanie Tuttle, Mark Helfaer, Vinay Nadkarni. (2009) A multi-institutional high-fidelity simulation “boot camp” orientation and training program for first year pediatric critical care fellows*. Pediatric Critical Care Medicine 10:2, 157-162
CrossRef116
Teodor P. Grantcharov, Richard K. Reznick. (2009) Training tomorrow’s surgeons: what are we looking for and how can we achieve it?. ANZ Journal of Surgery 79:3, 104-107
CrossRef117
M. Pilar Laguna, Theodorus M. Reijke, Jean J. Rosette. (2009) How far will simulators be involved into training?. Current Urology Reports 10:2, 97-105
CrossRef118
Nicole K. Roberts, Reed G. Williams, Michael J. Kim, Gary L. Dunnington. (2009) The Briefing, Intraoperative Teaching, Debriefing Model for Teaching in the Operating Room. Journal of the American College of Surgeons 208:2, 299-303
CrossRef119
Andrée Sansregret, Gerald M. Fried, Harrith Hasson, Dennis Klassen, Maryse Lagacé, Robert Gagnon, Stephen Pooler, Bernard Charlin. (2009) Choosing the right physical laparoscopic simulator? comparison of LTS2000-ISM60 with MISTELS: validation, correlation, and user satisfaction. The American Journal of Surgery 197:2, 258-265
CrossRef120
EGG Verdaasdonk, J Dankelman, MP Schijven, JF Lange, M Wentink, LPS Stassen. (2009) Serious gaming and voluntary laparoscopic skills training: A multicenter study. Minimally Invasive Therapy & Allied Technologies 18:4, 232-238
CrossRef121
Michael G. C. Pellen, Liam F. Horgan, J. Roger Barton, Stephen E. Attwood. (2009) Construct validity of the ProMIS laparoscopic simulator. Surgical Endoscopy 23:1, 130-139
CrossRef122
Deborah J. Davis, Charlotte Ringsted, Mie Bonde, Albert Scherpbier, Cees Vleuten. (2009) Using participatory design to develop structured training in child and adolescent psychiatry. European Child & Adolescent Psychiatry 18:1, 33-41
CrossRef123
Niyant V. Patel, James M. Robbins, Charles J. Shanley. (2009) Low-fidelity exercises for basic surgical skills training and assessment. The American Journal of Surgery 197:1, 119-125
CrossRef124
Aaron R. Jensen, Andrew S. Wright, Adam E. Levy, Lisa K. McIntyre, Hugh M. Foy, Carlos A. Pellegrini, Karen D. Horvath, Dimitri J. Anastakis. (2009) Acquiring basic surgical skills: Is a faculty mentor really needed?. The American Journal of Surgery 197:1, 82-88
CrossRef125
James I. Fann, Anthony D. Caffarelli, Gerald Georgette, Steve K. Howard, David M. Gaba, Patricia Youngblood, R. Scott Mitchell, Thomas A. Burdon. (2008) Improvement in coronary anastomosis with cardiac surgery simulation. The Journal of Thoracic and Cardiovascular Surgery 136:6, 1486-1491
CrossRef126
(2008) IMPLICIT LEARNING OF MOVEMENT SKILLS FOR SURGERY. ANZ Journal of Surgery 78:12, 1062-1064
CrossRef127
Z. Kulcsar, A. Aboulafia, T. Hall, G. D. Shorten. (2008) Determinants of learning to perform spinal anaesthesia. European Journal of Anaesthesiology 25:12, 1026-1031
CrossRef128
Mark Albanese, George Mejicano, Larry Gruppen. (2008) Perspective: Competency-Based Medical Education: A Defense Against the Four Horsemen of the Medical Education Apocalypse. Academic Medicine 83:12, 1132-1139
CrossRef129
A. G. Gallagher, O. Traynor. (2008) Simulation in surgery: opportunity or threat?. Irish Journal of Medical Science 177:4, 283-287
CrossRef130
Robert Hanscom. (2008) Medical Simulation from an Insurer’s Perspective. Academic Emergency Medicine 15:11, 984-987
CrossRef131
MICHAEL H. GRODIN, T MARK JOHNSON, J LANCE ACREE, BERT M. GLASER. (2008) OPHTHALMIC SURGICAL TRAINING: A CURRICULUM TO ENHANCE SURGICAL SIMULATION. Retina 28:10, 1509-1514
CrossRef132
Thomas P. Noeller, Michael D. Smith, Laura Holmes, Melissa Cappaert, Andrew J. Gross, Kathy Cole-Kelly, Kathleen R. Rosen. (2008) A Theme-based Hybrid Simulation Model to Train and Evaluate Emergency Medicine Residents. Academic Emergency Medicine 15:11, 1199-1206
CrossRef133
O. Safir, A. Dubrowski, L. Mirsky, C. Lin, D. Backstein, H. Carnahan. (2008) What skills should simulation training in arthroscopy teach residents?. International Journal of Computer Assisted Radiology and Surgery 3:5, 433-437
CrossRef134
Ernest E. Wang, Joshua Quinones, Michael T. Fitch, Suzanne Dooley-Hash, Sharon Griswold-Theodorson, Ron Medzon, Frederick Korley, Torrey Laack, Adam Robinett, Lamont Clay. (2008) Developing Technical Expertise in Emergency Medicine-The Role of Simulation in Procedural Skill Acquisition. Academic Emergency Medicine 15:11, 1046-1057
CrossRef135
Isabelle Van Herzeele, Rajesh Aggarwal, Simon Neequaye, Ara Darzi, Frank Vermassen, Nicholas J. Cheshire. (2008) Cognitive training improves clinically relevant outcomes during simulated endovascular procedures. Journal of Vascular Surgery 48:5, 1223-1230.e1
CrossRef136
Robert A. Cherry, Jameel Ali. (2008) Current Concepts in Simulation-Based Trauma Education. The Journal of Trauma: Injury, Infection, and Critical Care 65:5, 1186-1193
CrossRef137
John R. Boulet. (2008) Summative Assessment in Medicine: The Promise of Simulation for High-stakes Evaluation. Academic Emergency Medicine 15:11, 1017-1024
CrossRef138
Jordan Chenkin, Shirley Lee, Thien Huynh, Glen Bandiera. (2008) Procedures Can Be Learned on the Web: A Randomized Study of Ultrasound-guided Vascular Access Training. Academic Emergency Medicine 15:10, 949-954
CrossRef139
Debra DaRosa, David A. Rogers, Reed G. Williams, Linnea S. Hauge, Heather Sherman, Kenric Murayama, Alexander Nagle, Gary L. Dunnington. (2008) Impact of a Structured Skills Laboratory Curriculum on Surgery Residentsʼ Intraoperative Decision-Making and Technical Skills. Academic Medicine 83:Supplement, S68-S71
CrossRef140
James D. Michelson, Lance Manning. (2008) Competency assessment in simulation-based procedural education. The American Journal of Surgery 196:4, 609-615
CrossRef141
Susan Laschinger, Jennifer Medves, Cheryl Pulling, Dr. Robert McGraw, Brett Waytuck, Margaret B Harrison, Kasey Gambeta. (2008) Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. International Journal of Evidence-Based Healthcare 6:3, 278-302
CrossRef142
Robert M. Sweet, Elspeth M. McDougall. (2008) Simulation and Computer-Animated Devices: The New Minimally Invasive Skills Training Paradigm. Urologic Clinics of North America 35:3, 519-531
CrossRef143
Kathryn L. Ossowski, Diane C. Rhee, Elaine N. Rubinstein, Berrylin J. Ferguson. (2008) Efficacy of Sinonasal Simulator in Teaching Endoscopic Nasal Skills. The Laryngoscope 118:8, 1482-1485
CrossRef144
Katherine Gray, Peter Heathcote, David Nicol. (2008) DOES TEACHING AFFECT OUTCOME WITH MAJOR OPEN SURGERY?. ANZ Journal of Surgery 78:8, 646-647
CrossRef145
Stephen J. O'Leary, Matthew A. Hutchins, Duncan R. Stevenson, Chris Gunn, Alexander Krumpholz, Gregor Kennedy, Michael Tykocinski, Marcus Dahm, Brian Pyman. (2008) Validation of a Networked Virtual Reality Simulation of Temporal Bone Surgery. The Laryngoscope 118:6, 1040-1046
CrossRef146
Indran Balasundaram, Rajesh Aggarwal, Ara Darzi. (2008) Short-phase training on a virtual reality simulator improves technical performance in tele-robotic surgery. The International Journal of Medical Robotics and Computer Assisted Surgery 4:2, 139-145
CrossRef147
A. Thomas Pezzella. (2008) Evolution of cardiothoracic surgery residency training programs in India. Indian Journal of Thoracic and Cardiovascular Surgery 24:2, 157-163
CrossRef148
Britt-Marie E. Ljung, Jill Langer, Ernest L. Mazzaferri, Yolanda C. Oertel, Samuel A. Wells, Jerry Waisman. (2008) Training, credentialing and re-credentialing for the performance of a thyroid FNA: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagnostic Cytopathology 36:6, 400-406
CrossRef149
L. Michael Brunt, Valerie J. Halpin, Mary E. Klingensmith, Debra Tiemann, Brent D. Matthews, Jennifer A. Spitler, Richard A. Pierce. (2008) Accelerated Skills Preparation and Assessment for Senior Medical Students Entering Surgical Internship. Journal of the American College of Surgeons 206:5, 897-904
CrossRef150
James A. Gordon, Nancy E. Oriol. (2008) Perspective: Fostering Biomedical Literacy Among America??s Youth: How Medical Simulation Reshapes the Strategy. Academic Medicine 83:5, 521-523
CrossRef151
Nick R. Howells, Mark D. Brinsden, Richie S. Gill, Andrew J. Carr, Jonathan L. Rees. (2008) Motion Analysis: A Validated Method for Showing Skill Levels in Arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery 24:3, 335-342
CrossRef152
Daniel R. Leff, Julian J. H. Leong, Rajesh Aggarwal, Guang-Zhong Yang, Ara Darzi. (2008) Could Variations in Technical Skills Acquisition in Surgery Be Explained by Differences in Cortical Plasticity?. Annals of Surgery 247:3, 540-543
CrossRef153
M Margaret Knudson, Linda Khaw, M Kelley Bullard, Rochelle Dicker, Mitchell Jay Cohen, Kristan Staudenmayer, Javid Sadjadi, Steven Howard, David Gaba, Thomas Krummel. (2008) Trauma Training in Simulation: Translating Skills From SIM Time to Real Time. The Journal of Trauma: Injury, Infection, and Critical Care 64:2, 255-264
CrossRef154
Scott T. Rehrig, Kinga Powers, Daniel B. Jones. (2008) Integrating Simulation in Surgery as a Teaching Tool and Credentialing Standard. Journal of Gastrointestinal Surgery 12:2, 222-233
CrossRef155
Ryan Brydges, Allison Kurahashi, Vera Brümmer, Lisa Satterthwaite, Roger Classen, Adam Dubrowski. (2008) Developing Criteria for Proficiency-Based Training of Surgical Technical Skills Using Simulation: Changes in Performances as a Function of Training Year. Journal of the American College of Surgeons 206:2, 205-211
CrossRef156
Max Berry, Mikael Hellström, Jan Göthlin, Richard Reznick, Lars Lönn. (2008) Endovascular Training with Animals versus Virtual Reality Systems: An Economic Analysis. Journal of Vascular and Interventional Radiology 19:2, 233-238
CrossRef157
David A. McClusky, C. Daniel Smith. (2008) Design and Development of a Surgical Skills Simulation Curriculum. World Journal of Surgery 32:2, 171-181
CrossRef158
John A. E. Hubbell, William J. A. Saville, Rustin M. Moore. (2008) Frequency of activities and procedures performed in private equine practice and proficiency expected of new veterinary school graduates. Journal of the American Veterinary Medical Association 232:1, 42-46
CrossRef159
Luke P. Brewster, Donald A. Risucci, Raymond J. Joehl, Fred N. Littooy, Barbara K. Temeck, Patrice Gabler Blair, Ajit K. Sachdeva. (2008) Comparison of resident self-assessments with trained faculty and standardized patient assessments of clinical and technical skills in a structured educational module. The American Journal of Surgery 195:1, 1-4
CrossRef160
Ajit K. Sachdeva, Richard H. Bell, L D. Britt, John L. Tarpley, Patrice Gabler Blair, Margaret J. Tarpley. (2007) National Efforts to Reform Residency Education in Surgery. Academic Medicine 82:12, 1200-1210
CrossRef161
Lars Lund, Adam Dubrowski, Hether Carnahan. (2007) A MODULAR APPROACH FOR TRAINING UROLOGISTS IN LAPAROSCOPY. BJU International 100:6, 1216-1218
CrossRef162
Rajesh Aggarwal, Jonnie Ward, Indran Balasundaram, Parvinderpal Sains, Thanos Athanasiou, Ara Darzi. (2007) Proving the Effectiveness of Virtual Reality Simulation for Training in Laparoscopic Surgery. Annals of Surgery 246:5, 771-779
CrossRef163
Erika H. Banks, Scott Chudnoff, Ira Karmin, Cuiling Wang, Setul Pardanani. (2007) Does a surgical simulator improve resident operative performance of laparoscopic tubal ligation?. American Journal of Obstetrics and Gynecology 197:5, 541.e1-541.e5
CrossRef164
Matthew B. Weinger. (2007) Experience ≠ Expertise. Anesthesiology 107:5, 691-694
CrossRef165
A. L. McCluney, M. C. Vassiliou, P. A. Kaneva, J. Cao, D. D. Stanbridge, L. S. Feldman, G. M. Fried. (2007) FLS simulator performance predicts intraoperative laparoscopic skill. Surgical Endoscopy 21:11, 1991-1995
CrossRef166
Ajit K. Sachdeva. (2007) Surgical Education to Improve the Quality of Patient Care: the Role of Practice-Based Learning and Improvement. Journal of Gastrointestinal Surgery 11:11, 1379-1383
CrossRef167
John A Windsor. (2007) WHITHER, NOT WITHER, FOR SKILLS TRAINING. ANZ Journal of Surgery 77:10, 811-811
CrossRef168
Paul E. Ogden, Lauren S. Cobbs, Martha R. Howell, Stephen J.B. Sibbitt, Donald J. DiPette. (2007) Clinical Simulation: Importance to the Internal Medicine Educational Mission. The American Journal of Medicine 120:9, 820-824
CrossRef169
Gerald M. Fried. (2007) Canadian Surgery: A Reflection on the People and the Land. World Journal of Surgery 31:8, 1533-1535
CrossRef170
James M. McGreevy, Tyler D. Otten. (2007) Briefing and Debriefing in the Operating Room Using Fighter Pilot Crew Resource Management. Journal of the American College of Surgeons 205:1, 169-176
CrossRef171
M. Sean Grady. (2007) Surgical education in the twenty-first century. Journal of Neurosurgery 106:6, 959-960
CrossRef172
Tommaso Falcone, A Marcus Gustilo-Ashby. (2007) Current and future applications of robotic gynecologic surgery. Expert Review of Obstetrics & Gynecology 2:3, 305-313
CrossRef173
Steven Dawson, Derek A Gould. (2007) Procedural simulation's developing role in medicine. The Lancet 369:9574, 1671-1673
CrossRef174
(2007) Teaching Surgical Skills. New England Journal of Medicine 356:13, 1381-1381
Full Text175
Cox, Malcolm, Irby, David M., , Epstein, Ronald M., . (2007) Assessment in Medical Education. New England Journal of Medicine 356:4, 387-396
Full Text176
E.J. Cohen. (2007) Teaching Surgical Skills—Changes in the Wind. Yearbook of Ophthalmology 2007, 260-261
CrossRef177
Aggarwal, Rajesh, Darzi, Ara, . (2006) Technical-Skills Training in the 21st Century. New England Journal of Medicine 355:25, 2695-2696
Full Text
- Letters
