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Resumen Introduccion Evaluar el impacto de la fatiga por incorrecto descanso nocturno en la realizacion de una anastomosis manual laparoscopica. Metodos Se lleva a cabo un estudio prospectivo observacional evaluando la realizacion de una anastomosis manual enteroenteral en endotrainer por residentes. Se dividen en dos grupos; el grupo descanso incluye a residentes que han dormido en casa siete o mas horas vs. al grupo fatiga formado por residentes de guardia o que han dormido menos de siete horas. Se evalua el tiempo empleado, la longitud de la anastomosis, la correcta tension de la linea de sutura, la correcta aposicion de los bordes, la distancia entre puntos y la fuga de aire, en prueba neumatica de estanqueidad. Resultados Se evaluan 402 anastomosis, siendo 211 pertenecientes al grupo descanso y 191 al grupo fatiga. Se detecta fuga en el 33,5% de las anastomosis del grupo fatiga frente al 19,4% en el grupo descanso (p Discusion La fatiga aumenta el riesgo de fuga y el tiempo que se tarda en completar el ejercicio.

Resumen Introduccion El aprendizaje de las tecnicas quirurgicas es un proceso dinamico. David Kolb describio en los anos ochenta un modelo de aprendizaje que permite adaptar el tipo de ensenanza y mejorar los resultados de esta. El objetivo del estudio es identificar los estilos de aprendizaje segun Kolb de los participantes en un curso de habilidades tecnicas laparoscopicas y comprobar si existe relacion con el rendimiento final de la tarea realizada. Metodos Estudio observacional descriptivo que incluye 64 participantes que completaron un curso intensivo donde realizaron anastomosis intestinales manuales laparoscopicas. Todos ellos completaron el inventario de estilos de aprendizaje de Kolb. En cada anastomosis se recogio el tiempo de ejecucion y se valoro su calidad. Posteriormente, los datos fueron analizados estadisticamente. Resultados El estilo de aprendizaje mas frecuente fue el asimilador (39,1%). No se observan diferencias significativas entre los estilos y el sexo de los participantes, su categoria profesional, el tiempo en realizar la anastomosis o su calidad. Conclusiones El estilo de aprendizaje predominante es el asimilador, sin diferencias entre categorias, edad o sexo. No existe relacion entre el estilo de aprendizaje de los participantes y los resultados obtenidos en el curso.

Introduction Learning surgical techniques is a dynamic process. In the 1980s David Kolb described developed a learning model that enabled teaching styles to adapt for better learner outcomes. The aim of this study was to identify the Kolb learning styles of the participants in a laparoscopic technical skills course and to check see if there was any relationship with performance. Methods An observational descriptive study was conducted with 64 participants in an intensive course in which they performed laparoscopic manual intestinal anastomoses. All completed Kolb's inventory of learning styles. For each anastomosis, join quality was assessed and the performing time recorded. After that, they were analyzed through statistical studies. Results The most frequent learning style was assimilating type (39.1%). No significant differences were observed between different learning styles and gender, professional category, the time taken or the quality of the anastomoses. Conclusions Assimilating type was the most frequent Kolb learning style, with no differences observed between categories, age or gender. There is no relationship between the learning style of the participants and the results obtained in the course.

Resumen Introduccion El entrenamiento quirurgico basado en simulacion busca la adquisicion de habilidades en los participantes noveles y la capacitacion en los expertos. El objetivo de este estudio es valorar la evolucion de los alumnos en un curso intensivo de anastomosis laparoscopica y el analisis de sus resultados dependiendo de su nivel y experiencia previa. Metodos Se analizaron los alumnos de todos los cursos de anastomosis realizados durante 30 meses en el Hospital virtual Valdecilla (Santander). Se realizaron anastomosis intestinales latero-laterales manuales con visceras «ex vivo» porcinas en un endotrainer laparoscopico. Se analizaron las diferencias tecnicas y de calidad entre la primera y la ultima anastomosis y se comparo la progresion entre residentes y los facultativos especialistas. Resultados Se analizaron 45 participantes, 22 de ellos residentes y 23 especialistas. Se observo una mejoria estadisticamente significativa del 80,5% en todos los parametros procedimentales (94,8% residentes vs. 67,3% especialistas). El tiempo se redujo un 48,1% en los residentes y un 43,2% en los especialistas (p En cuanto a calidad, se obtuvieron mejorias significativas en el grupo de residentes: incremento del 90% de tension adecuada, reduccion del 75% de bordes evertidos y 60% de las fugas. Ademas, obtuvieron resultados comparables a los especialistas (27,3% fuga en ultima anastomosis vs. 34,8% especialistas, p = 0,59), los cuales presentaron mejoria sin significacion estadistica. Conclusiones El grupo de residentes presenta una mejora mayor y significativa en habilidades procedimentales y en calidad de la tecnica, alcanzando el nivel de los especialistas tras completar el curso.

To assess the impact of fatigue due to incorrect night rest in the performance of a laparoscopic manual anastomosis.A prospective study evaluating the results from the realization of a manual endotrainer entero-enteral anastomosis performed by residents in terms of fatigue caused by inadequate nightly rest. Two groups were established; the fatigue group (F): anastomosis performed by residents coming off shift who slept less than seven hours and the rest group (R), being those who slept at home for more than 7 hours. The time taken, length of the anastomosis and quality of such were compared based on 4 parameters: Air leak test, correct tension on the suture line, accurate opposition of the edges and optimal distance between stitches.402 anastomoses were studied (211 rest group, 191 fatigue group). In the fatigue group leaks were detected in 33,5% anastomoses, as opposed to 19,4% in the rest group (p0.01). El rest group performed the anastomosis in 56,75 min and the fatigue group in 61,49 min (p = 0.006). There were no significant differences in the others parameters.Fatigue increases the risk of leakage and the time to do the exercise.

Resumen La ensenanza de la cirugia se ha visto afectada por multiples factores a lo largo de estos ultimos anos, como son la reduccion de la jornada laboral, la optimizacion del uso del quirofano o la seguridad del paciente. La metodologia de ensenanza tradicional no logra minimizar el impacto de estos factores en la formacion de los cirujanos. La simulacion como modelo de ensenanza minimiza dicho impacto y es mas eficaz que los metodos docentes tradicionales para integrar los conocimientos y las habilidades clinico-quirurgicas complejas. La simulacion complementa la asistencia clinica al paciente con la formacion, creando un entorno de aprendizaje seguro en el que no se ve afectada la seguridad del paciente ni se generan conflictos eticos ni legales. Las metodologias de aprendizaje que utilizan la simulacion permiten individualizar la ensenanza adaptandola a las necesidades de aprendizaje de cada alumno. Ademas, permiten entrenar todo tipo de habilidades tecnicas, cognitivas o de comportamiento.

Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeońs training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills.

Traditionally surgeons learned surgical techniques by training them directly in the patient by imitating the actions of the surgeon with more experience. Today this methodology is difficult to apply, since there are multiple factors that hinder its use. The limited time of training systems, scarcity of resources, patient safety or the need to learn new techniques of minimally invasive surgery, make the training of surgeons require a different learning methodology. This study has designed a new methodology for the learning of surgical techniques that minimizes the impact of all the previous factors on the training of surgeons. Its effectiveness in the teaching of laparoscopic manual intestinal anastomosis is analyzed. It has been asked a group of 24 expert surgeons teaching in intestinal anastomoses, which are the steps that must include the teaching of the technique. The phases evaluated with the highest score were included in the methodology. Once the steps of the methodology were designed, 25 general surgeons were chosen and divided into three groups according to their level of experience (experts, trained and beginners). Each participant performed five training sessions following the new methodology. The technical quality of the anastomosis, the overall development of the operation, as well as the feedback developed between the participants and the instructor was analyzed. After analyzing the results it was observed that structured feedback between the instructor and the participant increases the involvement of the participant in the learning process and reduces the time needed to acquire the competence. With this methodology the inexperienced participants perform the fifth anastomosis with quality parameters close to those obtained by the expert participants. In addition, this methodology allows to individualize the learning according to the needs of each participant.

Introduction Surgical training based on simulation seeks the acquisition of skills in novice participants and ongoing skill development in experts. The aim of this study is to assess the evolution of students in an intensive laparoscopic anastomosis course and to analyze their results depending on their level and previous experience. Methods The students of all the anastomosis courses conducted during 30 months in the Valdecilla virtual hospital (Santander) were analyzed. Manual side-to-side intestinal anastomoses with porcine ‘ex vivo’ viscera were performed in a laparoscopic endotrainer. The technical and quality differences between the first and the last anastomoses were analyzed and the progression between residents and specialists was compared. Results We analyzed 45 participants, 22 of them residents and 23 specialists. A statistically significant improvement of 80.5% was observed in all procedural parameters (94.8% residents vs. 67.3% specialists). The time was reduced by 48.1% in the residents and 43.2% in the specialists ( P In terms of quality, significant improvements were obtained in the group of residents: an increase of 90% in adequate tension, and a reduction of 75% of everted edges and 60% of leaks. In addition, they obtained results comparable to the specialists (27.3% leak in the last anastomosis vs. 34.8% by the specialists, P =.59), which presented improvement without statistical significance. Conclusions The group of residents presented a major and significant improvement in procedural skills and in the quality of the technique, reaching the level of the specialists after completion of the course.

Background The identification of developmental curve patterns generated by a simulation-based educational method and the variables that can accelerate the learning process will result in cost-effective training. This study describes the learning curves of a simulation-based instructional design (ID) that uses ex vivo animal models to teach laparoscopic latero-lateral small bowel anastomosis. Methods Twenty general surgery residents were evaluated on their performance of laparoscopic latero-lateral jejuno-jejunal anastomoses (JJA) and gastro-jejunal anastomoses (GJA), using swine small bowel and stomach on an endotrainer. The ID included the following steps: (1) provision of references and videos demonstrating the surgical technique, (2) creation of an engaging context for learning, (3) critical review of the literature and video on the procedures, (4) demonstration of the critical steps, (5) hands-on practice, (6) in-action instructor’s feedback, (7) quality assessment, (8) debriefing at the end of the session, and (9) deliberate and repetitive practice. Time was recorded from the beginning to the completion of the procedure, along with the presence or absence of anastomotic leaks. Results The participants needed to perform 23.8 ± 6.96 GJA (12–35) and 24.2 ± 6.96 JJA (9–43) to attain proficiency. The starting point of the learning curve was higher for the GJA than for the JJA, although the slope and plateau were parallel. Further, four types of learning curves were identified: (1) exponential, (2) rapid, (3) slow, and (4) no tendency. The type of pattern could be predicted after procedure number 8. Conclusions These findings may help to identify the learning curve of a trainee early in the developmental process, estimate the number of sessions required to reach a performance goal, determine a trainee’s readiness to practice the procedure on patients, and identify the subjects who lack the innate technical abilities. It may help motivated individuals to become reflective and self-regulated learners. Moreover, the standardization of the ID may help to measure the effectiveness of learning strategies and make comparisons with other educational strategies.