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Abstract Background Nontechnical issues are linked to up to 60% of adverse events in surgery and have become one of the core competencies of surgical education. Simulation-based training allows development of these skills. We hypothesized that we could both assess and improve the communication skills of interdisciplinary teams through a simulated crisis situation. Methods We designed a simulated crisis involving the intraoperative development of a tension pneumothorax. Audiovisual analysis was used to evaluate team interaction, and a combination of proctored assessment and self-assessment was used to evaluate individual learners. Time to communication and event intervention was measured. Data were analyzed using paired t -tests and 1-way analysis of variance in SPSS. Results Time from development of hypotension to communication of deterioration was 57 ± 60 seconds; time to intervention was 93 ± 30 seconds. Nontechnical skills in surgery II scores were greatest for surgery senior residents and least for surgery junior residents. Insight was least in surgery junior residents. Correctability was not different between groups but tended to be greater in surgery junior residents. Conclusions Poor communication delayed timing of intervention, indicating a need for enhanced communication in the operating room. Junior surgery residents scored lowest both on nontechnical skills and insight and should be taught nontechnical skills through simulation. Our curriculum is a suitable and reproducible model to educate surgery residents in communication skills. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for biliary dyskinesia; however, long-term outcomes remain unclear. METHODS: A retrospective review of patients diagnosed with biliary dyskinesia and treated with laparoscopic cholecystectomy at a single institution between 2001 and 2012 was conducted. Longterm outcome data were obtained by telephonic interview using a modified Likert scale. RESULTS: Sixty-seven patients met inclusion criteria, of which 34 patients (51%) had long-term follow-up data. Mean time of follow-up was 65 (range: 6 to 134) months. Long-term follow-up demonstrated symptom response in 88% (n = 30) of patients (responders), compared to no response in 12% (n = 4) of patients (nonresponders). Responders underwent a mean of 1.56 preoperative diagnostic procedures, compared to 2.5 for nonresponders (P = .01). CONCLUSION: This represents the longest mean time of follow-up study demonstrating the success of laparoscopic cholecystectomy to improve symptoms in patients with biliary dyskinesia. [ABSTRACT FROM AUTHOR]

Background: Graduating surgery residents often feel unprepared to practice autonomously in the current era of surgical training. We implemented an integrated simulation curriculum to improve residents' autonomy and increase their confidence to practice independently. In this study, we chose a laparoscopic ventral hernia repair (LVHR) as our pilot operation to test proof of concept and on which we would construct our integrated curriculum.Study Design: The curriculum included a web-based cognitive component, inanimate model simulation session with follow-up at 2 weeks and 6 months, and self-confidence questionnaires. Faculty rated each resident's procedure-specific skill by using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) criteria and a task-specific checklist.Results: Thirteen junior residents, 7 senior residents, and 7 faculty surgeons completed the curriculum. Four junior residents (31%) achieved proficiency at their first session, 10 (77%) after the second session (p = 0.031), and 6 (67%) at 6 months (p ≥ 0.99). Three residents regressed and did not maintain proficiency after the second assessment. Performance (GOALS) scores improved (p = 0.0313) at week 2 and were maintained at 6 months (p = 0.5625). Required faculty direction decreased (p = 0.004), and resident confidence in completing the procedure independently improved (p < 0.004) over the 6-month curriculum.Conclusions: Assessing procedure-specific and global laparoscopic skills through a simulation-based curriculum is feasible and can be used to augment resident training. Our curriculum demonstrated improvement in proficiency and self-confidence while performing an LVHR. Additional study is needed to examine the optimal way to integrate procedure-specific simulation models into training programs. [ABSTRACT FROM AUTHOR]