Global surgical education : journal of the Association for Surgical Education最新文献

{"title":"The collaboration of surgical education fellows' (CoSEF) guide to designing, executing, and publishing surgical education research.","authors":"Ariana Naaseh, Sarah Lund, John M Woodward, Joshua Roshal, Steven W Thornton, Nicole M Santucci, Maya L Hunt, Sergio M Navarro, Caitlin Silvestri","doi":"10.1007/s44186-025-00471-6","DOIUrl":"10.1007/s44186-025-00471-6","url":null,"abstract":"","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"5 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12855258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and evaluating image-based metrics for open surgical suturing skill assessment.","authors":"Jianxin Gao, Simar P Singh, Amir Mehdi Shayan, John F Eidt, Joe Bible, Joseph Vincent Valentino Blas, Sagar S Gandhi, Ravikiran Singapogu, Richard E Groff","doi":"10.1007/s44186-026-00596-2","DOIUrl":"10.1007/s44186-026-00596-2","url":null,"abstract":"<p><strong>Purpose: </strong>Open surgery training is vital in vascular surgery education. Traditionally, trainees' open surgical suturing skills are evaluated by their educators, which is a subjective and time-consuming process. This paper evaluates image-based metrics for surgical suturing skill assessment by comparing performance among three groups: attending surgeons, resident surgeons, and novices.</p><p><strong>Methods: </strong>A simulator, named SutureCoach, is developed to simulate a radial suturing task, performed either at \"depth,\" representing a cavity, or at \"surface.\" Among other sensors, the simulator includes cameras and computer vision software to track the motion of the needle and thread under the membrane being sutured. A set of image-based metrics are calculated for each suture based on video data. The set of metrics includes four previously proposed metrics as well as four new metrics inspired by a refined suturing phase segmentation scheme. To evaluate the performance of the image-based metrics, we conducted a study with 97 participants, divided almost evenly between attending surgeons, resident surgeons, and novices. Data was collected at several events over a 5-month period.</p><p><strong>Results: </strong>The statistical analysis shows that all metrics have significantly different means when comparing performance between novices and surgeons at both conditions, surface and depth. Furthermore, seven out of eight metrics have significant mean differences when comparing resident surgeons' and attending surgeons' performance at the depth condition.</p><p><strong>Conclusion: </strong>Image-based metrics are capable of suturing skill assessment, especially for distinguishing novices from surgeons. Depth constraints allow higher skill levels to be better differentiated.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s44186-026-00596-2.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"5 1","pages":"196"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of case-specific learning goal on robotic-assisted surgery care delivery.","authors":"Michael Meara, Theresa Wang, Heidi Pieper, David Renton, Xiaodong Phoenix Chen","doi":"10.1007/s44186-026-00514-6","DOIUrl":"10.1007/s44186-026-00514-6","url":null,"abstract":"<p><strong>Introduction: </strong>We hypothesize that resident's intraoperative case-specific learning goal may influence resident intraoperative autonomy and robotic-assisted surgery (RAS) surgical outcomes measured by operative time (OT), length of stay (LOS), direct cost (DC), and 30-day readmission (30R).</p><p><strong>Methods: </strong>Valid resident operative performance evaluations, which includes case-specific learning goal selection (LGS) and degree of learning goal completion (LGC) metrics, of three outpatient RAS procedures-inguinal hernia, ventral hernia, and cholecystectomy-performed by PGY2-5 residents were collected. Cases in which residents served as bedside assistants were excluded. OT, LOS, DC, and 30R for matched cases were extracted from hospital records. Descriptive statistical analysis was applied.</p><p><strong>Results: </strong>A total of 104 evaluations from 57 outpatient RAS cases were analyzed. Residents' overall permitted intraoperative autonomy was positively correlated with their LGS (0.66, <i>p</i> < 0.0001) and LGC (0.64, <i>p</i> < 0.0001). Overall LGS had minimal impact on OT, LOS, and DC. However, significant differences (all <i>p</i> < 0.05) in surgical outcomes were observed between different LGC scores: Compared to cases with an LGC score 5 (fully completed learning goal), cases with an LGC score 3 (partially completed learning goal) showed significantly longer LOS (8.00 h > 5.87 h) and OT (98.36 min > 74.49 min) as well as higher DC ($4471.84 > $3945.23). RAS cases with an LGC score 5 had a higher probability of 30R than those with an LGC score 3 (18.03% > 1.64%), though it was not significant. LGS also showed a similar trend.</p><p><strong>Conclusions: </strong>Study findings suggest the case-specific learning goal may influence resident autonomy as well as LOS, OT, DC and 30R of outpatient RAS cases. Identifying an achievable learning goal upon a resident's competency level may enhance intraoperative training and RAS care outcomes.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"5 1","pages":"111"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13002655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-fidelity simulation as a translational and educational platform for crisis ventilation: quantifying and mitigating tidal volume maldistribution during shared mechanical ventilation.","authors":"Syed Husain, Aushja Syed, John Bockbrader, Tim Dunlea, Scott Winfield, Daniel Vazquez","doi":"10.1007/s44186-026-00589-1","DOIUrl":"https://doi.org/10.1007/s44186-026-00589-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Shared mechanical ventilation has been proposed during ventilator shortages, but unequal tidal volume delivery remains a major limitation when lung compliance differs. Professional societies have cautioned against this practice, yet the intervention has never been validated clinically, and ethical constraints preclude direct patient testing. Translational simulation-simulation applied beyond education to probe clinical systems, test crisis-driven innovations, and generate actionable safety data-offers a methodological pathway for evaluating interventions that cannot be studied in vivo [1, 2]. In parallel, high-fidelity simulation offers a controlled environment in which clinicians can be taught the physiologic hazards of shared ventilation without risk to patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two high-fidelity patient simulators were connected to one ventilator in volume-control assist-control mode using a parallel circuit. One simulator was set to normal compliance and the other to reduced compliance. Tidal volumes were measured before and after adjustment of the higher-flow limb with inline flowmeters. This study was designed as a translational simulation to evaluate a crisis-care equipment configuration under controlled, reproducible conditions. The objective was to use high-fidelity simulation as a controlled, reproducible experimental platform to (1) empirically quantify the compliance-driven tidal volume reduction predicted by respiratory-mechanics theory during shared ventilation, (2) test whether inline flowmeters with adjustable valves partially mitigate this, and (3) evaluate the feasibility of high-fidelity simulation as a translational and educational platform for crisis-care innovations that cannot ethically or logistically be studied in real patients. We hypothesized that (H1) shared ventilation of two lung units with mismatched compliance would produce clinically relevant tidal volume reduction in the low-compliance limb, and (H2) this would be counteracted by inline flowmeters with adjustable valves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Without adjustment, the low-compliance simulator's delivered volume fell markedly relative to its normal-compliance baseline; after flow regulation, it returned toward baseline at both 900 mL and 1100 mL tidal volume settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates how high-fidelity simulation can function as a translational research platform for crisis-care innovations that are ethically and logistically impossible to study in clinical practice. Beyond confirming the physiologic limitations of unregulated ventilator sharing, the simulation generated reproducible, condition-specific tidal volume data that can inform crisis preparedness protocols and equipment pre-positioning decisions. This application of simulation as a systems-testing and device-evaluation tool, in addition to translating directly into a crisis-preparedness educational scenario,","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"5 1","pages":"185"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do expert surgeons use mental skills to improve their surgical performance?","authors":"Nicholas E Anton, Ashley M Yurco, Kareem A Kashif, Brisa Urquieta de Hernandez, Charles Brown, Dimitrios Stefanidis","doi":"10.1007/s44186-025-00392-4","DOIUrl":"10.1007/s44186-025-00392-4","url":null,"abstract":"<p><strong>Purpose: </strong>Surgeons often experience stress that may negatively impact performance. Mental skills are psychological techniques designed to prevent skill deterioration under stress and enhance performance. Mental skills curricula have proved effective in other disciplines but are rarely used in surgery. Additionally, research on mental skill use by surgeons has been very limited. The objectives of this study were to (1) explore whether expert surgeons use mental skills to enhance their performance, (2) determine how they implement mental skills, and 3) assess the need for mental skills training in surgical residency.</p><p><strong>Methods: </strong>After IRB approval, 7 expert surgeons (≥ 15 years of experience, prominence in their respective fields) from general surgery, obstetrics/gynecology, and neurosurgery voluntarily participated in semi-structured interviews. Responses were transcribed and analyzed until themes were identified.</p><p><strong>Results: </strong>All interviewed surgeons indicated that they regularly use some combination of mental skills to achieve their ideal performance state for surgery, manage intraoperative stress, and manage distractions before and during surgery. Further, all participating surgeons reported feeling responsible, as the leader of the surgical team, to project a calm demeanor during stressful situations to optimize the team's performance. While none of the participating surgeons had received mental skills training, 71% (5 of 7) advocated for the incorporation of mental skills training into surgery residency.</p><p><strong>Conclusions: </strong>Mental skills are routinely used by expert surgeons to enhance performance and manage stress. While mental skills seem to be acquired over years of practice, experts agree that these skills warrant formal introduction during residency.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"4 1","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Automated Assessment of Intracorporeal Suturing in Laparoscopic Fundoplication.","authors":"Shekhar Madhav Khairnar, Huu Phong Nguyen, Alexis Desir, Carla Holcomb, Daniel J Scott, Ganesh Sankaranarayanan","doi":"10.1007/s44186-025-00373-7","DOIUrl":"10.1007/s44186-025-00373-7","url":null,"abstract":"<p><strong>Introduction: </strong>Automated assessment of surgical skills using artificial intelligence (AI) is valuable for trainees to obtain instantaneous feedback. After bimanual tool motions are captured, the derived kinematic metrics have shown to be reliable predictors of performance in laparoscopic tasks. Implementing automated tool tracking assessment requires time-intensive human annotation. We have developed AI-based tool tracking using the Segment Anything Model (SAM) to eliminate the need for human annotators. Here we describe a study to evaluate the usefulness of our tool tracking model in automated assessment of performance in a laparoscopic suturing task of the fundoplication procedure.</p><p><strong>Method: </strong>An automated tool tracking model was applied to recorded videos of Nissen fundoplication on porcine bowel. The participating surgeons were grouped into novices (PGY1-2) and experts (PGY3-5, fellow and attendings). The beginning and the ending of each of the suturing steps were segmented and the motions of the left and right tools were extracted. A low-pass filter with a cut-off frequency of 24 Hz was then applied to remove any noise. Automated assessment of performance was implemented using both supervised and unsupervised models, and an ablation study was performed to compare the performance. For the supervised learning model, kinematic features included root mean square (RMS) velocity, RMS acceleration, RMS jerk, total path length, and Bimanual Dexterity in pixel coordinates (x, y) that were extracted and analyzed using Logistic Regression, Random Forest Classifier, Support Vector Classifier, and XGBoost. We further analyzed the performance with a reduced set of features selected using a Principal Component Analysis (PCA). For unsupervised learning, a Denoising Autoencoder (DAE) model with classifiers like a 1-D (Convolutional Neural Network) CNN and traditional Machine Learning models were trained for classification.</p><p><strong>Results: </strong>Data was extracted for 28 participants out of an initial cohort of 38, categorized into 9 novices and 19 experts. The approach for supervised learning utilized kinematic features with Principal Component Analysis (PCA) using a Random Forest model (the best model among other Machine Learning models) and obtained an accuracy of 0.795 ± 0.065 and an F1 score of 0.778 ± 0.071. The approach for unsupervised learning employed a 1-D CNN achieved the best results with an accuracy of 0.817 ± 0.108 and an F1 score of 0.806 ± 0.110. This second approach is superior as it eliminates the need to compute kinematic features.</p><p><strong>Conclusion: </strong>We successfully demonstrated an AI model for automated classification of performance independent of human annotation of surgical videos that can be used to enhance surgical skill evaluation.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of simulation scenarios for surgeons' non-technical skills evaluation.","authors":"Nicholas E Anton, Brittany Anderson-Montoya, Amy Holmstrom, Marian Obuseh, Yichuan Yan, Payton M Miller, Wendy S Li, Qais AbuHasan, Denny Yu, Dimitrios Stefanidis","doi":"10.1007/s44186-025-00390-6","DOIUrl":"10.1007/s44186-025-00390-6","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to identify specific simulated scenarios and events for surgeons that discretely and effectively measure non-technical skills (NTS) constructs and appropriately measure NTS using specific behavioral anchors.</p><p><strong>Methods: </strong>Over the course of two rounds, experts in NTS accumulated a comprehensive list of simulated scenarios used at our institution to evaluate NTS. Utilizing a survey, experts were able to review scenarios, events, and behavioral anchors to evaluate their agreement with the appropriateness of the events and effectiveness of the anchors. Coefficient of variation (CV) was used to evaluate agreement between raters. The highest rated events were identified.</p><p><strong>Results: </strong>The CV between raters was moderate, and further inspection revealed that 86% of event ratings had discordance within ± 1 point. The highest rated events in terms of appropriateness and behavioral anchor effectiveness evaluated surgeons' leadership and communication.</p><p><strong>Conclusions: </strong>In this study, experts identified three simulated events that isolate and discretely evaluate specific NTS among surgeons. In the future, these scenarios can be used to effectively evaluate surgeons' NTS.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44186-025-00390-6.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"4 1","pages":"79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive models for mentally visualizing a sharp instrument in a blind procedure.","authors":"Faith Mueller, Austin Bachar, Md A Arif, Gregory W King, Antonis P Stylianou, Gary Sutkin","doi":"10.1007/s44186-023-00153-1","DOIUrl":"10.1007/s44186-023-00153-1","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to understand the cognitive strategies used by surgeons to mentally visualize navigation of a surgical instrument through blind space.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 15 expert and novice surgeons following simulated retropubic trocar passage on 3D-printed models of pelvises segmented from preop MRIs. Midurethral sling surgery involves blind passage of a trocar among the urethra, bladder, iliac vessels, and bowel while relying primarily on haptic feedback from the suprapubic bone (SPB) for guidance. Our conceptual foundation was based on Lahav's study on blind people's mental mapping of spaces using haptic cues. Participants detailed how they mentally pictured the trocar's location relative to vital anatomy. We coded all responses and used constant comparative analysis to generate themes, confirmed with member checking.</p><p><strong>Results: </strong>Expert and novice participants utilized multiple cognitive strategies combined with haptic feedback to accomplish safe trocar passage. Some used a step-by-step route strategy, visualizing sequential 2D axial images of anatomy adjacent to the SPB. Others used a map strategy, forming global 3D pictures. Although these mental pictures vanished when they were \"lost,\" a safe zone could be reestablished by touching the SPB. Experts were more likely to relate their body position to the trocar path and rely on minor variations in resistance. Novices were more inclined toward backtracking of the trocar.</p><p><strong>Conclusions: </strong>Our findings may be extended to any blind surgical procedure. Teaching visualization strategies and incorporating tactile feedback can be used intraoperatively to help learners navigate their instrument safely around vital organs.</p>","PeriodicalId":101355,"journal":{"name":"Global surgical education : journal of the Association for Surgical Education","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71416496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}