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Browsing by Author "Ballas, Derek A."
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Item Emergency Undocking Curriculum in Robotic Surgery(Cureus, 2019-03-26) Ballas, Derek A.; Cesta, Megan; Gothard, David; Ahmed, Rami; Emergency Medicine, School of MedicineIntroduction Traditional instruction for robotic surgery is typically devoid of training that addresses the delineation of interprofessional roles for operating room personnel. An emergency undocking scenario was developed for robotic surgeons with the objectives of improving time to access the patient, provider knowledge of and confidence in emergency undocking, completion of predetermined critical actions, and delineation of operating room personnel roles. Methods Over one month, participants joined in three sessions: Session 1 - formative, Session 2 - review, and Session 3 - summative. Embedded standardized participants (ESPs) represented members of the interprofessional team. Prior to entering the operating room for Sessions 1 and 3, trainees were asked to complete a confidence survey and multiple choice questionnaire (MCQ) for knowledge assessment. Participants were randomized to one of two cases and participated in the reciprocal case for the final session four weeks later. Following Session 1, participants underwent an educational intervention, including the proper technique for emergency undocking, emphasis on operating room personnel roles, and hands-on practice. Obstetrics and Gynecology (OBGYN) residents in post-graduate Years 2-4 and attending physicians with robotics privileges at Summa Health Akron Campus or Cleveland Clinic Akron General Medical Center were invited to participate. A total of 21 participants enrolled and finished the study. Results Among the 21 participants, there was a significant increase in the baseline level of knowledge (p-value=0.001) and in the confidence of surgeons when faced with an emergency undocking after the completion of our curriculum (p-value=0.003). Additionally, an improvement in the undocking times (p-value<0.001) and an increase in the critical actions performed (p-value=0.002) were observed. Conclusion The results of this study demonstrate that incorporating this curriculum into the training programs of robotic surgeons is an effective way to improve the surgical skill of emergency undocking.Item Iatrogenic Critical Care Procedure Complication Boot Camp: A Simulation‐Based Pilot Study(Wiley, 2019) Riefkohl-Ortiz, Elaine; Frey, Jennifer A.; Yee, Jennifer; Gothard, M. David; Hughes, Patrick G.; Ballas, Derek A.; Ahmed, Rami A.; Emergency Medicine, School of MedicineBackground Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management. We hypothesize that a standardized simulation‐based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management. Methods This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre‐ and post‐intervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians, interquartile ranges, and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p<0.05 considered statistically significant. Results Eighteen residents participated in the study curriculum. The median confidence increased significantly by a summed score of 12.5 (8.75 –17.25) (p<0.001). Similarly, the median knowledge significantly increased by 6 points (3 –8) from the pre‐ to post‐intervention assessment (p<0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p<0.001 to p=0.002). Conclusion We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries.