Browsing by Author "Martin, John R."

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    A Competency-based Laparoscopic Cholecystectomy Curriculum Significantly Improves General Surgery Residents’ Operative Performance and Decreases Skill Variability: Cohort Study
    (Wolters Kluwer, 2022-12) Huffman, Elizabeth M.; Choi, Jennifer N.; Martin, John R.; Anton, Nicholas E.; Nickel, Brianne L.; Monfared, Sara; Timsina, Lava R.; Dunnington, Gary L.; Stefanidis, Dimitrios; Surgery, School of Medicine
    Objective: To demonstrate the feasibility of implementing a CBE curriculum within a general surgery residency program and to evaluate its effectiveness in improving resident skill. Summary of Background Data: Operative skill variability affects residents and practicing surgeons and directly impacts patient outcomes. CBE can decrease this variability by ensuring uniform skill acquisition. We implemented a CBE LC curriculum to improve resident performance and decrease skill variability. Methods: PGY-2 residents completed the curriculum during monthly rotations starting in July 2017. Once simulator proficiency was reached, residents performed elective LCs with a select group of faculty at 3 hospitals. Performance at curriculum completion was assessed using LC simulation metrics and intraoperative operative performance rating system scores and compared to both baseline and historical controls, comprised of rising PGY-3s, using a 2-sample Wilcoxon rank-sum test. PGY-2 group’s performance variability was compared with PGY-3s using Levene robust test of equality of variances; P < 0.05 was considered significant. Results: Twenty-one residents each performed 17.52 ± 4.15 consecutive LCs during the monthly rotation. Resident simulated and operative performance increased significantly with dedicated training and reached that of more experienced rising PGY-3s (n = 7) but with significantly decreased variability in performance (P = 0.04). Conclusions: Completion of a CBE rotation led to significant improvements in PGY-2 residents’ LC performance that reached that of PGY-3s and decreased performance variability. These results support wider implementation of CBE in resident training.
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    Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial
    (Lippincott, 2020-08) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of Medicine
    Objective: To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. Summary Background Data: There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. Methods: Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. Results: All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82–0.97) but moderate for GEARS ratings (0.40–0.67). Conclusions: We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.
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    Response to “Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial” Not only surgeon's manual skills...”
    (Wolters Kluwer, 2020-12) Satava, Richard M.; Stefanidis, Dimitrios; Levy, Jeffrey S.; Smith, Roger; Martin, John R.; Monfared, Sara; Timsina, Lava R.; Wardkes Darzi, Ara; Moglia, Andrea; Brand, Timothy C.; Dorin, Ryan P.; Dumon, Kristoffel R.; Francone, Todd D.; Georgiou, Evangelos; Goh, Alvin C.; Marcet, Jorge E.; Martino, Martin A.; Sudan, Ranjan; Vale, Justin; Gallagher, Anthony G.; Surgery, School of Medicine