As with medicine in general, surgeons working in this global or humanitarian arena must be trained first to do no harm.
eoSurgical’s founders are all members of the Royal College of Surgeons of Surgeons of Edinburgh. This college has built a dedicated Faculty of Remote, Rural and Humanitarian Healthcare – a response to the need within public health and industry to define and review standards of competence for organisations as well as medical and non-medical personnel delivering healthcare in remote, resource-limited, or austere environments. Their primary objective is “to improve the health outcomes of individuals living and working in remote, rural, austere and life-threatening areas of the world”. This is an objective shared by the teams at eoSurgical and Limbs & Things.
Everyone can play a role: government, individuals, healthcare professional volunteers, and industry. Médecins sans Frontieres illustrate just how diverse support can be. A natural disaster or conflict often presents a clear spike in frontline healthcare needs. Once this passes, many other challenges persist. Rebuilding infrastructure, retraining the workforce, rebuilding trust, dealing with a backlog – all are likely challenges. Optimising healthcare systems in such limited-resource settings is a daunting proposition. That said, there is an important role for healthcare training providers and simulation.
eoSurgical’s suite of simulators are low cost, portable, and pragmatic – making them ideal for use in low resource settings. Amongst sales in 95 different countries, many have been delivered to LMIC settings. We’ve also previously provided financial educational support for a trainee from Zambia in their quest to upskill as a surgeon. As we begin a new chapter as part of Limbs & Things, we will strive to continue to play a useful role in this arena.
Mark Hughes
Consultant Neurosurgeon
Director, eoSurgical
Email: mark.hughes@limbsandthings.com
Twitter: @eosurgical
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The eoSurgical team are delighted to announce that we have joined forces with Limbs & Things Ltd. Limbs & Things is a UK-based developer of task training and simulation training products for healthcare. Started by Margot Cooper in 1990, the vision was (and remains) to improve clinical education by providing repeatable, anatomically accurate, and cost-effective training solutions. Limbs & Things want students to become more competent and confident learners. This chimes exactly with our ethos at eoSurgical, making the union ideal.
The eoSurgical mission:
Evidence-based learning: eoSurgical provides evidence-based, accessible surgical skills simulation training to make surgery safer globally.
By Surgeons, For Surgeons: eoSurgical was conceived and developed by a team of three surgical registrars, who now work as consultants in tertiary surgical centres in the UK.
CPD and training: You're never too good to get better. Simulation is well established in training and has a growing role in continuous professional development.
Our entire team will now work within Limbs & Things. Hard work is going on behind the scenes to ensure a smooth transition and we are excited at the opportunities that this merger will bring. We’ll strive to further enhance the impact of our surgical simulators – beyond the 95 countries within which they are already in use and making a difference. Limbs & Things have offices in the US, Australia, and Europe and have international experience and knowledge. Becoming part of the Limbs & Things family is a fantastic development for both parties.
Mark Hughes
Consultant Neurosurgeon
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Apple’s latest hardware release has re-ignited virtual reality discourse. We have been waiting with bated breath for the VR revolution to come ever since Facebook bought Oculus. Facebook has backed VR to such a degree that they renamed their corporation Meta, as in the metaverse. The metaverse is where – we are told – we will soon be interacting. It will be a shared, immersive, 3D virtual space. Interacting here will probably involve some form of VR enabled headgear.
Some argue that the revolution has stalled. Heavy, cumbersome hardware makes many users feel nauseated. Even the gaming industry, which has arguably gone furthest in development of metaverse-like environments, has not yet embraced VR. However, Apple have now thrown their hat in the ring – with their Vision Pro – and so things may change.
Apple has a track record of changing behaviour. We will see whether the Apple Vision Pro changes the world like the iPhone or iPod. If VR really does take off, and we end up part-living in the metaverse, it is worth considering how surgery might benefit.
Interestingly, the Vision Pro allows the user to be immersed in the virtual world to varying degrees. Apple say that one can ‘…seamlessly blend digital content with your physical space’. Consider a situation of minimal immersion, where the real-world operating environment dominates, but in which a surgeon might pull up the patient’s MRI or CT partway through an operation (using the in-built eye tracking technology). Taking this further, real-time electrophysiology could be superimposed on screen, or settings for the electrocautery or other surgical instrumentation might be controlled via the headset to avoid asking scrub teams to change settings.
In the world of endoscopic or exoscopic surgery, where the surgeon visualises the surgical field via a screen, there is the immediate potential to stream the view within the headset itself. This could be a usefully immersive, high fidelity environment with potentially improved visualisation. As well as superimposed information as above, it would be possible to overlay patient-specific anatomical detail in real-time (as is already possible using intra-operative surgical navigation hardware).
These developments could certainly prove useful and seem entirely feasible. However, might the extra information be too distracting? Settling down behind the microscope can be isolating in a good way; the rest of the room falls away and the surgical task at hand is magnified, quite literally. This focused immersion is arguably crucial to phases of operating.
Mark Hughes
Consultant Neurosurgeon
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
Photo by James Yarema on Unsplash
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In well-funded healthcare settings, robotic surgery is gathering momentum. The technological rate-limiting steps are rapidly being tackled: progressive miniaturisation of components, enhanced optics, and progress with AI are important steps. Currently, these robots work largely as an extension of a human surgeon operator and are certainly far from autonomous. For example, the human-controlled da Vinci system (Intuitive Surgical, USA) is probably the best known.
Whilst robotic surgical systems are building a progressively solid evidence base (in the right setting), there are some important questions to be considered. Utilising robots adds complexity to an already complex arena. Just as humans can ‘break-down’, or surgical kit can malfunction, so too can mechanical or electronic systems. However, if robots can be incorporated safely to enhance performance (and therefore also improve patient care and outcomes) it is inevitable that the technology will be embraced and will develop.
There is, however, another very large elephant in the operating room.
Consider cars. They are gradually becoming more autonomous (by way of 3D cameras, AI, and constant connectivity) and will ultimately become driverless. The rail and aviation industries are heading in a similar direction. Will we ultimately be operated upon by fully autonomous surgical robots?
Robots that are able to make decisions and learn from experience are already in existence. Recent advances in machine learning are well publicised. As time passes, the control ‘dial’ is likely swing away from humans and towards more isolated, autonomous robotic systems. This redistribution of decision-making and motor performance poses a legal question. Who would be liable in the event of a mistake? Moreover, problem solving strategies utilised by machine learning algorithms are (almost by definition) not accessible to an average human mind – resulting in a ‘black box’ of decision-making that will be very hard to unpick.
What this means in practise is hard to predict. A human surgical supervisor (at the very least) is probable for some time yet. From a governance perspective, it has already become urgently necessary to establish international standards for the use of AI in health care – to ensure accountability and to protect patients. All this aside, it is worth reiterating that operating is just one part of being a surgeon. Human to human interaction is the bedrock of the therapeutic alliance needed to provide surgical care for people. Robots will struggle to fulfil this role.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Photo by Possessed Photography on Unsplash
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Most people set themselves goals of one sort or another. Surgeons seem particularly goal driven. We seek first to be selected into a surgical training program, then we study to pass exams, we work hard to log cases, we complete workplace-based assessments, and then defend ourselves at annual reviews of performance. These are largely performance orientated goals or hurdles. They are important but they are also a means to an end.
The ultimate aim is to perform well in the real world, on real patients, working with real colleagues. This is mastery. Career long, the best surgeons strive to master their role.
Where does eoSurgical sit amongst these two goal orientations, performance and mastery? In some ways, the tasks you perform in eoSim encapsulate performance-driven learning. The task is set, the clock begins, your instrument movement metrics are collated, and on completion you are provided with a summary and feedback for improving. We provide thresholds for attaining a specified level of performance for progression. However, our surgical training platform can take you much further.
A mastery orientation to learning involves mastering a task according to standards set by the learner themselves. They use their own insight to develop new skills and acquire new knowledge. A surgeon may therefore return to a given eoSim task (or indeed develop their own task), informed by their own personal assessment of learning needs. How could I have performed better during that real procedure? What nuance of technique can I personally focus on to advance?
Go further yet and you enter the realm of innovation: is there an even better way of doing this? Is there a better instrument for this? Can I develop a better instrument for this? All this is feasible on the eoSim platform - which we are proud is now in use on over 90 countries across the world.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Towards the end of last year, eoSurgical put their support behind five oarsmen attempting to row across the Atlantic as part of the Talisker Whisky Atlantic Challenge. The team, Atlantic Body and Soul, have done it – crossing the finishing line in Antigua in just under 40 days.
They overcame treacherous seas, technical issues with their batteries (crucial for desalination of drinking water and also for running navigational equipment), and the physical challenge of rowing in two-hour shifts for 40 days. In doing so, they have raised significant funds for their two charities: Body & Soul and The Junction. We’re delighted to have played a small part in supporting their project.
Delivering excellent patient care trumps any sporting endeavour. However, this project mirrors some of the challenges we face as surgeons – and the satisfaction that comes with a job well done. After the crew left the safety of land, they were committed. Difficulties needed to be overcome as they faced them – all be it with communication and help from support teams.
Operations can be similar. Even with thorough preparation, we can face unexpected challenges. Coping with these, seeking help when needed, is crucial to achieving the best outcome. Long cases are a mental and a physical challenge – demanding we look after ourselves and are ready to perform optimally. Surgery is also a team sport. Every member of the team contributes and, when all these vectors are aligned, great things can be achieved.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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eoSurgical’s instrument tracking training software, SurgTrac, is able to generate natural language feedback based on surgeon performance during simulated tasks. We analyse your data and suggest specific areas to focus on by articulating instructions in a natural language format. For example, if our instrument tracking software reveals that you rely heavily on your dominant hand to complete a task, we suggest you spread instruments movements more evenly (as is observed in experienced, high performing surgeons).
Joining the party recently is another fledgling technology that can understand and generate natural language text: ChatGPT, a chatbot developed by OpenAI. We thought we would test it, by tasking it to write the next blog:
“The medical field has come a long way since the days of apprenticeship-style learning, where students would observe and assist experienced physicians in real-life procedures. Today, the use of simulation training has revolutionized medical education, offering a safe and controlled environment for students to learn and practice their skills.
Simulation training has been used in the aviation industry for decades, and now it has made its way into the medical field. The use of simulation in medical education allows students to experience procedures in a realistic, yet controlled environment. By using realistic models and equipment, students can practice procedures, such as surgeries, without risking the safety of real patients.
In the field of surgery, simulation training has been especially beneficial. With the help of eoSurgical, a leading provider of medical simulation training, surgical students and residents can now practice procedures safely. Not only does simulation training benefit students, but it also has the potential to improve patient safety. By allowing medical students and residents to practice procedures in a controlled environment, simulation training reduces the risk of errors and adverse events in real-life procedures. This can lead to better outcomes for patients, and it can also help to reduce the cost of healthcare by reducing the number of complications and re-operations.”
This a decent summary by an AI! How this technology develops and finds utility – generally and also in healthcare settings – will be interesting and exciting.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
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Cover Photo by Maxence Pira on Unsplash
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Surgery can take a large toll on the environment. It is resource intense in many ways: infrastructure, personnel, and consumables. Operating theatres contribute up to 25% of a hospital’s overall carbon footprint. The NHS itself contributes 6% of the UK’s total carbon footprint. Our motivation to improve matters here can fall behind the day-to-day challenges of keeping a precarious service going, in these challenging times.
There is a growing public expectation that large public sector bodies need to lead the way, owing to their climate impact. Large organisations can drift away from ‘lean’ principles. The amount of waste in the NHS is huge – be it through lights left on, inefficient heating of buildings, unnecessary opening of equipment that must then be disposed of, and the list goes on and on.
With NHS founding principles enshrining the philosophy of services ‘free at point of care’, there comes a powerful drive to provide the best care for patients without being influenced by cost (as may happen in the private sector). One consequence, however, is that NHS workers are largely insulated from the knowledge of just how much items and services cost. As such, inefficiency and intolerance of waste is not perceived as it might be in the private sector.
Things can change. From a surgical perspective, we should return to using reusable gowns, drapes, and scrub caps. Targeted changes to anaesthetic techniques can directly reduce greenhouse gas emissions. Ensuring industry works to reduce single use equipment reduces use of unnecessary non-recyclable packaging. The NHS has clout due to its size and the market it generates.
Some changes are also occurring as unintended positive benefits from otherwise negative events. The covid pandemic has hugely increased virtual consultations. The consequent reduction in car journeys is beneficial. Russia’s invasion of Ukraine, and the consequent energy crisis, is accelerating our (overdue) realisation that renewable locally sourced energy is key to security. We can all do some simple things: talk about the issue in theatre, raise reusability with company reps, think twice about disposing of waste in the correct bin, and cycle or walk to work if possible!
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Cover photo by philippe spitalier on Unsplash
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The 2022 football World Cup features 32 nations vying to become world champions. These countries have come through arduous qualifying campaigns to earn the right to play. We’re now getting to the sharp end of the tournament, with some of the world’s best aiming to perform at their peak on the world stage. Many years of practise, training, and commitment must now come together - and only the best team will succeed.
In another example of mass global participation and teamwork we are proud to report that eoSim, our flagship MIS simulator, is now being used in 95 different countries (see below). Our surgical simulation platform also supports practise, training, and commitment though our endgame is very different: a drive towards delivering high quality surgical care worldwide and improving patients’ lives.
We build our simulators so that they are both effective and affordable. We strive to democratise access to this form of learning and training so that the impact is felt globally and not restricted solely to wealthy healthcare settings. Our evidence base highlights efficacy and we are delighted that this impact is being felt across such a wide surgical diaspora.
The SurgTrac software and curricula that come embedded with eoSim are also being improved and iterated constantly. We have a range of speciality-specific courses and modules incorporating non-technical skills. We’re always working to make them – and therefore you – better. Our simulators support (indeed thrive on) mobile interfaces, which allows you to keep that training platform in your pocket, easily evidence your learning during annual assessments, and appreciate yourself as you improve your skills.
And if you are based I one of the (relatively few!) countries without an eoSim, get in touch and we’ll remedy that.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Countries where surgeons and patients benefit from eoSurgical simulators:
Great Britain
Australia
Germany
United States
Denmark
Fiji
Romania
Timor-leste
Tuvalu
France
Ireland
Greece
Saudi Arabia
Afghanistan
Belgium
Argentina
United Arab Emirates
Pakistan
Tunisia
New Zealand
Netherlands
Kuwait
Malaysia
Spain
Canada
Chile
Switzerland
Uganda
Anguilla
Congo
Kenya
Egypt
Qatar
India
Italy
Israel
Palestine, State Of
Nigeria
Bulgaria
Ghana
Mexico
Hashemite Kingdom Of Jordan
Brazil
Lebanon
Norway
Lithuania
Bangladesh
Papua New Guinea
Algeria
Turkey
Ukraine
Philippines
South Africa
Poland
Viet Nam
Montenegro
Singapore
British Indian Ocean Territory
Peru
Morocco
Croatia
Hungary
Yemen
Jamaica
Cyprus
Paraguay
Portugal
Iraq
Burkina Faso
Indonesia
Senegal
China
Georgia
Saint Helena, Ascension And Tristan Da Cunha
Nicaragua
Libya
Guadeloupe
Bolivia
Albania
El Salvador
Gibraltar
Aland Islands
Andorra
Aruba
Hong Kong
Japan
Taiwan
Benin
Sudan
Belize
Bahamas
Antarctica
Oman
Nepal
Historically, trainee surgeons served as an apprentice to senior, learned, experienced surgeon. They would have consistency in learning – both parties getting the measure of one another. The trainer would know implicitly how competent an apprentice was, based on regular cooperation. Good habits (and bad) would be passed on from trainer to trainee, like surgical DNA.
The ‘surgical firm’ echoed these origins and lived on for many years. A relatively consistent team of consultant, registrar, house officer – working long hours but with continuity of care and (hopefully) esprit de corps could be an efficient and fulfilling training environment.
These models have been serially eroded to almost non-existence in the current era. One of the main drivers has been the EWTD and a move towards shift working. The drivers for working fewer hours have, in many instances, come from honourable motivations: safety, improving work-life-balance. However, the unintended consequences have perhaps been equally damaging. Med Twitter is awash with disillusioned surgeons who feel rudderless, under-trained, and a rather anonymous cog in a big machine, moving from rotation to rotation without direction.
Being a surgical trainer has also been rather undermined. The pressures on consultants from the NHS are often at odds with providing a high-quality training environment. The current government focus, post covid and in the midst of recession, is demonstrably not on training future surgeons.
No training today, no surgeons tomorrow. How can we improve matters? Some advocate a move back towards firm-based systems and a sensible relaxation of working hours rules. We must also acknowledge that being exposed to multiple different ways of working – and different consultants – can be hugely valuable. A longer-term surgical mentor, present over the course of training, might also help to imbue a sense of continuity and understanding of trainee-specific goals. And, of course, utilisation of technological training advancements that work - surgical simulation being a keystone example.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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eoSurgical has a proud record in deploying our simulators worldwide. Our whole project began – and continues – with the motivation to improve surgical skills and therefore improve patient safety. The growing evidence base for eoSim is testament to the impact that surgical simulation can have.
Our modus operandi is pragmatic. We work hard to distil down the core elements of laparoscopic simulation such that learning is accelerated in a cost-effective and accessible way. We want everyone to have access to good surgical simulation.
Last month, it was therefore pleasing to see our simulators in use in Nepal. They were used for the surgical skills component of the 4th Royal College of Surgeons of Edinburgh / HExN (Health Exchange Nepal) Laparoscopic Surgery Course in both Kathmandu and Pokhara.
eoSim provides automated instrument movement metrics (SurgTrac) that can help individuals target specific areas for improvement. One trainee said:
"I never got such a chance before to practise in this way, and with feedback."
All of this is feasible with a portable and affordable eoSim box, eoSurgical software, and a smartphone/tablet. There is no need for expensive infrastructure, consumables, or VR/AR technology and this is key to global accessibility.
An eoSim simulator is also now at home in the United Mission Hospital, Tansen. If regional surgeons here can deliver laparoscopic operations, with a shorter recovery time, it can bring huge benefits to the local population – many of whom are subsistence farmers.
Please get in touch if you would like to know more or collaborate.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Surgery demands commitment, training, determination, and the ability to overcome challenges. These demands are in common with some of those required to row across the Atlantic Ocean! This is why eoSurgical.com is offering support to five oarsmen who are planning to compete in the Talisker Whisky Atlantic Challenge this winter – a gruelling trans-ocean rowing race.
The founders of eoSurgical have their own connections with rowing and the coastal rowing club for which these five train. The team, Atlantic Body and Soul, must row across the Atlantic starting from La Gomera, just off the west coast of Africa, and finishing in Antigua. They will be racing ~40 other crews, rowing 24/7 in shifts. The task requires massive commitment simply to get to the start line:
- Acquiring a suitable ocean-going rowing boat
- Clocking up hours to familiarise themselves with life aboard and navigation
- Preparing for the physical challenge of rowing for two hours, sleeping for two hours – repeatedly - for the ~40 days of the race
- Fundraising for their chosen charities (Body & Soul and The Junction)
- Preparing for the psychological demand and isolation that come with crossing an Ocean unsupported.
Such a challenge mirrors, in some ways, the pathway of surgical training or, in microcosm, those required for a big surgical case. The assessment and work-up, a team approach to clarifying the best approach, ensuring all logistic elements are in place, preparing oneself to perform – and then performing the operation as best as possible.
The team is now firmly on track to get to the start in good shape – with racing starting in just under 100 days. We’re delighted to help them on their way and will keep tabs on them after the race begins.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
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It is one thing to have the surgical simulation tools available - but quite another to ensure their continued use. eoSurgical simulators have been the subject of extensive research assessing and confirming the utility of surgical simulation as a means of improving performance. One model for use is the self-motivated trainee or surgeon – someone who is independently driven to improve skills. Another model is the incorporation of take-home simulation into training programmes.
Scotland is at the forefront of exploring how to embed incentivised take-home laparoscopic practise into training. Here, we look at the Scottish Surgical Simulation Collaborative’s latest findings. The group, led by Prof Walker, has been exploring the issue for several years, iteratively working to improve the impact of simulation within surgical training.
In a prior study, engagement with a take-home simulation platform had been somewhat limited. Reasons cited by trainees included a lack of appreciation of the evidence base for simulation, a desire for individualised human feedback, and a perceived need to focus instead on ‘point scoring’ tasks that would enable downstream career progression. The latest work, published here, assessed the engagement of three subsequent years of new-start Core Surgical Trainees (147 trainees in total) - after making changes to the program. These changes were informed by prior local feedback and broader literature review.
All trainees were again loaned portable take-home simulators (eoSim). This time, all attended a Surgical Bootcamp prior to being issued with their simulator. The learning cycle was modified, with distributed practice punctuated by regular formative assessments and also enhanced faculty engagement. Importantly, completing the program and achieving a pass (via an OSATS task) was expected but not mandatory for progression through training. Pass rates ranged from 70-94% across the most recent three years, much improved compared with 26% in an earlier iteration of the programme.
The key message here is that merely providing good simulators (with curricula, performance metrics, and support) is not in itself adequate. To optimise engagement and impact, a broader program is required (see infographic above from their paper) with motivated learners, motivated trainers, periodic feedback, clear goals, and benchmarking.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Walker KG et al. Scotland's “Incentivised Laparoscopy Practice” programme: Engaging trainees with take-home laparoscopy simulation, The Surgeon, 2022. ePub
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The metaverse describes a graphically rich virtual space where humans can interact. The idea is not new but its manifestation is contingent upon the evolution of multiple technological strands.
High speed internet is fundamental, providing ubiquitous connectivity which transcends geographical boundaries. Tools that allow people to interface meaningfully with the metaverse are also key. Initial internet interactions were limited to typing commands via a keyboard. The mouse, touchscreen technology, and more contemporary gesture interface tools are improvements.
The output from the metaverse is currently a key rate-limiting factor. Receiving realistic haptic feedback and moving from 2D to 3D visual feedback is a crucial to achieving any degree of verisimilitude with the real world. Gaming leads the way in many senses here, providing immersive interactive online 3D arenas. Virtual reality platforms are yet to fulfil their promise but will be a key aspect of the metaverse.
Whilst it will take time for the concept to mature, it is worth considering surgical applications now. The conflict in Ukraine highlighted how even the relatively crude interactions afforded by Zoom (a metaverse prelude technology) could help local surgeons respond to the challenges of the war. Medicine sans Frontier do similar, using online teleconferencing for training, supervision, and consultations. The fidelity of these platforms will be enhanced as the metaverse matures. Growing centralisation of subspecialty practise means some trainees are not exposed to certain cases. Telemedicine and downstream metaverse iterations could allow units to cooperate and remove this barrier. For example, Proximie combines AI, machine learning, and augmented reality to allow distant clinicians to interact during a live surgical procedure or assessment. Particularly relevant to surgery is how surgical robots will interface with the metaverse. There are already examples of surgeons in distant locations controlling surgical robots to perform procedures, including the placement of a deep brain stimulation electrode for Parkinson’s disease.
Humans evolved in the context of face to face interactions and human touch - and it is hard to contemplate a future without this. However, we already exist in a hybrid reality. Development of the metaverse will change our day to day reality as well as surgical training and surgical delivery.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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It is unnerving as a surgeon to recognise that half the surgical workforce is, statistically speaking, below average. No surgeon would like to think they fall into this half and the overwhelming majority do everything they can to perform well. As a patient, it is more unnerving yet, to think that you might be operated on by someone ‘below average’.
Of course, it’s not as simple as this. By what measure do we reasonably assess a surgeon’s performance? It is not straight forward. Outcome measures in medicine and surgery are various: some are more meaningful than others and the context hugely affects which ones.
“Make the important measurable, not the measurable important.”
Consider the outcome measure of gross tumour resection. More is better, one might reasonable think. But this is not necessarily the case. A targeted debulk that achieves the aims of decompressing a critical structure, brings the patient minimum risk and maximum symptomatic benefit, is clearly the sensible and preferable option for someone in their 80s, with a relatively short life expectancy. This may be quite different for a young adult, where maximal resection of tumour brings potential lifelong benefits. The risk/benefit analysis is different and personalised. Such decisions are commonplace in surgery. Making the right call is rarely straightforward. People vary in terms of physiology, outlook, expectations, risk appetite, and more. For a surgical plan to not cater for this nuance means defeat from the outset, almost regardless of how technical proficient and complication-free an operation may be.
All of this said, if we actually could hypothetically distil all useful surgical outcome measures, we would yet be left with the unarguably fact that half of surgeons will be below average. Some might be better communicators, some might be better technicians, some might cope better or worse under pressure. But half would still be – overall – below average.
The answer to this issue is very simple. Reduce variation and increase mean level of performance. If variability is reduced and, on average, we all perform better – there will be improved outcomes for patients. Tools and training and mentoring and coaching and honest audit of outcomes – all are ways of driving performance in the right direction. At eoSurgical, we consider our simulation tools to be one cog in this machine of ongoing global health improvement.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Cover Photo by Jess Bailey on Unsplash
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eoSurgical is driven by innovation underpinned by evidence. We have a track record in publishing and presenting evidence highlighting the efficacy of our simulators. More objective yet, many independent studies using our hardware and software continue to illustrate efficacy in a number of different domains and surgical subspecialties.
We have recently explored a new angle as regards box simulator use: the impact of non-technical stressors (visual and auditory) on simulated laparoscopic task performance among surgeons and Students.
Surgical training emphasizes technical competence and eoSim is designed to improve relevant skills in a risk-free, controlled environment. However, non-technical skills are also significant in determining performance. Surgeons need to be aware how their performance is affected by pressure or distraction, for example.
Our recent study assessed the impact of novel auditory and visual stressors on performance during a simulated laparoscopic task. We have now developed NOTSS modules that can overlay these stressors within SurgTrac during training.
- A visual distraction overlay (progressive red saturation of the surgical field, timing personalized to the user's index performance)
- An auditory distraction overlay (typical operating theatre environmental noise).
We found that the impact of visual and auditory distraction on surgical performance can be modelled in our laparoscopic simulation environment and the effect of distraction varies according to expertise. eoSim may therefore become an effective setting within which to learn to mitigate stress-induced diminution in performance; an important skill to take to the real operating theatre. Read more here.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Hughes MA, Swan L, Taylor CL, Ilin R, Partridge R, Brennan PM. The Impact of Novel Nontechnical Stressors (Visual and Auditory) on Simulated Laparoscopic Task Performance Among Surgeons and Students. J Laparoendosc Adv Surg Tech A. 2022 Feb;32(2):189-196.
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Alain de Botton, philosopher and author, suggests:
“A firm belief in the necessary misery of life was for centuries one of mankind’s most important assets, a bulwark against bitterness, a defence against dashed hopes – and yet one cruelly undermined by the expectations incubated by the modern world view.” *
More and more, there is an expectation that work ought to make us happy. This modern view is certainly appealing, though the former may seem more appropriate for some NHS surgical trainees facing unstaffed rotas and covid-related disruption to training!
Most previous civilisations considered work a necessary practical burden. The first hint of a more positive outlook came from the Renaissance. It was suggested that work could, in fact, be a route towards authenticity and fulfilment – especially amongst the great artists and thinkers.
This idea that work could not only deliver necessary remuneration, but also provide stimulation and self-expression, evolved over the coming centuries. The subsequent vision of a meritocracy – where talent and effort replace unfair privilege – took us further. But have we gone too far? Fulfilment comes with many jobs – healthcare arguably more than most – but do we expect too much from work, based on unfair preconceptions and pretensions?
The economic imperatives that govern healthcare vary wildly according to the delivery system and wealth of a nation or individual. The NHS is cash-strapped and always will be (with occasional subtle fiscal oscillations). Whilst profit is not a motive, squeezing every last drop from the system (especially its workforce) is a constant. This sometimes makes the work hard and tiring - and possibly out of sync with some modern expectations of how work should be.
So perhaps we should realign our expectations a little. Working for safer systems, safer staffing levels, and safer training remains crucial. However, a mindset where we do not expect work to reliably generate happiness may well be a wise adaptation. Work’s rewarding aspects, including those unique to surgery, would only be heightened.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Cover Photo by Christian Erfurt on Unsplash
In the UK, and probably worldwide, surgeons are not being trained as they were pre-pandemic. The cancellation and resultant backlog of elective surgery has decimated training opportunities across subspecialties. Currently, some patients are being listed for procedures on a waiting list that simply doesn’t move.
Restoring and enhancing surgical training is critical to the future workforce. We are now entering a third year of the pandemic. There are trainees entering middle years of registrar training who have experienced only the slim pickings of restricted elective operating, watered down further by redeployment away from surgery. Trainee logbooks comparing 2019 with 2020 show a 50% reduction in operations with the trainee as the primary surgeon.
Senior trainees, in need of fine tuning and complex procedural experience, are no less impacted. The issue extends beyond technical skills: all trainees are less exposed to patient assessment and decision-making in the outpatient department, on the ward, and within the MDT. Among more senior trainees, 12% of those nearing the end of training were officially recognised as “delayed due to covid-19” in their latest annual review of competency progression.
The impact will be felt at the consultant level sooner than many appreciate. The system relies upon a balance between perpetual revitalisation of personnel from below, in combination with pre-existing seasoned wisdom and experience.
Catching up
There is a glimmer of hope in that we may be transitioning towards a situation of living with and tolerating covid, enabled by the mitigation strategy of vaccination. The substantial backlog of operations represents a training opportunity that must not be lost (for example by farming out procedures to a private sector devoid of trainees). Individualised trainee trajectories, expanding high quality e-learning, and enhancing simulation are all needed in addition.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Surgeons, amongst doctors in general, sometimes distance themselves from patients. This engineered distance is partly pragmatic. Distance from the human with the disease may allow a clear head for executing the necessary procedure on the disease.
It is perhaps also protective, for when things do not go well. French surgeon René Leriche is often quoted: “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.” Such reflection is hard – and harder yet without some distance.
Other facets of contemporary medicine drive depersonalisation in different ways. Biomedical mechanistic approaches and evidence based medicine pay little heed to the emotional and moral aspects of the patient:doctor relationship. Telemedicine, the utility of which has rightly exploded in pandemic times, has (quite literally) enforced a greater distance between the patient and surgeon.
In this environment, how do we try to enhance empathy? David Jeffrey, a palliative medicine doctor here in Edinburgh, suggests we look back to Shakespeare.
Shakespeare’s works are compelling because of his empathy. Human relationships are essentially unchanged from Shakespeare’s time, whilst the stage upon which they play out has changed. He existed in a world not yet complicated by the Scientific, Industrial, and Digital Revolutions. Looking back at his fundamental portrayals of human interaction may help us to be more empathic surgeons today.
Jeffrey writes: “Human relationships are constrained by the inaccessibility of other minds, any conclusions about another’s mind must rely on human interpretation. Shakespeare’s defining gift is his empathic approach: each of his characters speaks in their own voice, generating a narrative composed of multiple individual perspectives, while suppressing his own ego.” This sounds like a good starting point for a surgical consultation.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
* Jeffrey DI. Shakespeare's empathy: enhancing connection in the patient-doctor relationship in times of crisis. J R Soc Med. 2021 Apr;114(4):178-181.
The 2021 UN Climate Change Conference (COP 26) took place just 50 miles west of eoSurgical HQ in Edinburgh. Acting to avert the impending climate change disaster is going to take a combination of political, industrial, societal, and personal change – all well as yet unseen innovation.
When it comes to climate impact, health care delivery has not been scrutinised enough. Countries or companies contributing to carbon emissions and climate change are frequently named and shamed. If global healthcare were a country, it would be the fifth biggest contributor worldwide. As with so many inequitable aspects of life, it is the richer countries enjoying the luxury of high-quality healthcare, that are particularly culpable in terms of planetary harm. The National Health Service in the UK, of which we are so rightly proud, is responsible for over a third of the UK’s public sector carbon emissions. Amongst specialties, surgery is disproportionately guilty.
There is an urgent need to seek ways to reduce waste, to return to reusable instruments whenever possible, and to reduce packaging. Some of these changes will need to come from the industries who support healthcare and surgeons, as customers, can help to drive this change. 10% of carbon emissions generated by NHS activity are due to staff commute and patient and visitor travel. Telemedicine that became a pandemic-driven necessity ought, arguably, become the default in any setting where it is safe.
Here at eoSurgical.com, we continue to try our best to reduce our impact. Our packaging is, in large part, an immediate recycling of upstream suppliers’ packaging. It is fully recyclable after our customers unpack their simulator. We have eliminated all plastic foam, have opted for paper tapes to further reduce plastic use, and offset carbon emissions generated by our delivery partners. Prior to the pandemic, we moved the majority of company work to an online setting and therefore stopped the need to heat and maintain an office. At the time we felt innovative, though the pandemic has now made this model the norm for many companies! We will continue to try to do better, as must all those involved in healthcare.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Being a surgeon can be deeply rewarding. That reward is intimately connected with patient outcome: an operation completed without complication, a complete tumour resection, the restoration of function, the preservation of life. And the reward is enhanced when a patient expresses gratitude. No doubt, plenty of us keep a few thank you letters in the drawer to read on the days and nights when things go less than perfectly. Sometimes, however, that gratitude can feel a little awkward and maybe we sometimes underplay it.
Giskin Day performs research regarding gratitude and the 'gratitudinal encounter'. She writes:
"Surgeons may see their self-effacing refusal of gratitude as a rare opportunity to counter their reputation as confident, commanding, self-assured operators".
I think she is right. "It's just my job, I'm just a part of the team", are phrases used to 'minimise thanks'. I've used them myself and heard other surgeons do the same.
Interestingly, this may not be the right approach. She continues: "The true sign of humility is the recognition that the patient's need to express gratitude may be greater than the surgeon's need to hear it." She advocates a more positive outlook, arguing that if gratitude is 'seen' and acknowledged, rather than downplayed, it is likely to benefit the subjective well-being of everyone in the encounter.
Surgeons' mental health can be brittle, burnout is a real issue, and cynicism is easy to let in as the years go by. Maybe, therefore, we should all try to acknowledge gratitude better. These ideas are not limited to the patient: surgeon relationship. Staff feeling undervalued by other colleagues compounds unhappiness. Gratitude is a key part of a supportive culture and something that we can all share. At the end of the next theatre list, a quick expression of gratitude may well improve the whole team's wellbeing - including your own.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Cover photo by Nathan Dumlao on Unsplash
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As jobbing surgeons working in the NHS, the founders of eoSurgical are entirely familiar with the impact of financial constraints on healthcare delivery. The UK spends heavily on health and social care: over £200 billion in 2020/21. However, as prophesied by the founder of the NHS, Aneurin Bevan, there is almost unquenchable demand.
Covid has added insult to injury and the NHS feels perpetually at breaking point. That this is the situation for the UK, with the fifth largest worldwide economy (as measured by GDP), shows how hard it is to get healthcare right. The UK is rightly proud of its NHS and, whilst imperfect, it is envied by many.
Less economically developed regions face a harder battle. As some nations’ economies improve, they may transition from fragile health infrastructure to more robust, potentially universal, systems. In situations of severe healthcare rationing, it can seem that a surgical service is a luxury that ought to be funded after, for example, oral rehydration therapy and vaccines. This is simply not the case.
The World Bank’s recent economic evaluation of surgery (Disease Control Priorities, 3rd edition) illustrated that establishing capacity for 44 essential surgical procedures is as life-saving and cost effective as some of the most fundamental public health interventions. Surgery is an indivisible component of good healthcare.
eoSurgical simulation tools are used globally – in over 80 different countries with varying degrees of economic development. We began – and remain – committed to accessibility, as part of the ongoing drive to ensure global access to high quality surgical care.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
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Non-Technical Skills for Surgeons (NOTSS) are fundamental to safe patient care. Implementation of NOTSS- training has been shown to lead to safer and more effective surgical care*. All three directors at eoSurgical are Fellows of Royal College of Surgeons or Edinburgh (RCSEd) and work in busy NHS organisations. The RCSEd continues to take the lead when it comes to NOTSS – building a taxonomy and training system and raising awareness. Four categories of surgeons' non-technical skills have been defined: situation awareness, decision making, communication & teamwork, and leadership. The RCSEd has developed two online learning objectives:
NOTSS in a Box (for senior trainees and consultants)
NOTSS for Trainees (for early stage trainees).
What has not existed, until now, is an application of NOTSS to technique-centric simulators. A critical aspect of a surgeon’s non-technical skillset is to ensure that their performance remains unaffected by pressure and distraction. Stressful stimuli originating from the operating environment severely impact a surgeon’s workflow and technical proficiency. We have therefore developed NOTSS-inspired overlay modules that aim to recapitulate visual and auditory pressure during surgery.
Visual distraction, in the form of fade-to-red obscuration of the surgical field, can now be programmed. The rate of ‘red-out’ of the surgical field can be personalised to increase/decrease pressure. Auditory stress is generated by turning on a soundtrack (consisting of varying rate heart rate monitor, background noise from operating machinery, work-unrelated conversations, and a ringing telephone).
We have shown (manuscript in preparation) that these overlays have an impact upon surgeon performance. Trainee performance worsened in conditions of distraction (auditory or visual) whereas seasoned consultants maintained their performance better. We hypothesise that simulated training in the context of distraction and pressure will help trainees to maintain their performance levels better in real world situations.
These modules are now available as part of SurgTrac, our comprehensive curriculum of laparoscopic tasks. If you would like to know more, or have more NOTSS-related ideas, please get in touch.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
* Crossley J, Marriott J, Purdie H & Beard JD (2011). Prospective observational study to evaluate NOTSS (Non-Technical Skills for Surgeons) for assessing trainees’ non-technical performance in the operating theatre. British Journal of Surgery. 98, 1010-1020.
]]>Within Plastic and reconstructive surgery, there are contemporary examples of surgeons moving into or combining both worlds. Lisa Sacks is both an established plastic surgeon and recognised sculptor. Donald Sammut uses art as part of his assessment and planning: drawing detailed illustrations pre and post-op.
Neri Oxman explodes this interface in ways that are hard to fully comprehend. She began medical school (and was initially committed to becoming a surgeon) but after two years changed to study architecture. She now works as a designer and professor at the MIT Media Lab. Her artistic and architectural projects combine biology, design, computing, and materials engineering.
The Mediated Matter Group at MIT that she founded pioneers a new field called Material Ecology. This merges technology and biology in an effort to achieve ecological sustainability.
Synthetic Apiary: an engineered collaboration between a 3D printed structural shell and honey bees.
Oxman’s philosophy includes, in her own words, a “shift from consuming nature as a geological resource to editing it as a biological one.” She uses multi-scale biological shapes, includes living components in fabrication processes, and advocates that engineering, design, and art ought to be more actively connected.
There is a tangible overlap between her approach and the day to day task of surgeons. Whilst surgeons intervene on a much more limited temporal and spatial scale, we too edit out pathology and rely on biological fabrication (healing) in order to be effective. Perhaps a surgical mindset still influences in her work – and perhaps we can innovate and inspire reciprocally.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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Becoming a good surgeon relies upon many and diverse skills. Being able to establish a therapeutic relationship, take a thorough history, integrate examination and diagnostic test findings, knowing what can and cannot be achieved with a scalpel, the potential risks of surgery, and being able to articulate all of this in a bespoke, patient-centred and a collaborative way is no easy task. And that comes before one even enters the operating theatre.
Once the decision to proceed to surgery has been made, however, the skillset changes somewhat. Surgical skills are paramount, as is an in-depth surgical anatomical knowledge. Current trainees and surgeons are fortunate, therefore, to have access to a remarkable array of digital anatomical resources. Here, we briefly describe a selection of free resources.
Henry Gray’s anatomy was first published in 1848 but it remains an evergreen resource. It can be accessed online in digital form here. The historic illustrations remain hugely instructive.
Radiopedia.org is a rapidly growing online radiologist-built educational resource. It is becoming ever more comprehensive and provides excellent pathology-specific cases that allow correlation with the relevant imaging findings. They are committed to keeping it free which means a few (tolerable) in-built adverts.
For the neurosurgeons out there, The Neurosurgical Atlas is a must-know online resource. This comprehensive resource will serve you well from student right through to seasoned consultant. Resources include 3D rendered, manipulatable anatomical models, detailed surgical approaches, and a huge library of talks/webinars covering the full breadth of neurosurgery.
For members of the Royal College of Surgeons of Edinburgh, a number of online learning resources are available. Among them is online access to Acland anatomy. This comprehensive platform includes narrated videos describing real anatomical specimens, high quality rendered dissection specimens, and the capacity to build complex anatomical structures in digital form.
Touch Surgery began by developing visual representations of surgical procedures, though they have since broadened their outlook. They continue to provide a free app (for smartphone and tablet) which includes stepwise, procedural simulations of operations. All sub-specialties are catered for and the anatomical rendering is high quality.
These are just a few of the myriad online resources available, which will surely expand as technology advances.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
Cover Photo by Glenn Carstens-Peters on Unsplash
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The pandemic has forced numerous and varied adaptations in how we live and work as surgeons. Some involve long overdue improvements in digital technology. In the NHS for instance, telemedicine has been made feasible across the board, together with reliable access to virtual desktops that enable some work from home.
Other enforced changes have been much less welcome for patients and surgeons alike. The largely necessary cuts in elective operating meant fewer training opportunities – starkly visible on trainee logbooks. Now, however, a massive backlog must be faced. These operating lists must take place with trainee involvement and not simply be outsourced to a training-unfriendly private sector. Hopefully this can promote longer term involvement of trainees in waiting list initiatives and outsourced lists.
The conference merry-go-round has also had to change. At first, conferences were cancelled and then, later in the pandemic, online iterations became standard. Some have achieved great success. The environmental benefits and convenience of avoiding in-person attendance have been welcomed by many. Whilst F2F networking is a valuable aspect of some meetings, a hybrid model that facilitates remote attendance must surely become the norm. It is likely that future in-person events will also need to raise the bar to attract attendance. For surgeons, this might involve enhanced tangible experiences. For example, testing new surgical technology or practising specific simulated skills. Even skills training, however, can cross into the digital world.
eoSurgical essentially represents an online MIS skills environment, allowing flexible and personalised skills development at a distance. This has clearly been valued peri-pandemic as more and more deaneries incorporate our platform into their training. Online surgical MSc programs are also moving away from purely theoretical knowledge to begin to incorporate skills training and we are proud to be involved. This change is likely to persist and become an embedded component of training curricula.
There are, therefore, several reasons to be positive - the enforced changes we have all faced are likely to leave several residual benefits in their wake.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
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An oft quoted retort to purists seeking an evidence base for everything is whether a randomised controlled trial has ever been performed regarding the benefits of using a parachute, or not, when jumping from an aircraft. That trial, of course, will never happen (despite some larking around from the BMJ). On a similar, more pertinent, note we will also never conduct an RCT to see whether removing an extradural haematoma in a comatose patient works. The operation evidently saves lives.
Confirming the efficacy of surgical simulation is more complex. No one has yet done an RCT of being operated on by new-start surgeons - who have never had any simulation training - versus those surgeons who have. It is increasingly unlikely that such a trial would receive ethical approval, given an evidence ladder that grows more and more compelling.
Each rung is a logical continuation of the next:
Rung one
Rehearsal with a box simulator improves quantifiable performance metrics over time:
Johnston TJ, Tang B, Alijani A, Tait I, Steele RJ, Ker J, et al. Laparoscopic Surgical Skills are Significantly Improved by the Use of a Portable Laparoscopic Simulator: Results of a Randomized Controlled Trial. World J Surg. 2013 May;37(5):957–64.
Rung two
Improved skills in a simulator result in improved skills in theatre:
Dawe SR, Pena GN, Windsor JA, Broeders JA, Cregan PC, Hewett PJ, Maddern GJ. Systematic review of skills transfer after surgical simulation-based training. Br J Surg. 2014 Aug;101(9):1063-76. doi: 10.1002/bjs.9482.
Rung three
Procedures performed by surgeons with superior objectively measured minimally invasive technical skills have better patient-centred post-op outcomes:
Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013 Oct 9;369(15):1434–42.
In summary, rehearsing on a box simulator improves measurable metrics. Such improvements translate to improved intra-operative skills. Those with better skills have better outcomes. It is intuitively clear, but this evidence ladder helps to spell it out.
Mark Hughes
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Director, eoSurgical
Email: mark.hughes@eosurgical.com
Twitter: @eosurgical
https://www.ed.ac.uk/profile/dr-mark-hughes
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Cover photo by Scott Graham on Unsplash
]]>We began by routinely incorporating a webcam as part of the eoSim hardware, allowing connection to a desktop for visualisation. Then we enabled the option to use with a smartphone or tablet and its own in-built camera.
Now, informed by ever-better cameras and optics that come with the latest generation of smartphones, we have moved to the option of a purely mobile version. Using a smartphone or tablet with an eoSim provides the option of using its own screen directly – or of broadcasting the image to a separate monitor or device. We’ve included details about how this can be done below, and online.
Our software and curriculum is well-established on iOS and Android. Simply download the app to your phone, get hold of an eoSim, and start practising. It’s as simple as that.
An ever-growing evidence base and current use in over 80 countries is testament to the impact that this model of simulation training can have.