LATIN AMERICAN RESIDENTS’ SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA?

PANDEMIA DE COVID-19 E EDUCAÇÃO CIRÚRGICA DE RESIDENTES DA AMÉRICA LATINA. QUE ESTRATÉGIAS SURGIRAM PARA SE ADAPTAR A ESTA NOVA ERA?

ABSTRACT

BACKGROUND:  The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents’ surgical training and supervised clinical practice.

AIMS:  This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD:  A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world.

RESULTS:  In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested.

CONCLUSIONS:  Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

HEADINGS: COVID-19; SARS-CoV-2; Training Support; Surgical Procedures, Operative; Education

RESUMO

RACIONAL:  A pandemia de COVID-19 teve um efeito negativo na educação cirúrgica na América Latina, diminuindo o treinamento cirúrgico dos residentes e a prática clínica supervisionada.

OBJETIVOS:  Identificar estratégias que foram propostas ou implementadas para adaptar o treinamento cirúrgico e a prática clínica supervisionada às limitações relacionadas ao COVID-19 na América Latina.

MÉTODOS:  Foi realizada revisão de literatura entre abril-maio de 2021, dividida em duas buscas. O primeiro procurou identificar estratégias de adaptação em América Latina para treinamento cirúrgico e prática clínica supervisionada. A segunda foi realizada como complemento para identificar metodologias propostas no resto do mundo.

RESULTADOS:  Na primeira busca, foram selecionados 16 dos 715 artigos. Na segunda, foram selecionados 41 dos 1.637 artigos. Estratégias adaptativas propostas na América Latina com foco em videoconferência e simulação. No resto do mundo, foram sugeridas análises críticas remotas de cirurgias gravadas/ao vivo, tele-mentoria intra-cirúrgica e gravação de cirurgia com feedback pós-operatório.

CONCLUSÕES:  Múltiplas estratégias de adaptação para educação cirúrgica durante a pandemia de COVID-19 foram propostas na América Latina e no resto do mundo. Há uma oportunidade de implementar novas estratégias a longo prazo para treinamento cirúrgico e prática clínica supervisionada, embora mais estudos prospectivos sejam necessários para gerar recomendações baseadas em evidências.

DESCRITORES: COVID-19; SARS-CoV-2; Apoio ao Desenvolvimento de Recursos Humanos; Procedimentos Cirúrgicos Operatórios; Educação

INTRODUCTION

Since December 2019, SARS-CoV 2 virus (COVID-19) has infected more than 445 million people, causing at least 6 million deaths¹³. Latin America (LA) became an epicenter with 2,960 deaths per million people reported by March 23, 2022, which makes it the area with the highest COVID-19 mortality³,¹².

Studies from LA pointed out the need to suspend elective surgeries during COVID-19 outbreaks²⁹,³⁰, which caused a significant decrease in the total number of surgeries performed³⁵,⁴². Consequently, the number of surgeries performed by residents decreased by 56–90%²¹,²²,³⁰. On the other hand, there was a decrease in surgical education and training instances, with 61–83% of residents reporting a negative effect on their training²⁹,⁴⁷,⁶².

The effect of the pandemic on surgical education could be long-lasting, as surgical skills deteriorate when clinical practice is stopped⁵¹. For that reason, it is essential to describe how surgical training and supervised clinical practice have been adapted to minimize and prevent negative outcomes linked to this worldwide scenario.

The objective of this review was to identify which adaptation strategies have been used and proposed in LA to adapt surgical training and supervised clinical practice to COVID-19-related limitations. This review also aimed to identify which strategies have been used or proposed in the rest of the world.

METHODS

Search strategy

This review was conducted between April and May 2021. To find which strategies of surgical adaptation were implemented in LA and the rest of the world during COVID-19 pandemic, the following two research questions were made:

1. Which strategies have been proposed or implemented in LA surgical programs to adapt surgical training and supervised clinical practice to COVID-19-related restrictions?

2. Which strategies have been proposed or implemented in the rest of the world to adapt surgical programs, specifically surgical training and supervised clinical practice, to COVID-19-related restrictions?

For the first question, a search was conducted in OVID MEDLINE using the following search strategy: “(covid OR pandemic) AND (surgery OR surgical OR training OR resident OR residents OR residency)” filtered by the authors’ affiliation countries to include exclusively LA articles. The same terms translated to Spanish were searched in LILACS and Google Scholar: “(covid OR pandemia) AND (cirugía OR quirúrgico) NOT (españa OR español).” In all three databases, these terms were screened only in the article's title.

For the second question, a search was performed in three databases. First, the following search strategy was used in OVID MEDLINE: “(covid OR pandemic) AND (surgery OR surgical) AND (education OR training OR simulation OR residency OR resident OR program OR mentorship OR teaching OR learning).” Second, in Google Scholar, the following search strategy used was: “covid AND (surgery OR surgical) AND (education OR training OR simulation OR residency OR resident OR program OR mentorship OR teaching OR learning).” Lastly, in Trip Database, the following search strategy was used: “covid AND surgical AND (resident OR teaching OR learning).” These terms were screened in the article's title.

Inclusion and exclusion criteria

The inclusion criteria for the first search were as follows: articles published by LA authors focused on surgical training and supervised clinical practice adaptation strategies during the pandemic. There were no exclusion criteria. The inclusion criteria for the second search were as follows: articles that describe strategies to adapt surgical training and supervised clinical practice during the pandemic in countries outside LA. There were no exclusion criteria.

Study selection and data extraction

Two researchers independently screened the titles and abstracts of each record, applying the inclusion criteria. Once finished, their results were compared. Disagreements between the two reviewers were resolved by a third reviewer. Relevant information from included articles was transferred to data extraction forms, which included title, country, main ideas, quotes, and citations. Finally, a structured synthesis was carried out.

RESULTS

Search results

The first OVID MEDLINE search returned 206 results, of which 10 were selected. Of 111 results in LILACS, 9 were selected. Finally, in Google Scholar, out of 398, 15 more results were selected. In total, 34 articles fulfilled the inclusion criteria, but 18 were duplicates, resulting in 16 articles being analyzed (Figure 1).

Figure 1
Flow diagram of the first search.

The second search returned 294 results from OVID MEDLINE, out of which 21 were selected. From Trip Database, 3 results out of 896 were selected. Finally, 15 out of 426 articles from Google Scholar were chosen. A total of 39 articles fulfilled the inclusion criteria, but 13 were duplicates, resulting in 26 articles left to be analyzed. Next, 15 extra articles were included from articles’ references, leaving a total of 41 articles (Figure 2).

Figure 2
Flow diagram of the second search.

1. Which strategies have been proposed or implemented in LA surgical programs to adapt surgical training and supervised clinical practice to COVID-19-related restrictions?

Surgical training

Videoconferencing

Some centers expanded their activities with foreign institutions. Thanks to this implementation, a pediatric surgery program changed their in-person academic sessions to online presentations via “ZOOM,” allowing them to double the attendance and facilitating undergraduate and foreign students’ participation²⁰. Likewise, a vascular surgery training program involving 33 institutions from 13 countries was carried out via “ZOOM,”¹⁸ allowing participants to compare the incidence of vascular diseases and their management between different countries.

Simulation

Three studies reported an increase in simulated training in Argentinian⁴¹, Chilean⁹, and Mexican³⁵ programs. Simulated training was suggested as a strategy to adapt residency programs to the pandemic with the objective of improving surgical skills in a safe and standardized environment⁶¹. Residents from a Mexican hospital had more time to practice basic laparoscopic skills using portable, low-cost simulators³⁵, showing promising results⁵².

Another strategy proposed was simulated training with asynchronous feedback. In this case, the students record their simulation sessions and are subsequently evaluated by a tutor, who provides feedback through text, annotations, audios, or videos⁹,⁴⁸.

Surgery video recording

One Chilean study showed the use of “GoPro” cameras to record surgeries, but no additional details were given in regard to its implementation or effectiveness⁴⁶.

Supervised Clinical Practice

In relation to short-term adaptations, in a consensus study from Colombia, it was suggested to make the most out of each surgical case, allowing the simultaneous participation of several residents¹⁵.

In relation to long-term adaptations, the Colombian studies suggested reducing the number of newly admitted residents to offer adequate surgical exposure and adjust the programs for each resident individually, making rotations more flexible and making up for identified deficiencies⁶,¹⁵. On the other hand, Peruvian and Chilean studies raised the need to extend the duration of residence periods²⁸,³⁰.

• ^2.

  Which strategies have been proposed or implemented in the rest of the world to adapt surgical programs, specifically surgical training and supervised clinical practice, to COVID-19-related restrictions?

Surgical training

Online educational courses

One study reported the virtual platform “WebSurg” as useful, which is available in multiple languages. It publishes academic content from different surgical specialties having more than 4,000 videos available¹². There are other English platforms available, such as “Aischannel,” which facilitate taking online courses¹,⁴².

Simulation

Multiple options were reported regarding the manufacture of laparoscopic simulators, where homemade ones had a cost between US$4 and 300, while commercial ones between US$85 and 6,000¹⁴,³³,³⁸,³⁹,⁵⁶. Notably, 55% of home simulators were included in validated studies, compared to 92% of commercial ones. Due to the pandemic, videoconferencing platforms were used to carry out training sessions remotely⁴,¹⁰,¹¹, showing similar results to those achieved through in-person simulation¹⁰. Remote simulation programs with asynchronous feedback were also suggested, which were adapted to this methodology and demonstrated successful results⁵³.

Mobile Apps

Currently, there are multiple mobile applications available that have been designed to view and simulate surgical procedures. Different authors mentioned the usefulness of “Touch Surgery” as a complement to simulation during the pandemic¹⁶,²³,⁴². It includes simulation courses for 12 surgical specialties with more than 200 procedures and an evaluation component².

Surgical Video Analysis

It has been suggested as a complement to traditional learning⁸. Most residents of the surgical area use “YouTube” as the main platform to watch videos for prior preparation to surgical procedures⁴⁴,⁵⁰. Multiple alternatives are also available, which host high-quality videos whose technique has been reviewed, such as the American College of Surgeons Online Video Library, C Surgeries Surgical Video Journal, Journal of Medical Insight, Incision Academy, TeachMeSurgery, and Advances in Surgery¹⁷.

Live Surgery Analysis

It consists of live broadcasts of surgeries performed by expert surgeons, allowing residents to watch and interact remotely. For the implementation of this strategy, several authors described the use of “GoPro” cameras on the head of the first surgeon, in the operating room lights and/or endoscope cameras, and the installation of a Bluetooth speaker with a microphone, allowing the operating room personnel to participate in discussions via “ZOOM” or other videoconferencing apps⁷,³¹. An example of a platform useful for this strategy is “Proximie,” which also helps with the creation of a digital library of procedures performed, for subsequent review⁵⁸.

Supervised Clinical Practice

Intrasurgical tele-mentoring

It consists in the live transmission of a surgery performed by a resident, while an expert tutor observes it remotely and provides feedback in real time¹⁷,³⁴,⁴⁹.

Surgery recording for postoperative feedback

It consists in recording the performance of a resident during surgery, which is then evaluated by a tutor, identifying individualized goals and designing an action plan to achieve the proposed objectives. This strategy, which could be done in-person or remotely, is an emerging tool that has been shown to facilitate the acquisition of new skills and accelerate the learning curve²⁴,²⁶,²⁹,³⁴. “VISTA” is an example of a digital platform, which allows users to upload videos for analysis and commentaries by multiple tutors, who are trained to assess the performance and give feedback³⁶,⁵⁴.

DISCUSSION

Simulation

Simulation shows a simplified, but effective, reality when it comes to preserving the key aspects of the real scenario⁶⁰,⁶⁴. It allows the acquisition of surgical skills in several areas while avoiding the risk of damage to self and/or others⁶¹,⁶³,⁶⁴. Simulation is an effective strategy to improve surgical performance in surgical time, precision, mistakes, and postsurgical complications⁴³, so surgeons trained in this method are likely to show better results than surgeons trained in the classical method²⁵,⁵⁷. The acquired skills have been shown to be transferable to the operating room successfully⁵, resulting in an increase in the number and complexity of surgeries performed by residents. Furthermore, simulation has proven to be effective when it comes to preventing the deterioration of surgical skills due to a lack of training²⁷.

Currently, most of the simulation programs focus on skills for beginners, mainly the first-year residents³⁷. Its implementation does not intend to replace supervised clinical practice during the later stages of surgical residency¹⁵.

Simulated training with remote asynchronous digital feedback is an adaptation strategy to maintain simulation training despite the mobility and attendance restrictions due to COVID-19. In 2019, Quezada et al. adapted an advanced laparoscopic simulated training to a remote and asynchronous modality⁴⁸,⁵⁹, which has advantages such as reducing the time used by the instructor to perform the assessments, who can be found in remote geographic locations, and allowing the student to review their recordings and feedback as many times as they want²⁷,⁴⁸. This modality has shown to be as effective as simulated training programs with in-person feedback²⁵,³²,⁴⁸.

Surgical Video Analysis

As previously mentioned, YouTube is the most used platform to watch surgical videos. However, the quality of the available videos has been questioned⁴⁰, as dangerous safety violations have been found in multiple videos⁵². Therefore, it is important that surgical programs provide high-quality surgical videos if this teaching modality is one of their strategies.

Live Surgery Analysis

Live broadcast of surgeries by experts allows residents to actively participate in learning rather than passively watching recordings¹⁹. In their opinion, tutors reported that they felt the residents’ involvement in a more intimate way than in the operating room, encouraging more interaction and discussion¹⁹. Studies have shown that safety and complication rate of broadcasted procedures are similar when compared to conventional procedures, despite concerns of an increased risk linked to this new modality⁴⁵,⁵⁵.

Intrasurgical tele-mentoring and Surgery recording for postoperative feedback

Currently, there is no clear evidence that one method is superior to the other from a training point of view, and both have evidence that support their effectiveness, so its selection can be made according to its costs and difficulties at the time of implementation. On the one hand, tele-mentoring could be considered a better strategy for junior residents, since the tutor's synchronous feedback could increase patient safety. On the other hand, surgery recording for postoperative review and feedback could be useful in surgeries performed by senior residents.

LA versus the rest of the world

Between LA and the rest of the world, there were differences in terms of the adaptation strategies suggested, particularly supervised clinical practice. This could be an opportunity for LA to adopt strategies that have been suggested in the rest of the world.

Limitations

This study presents some limitations. Our searches only returned studies from some countries of LA such as Chile, Colombia, Brazil, Argentina, Peru, and México, which may not be representative of the rest of the continent. Regarding the rest of the world, the studies included came from the USA, Canada, the UK, Italy, Spain, Portugal, Germany, Hungary, New Zealand, Singapore, Hong Kong, and India. These may not be representative of the rest of the world.

CONCLUSION

Multiple strategies have been suggested to adapt surgical education to COVID-19-related restrictions, such as simulation with remote asynchronous feedback, live and recorded surgery analysis, intrasurgical tele-mentoring, and surgery recording for postoperative feedback. These strategies could be a useful complement to surgical education in the long term, beyond the pandemic. However, more prospective studies are required to determine which strategies deliver the best results and to generate evidence-based recommendations.

DISCLOSURES

Dr. Julian Varas is the founder of Training Competence, an official spinoff startup from the Pontificia Universidad Católica de Chile. Drs. María Inés Gaete and Francisca Belmar are consultants of this startup.

• Financial source: Nome
• Editorial Support: National Council for Scientific and Technological Development (CNPq).
• Central Message
  The effect of the pandemic on surgical education could be long-lasting, as surgical skills deteriorate when clinical practice is stopped. It is essential to describe how surgical training and supervised clinical practice have been adapted to minimize and prevent negative outcomes linked to this Latin America and worldwide scenario.
• Perspectives
  Multiple strategies have been suggested to adapt surgical education to COVID-19-related restrictions, such as simulation with remote asynchronous feedback, live and recorded surgery analysis, intrasurgical tele-mentoring, and surgery recording for postoperative feedback. These strategies could be a useful complement to surgical education in the long term, beyond the pandemic.

REFERENCES

• ¹ AIS Channel [Internet]. Available at: https://aischannel.com/ Accessed: Feb. 3, 2022.
  » https://aischannel.com/
• ² Arezzo A, Vignali A, Ammirati CA, Brodie R, Mintz Y. Is it possible to continue academic teaching in surgery during the COVID pandemic era? Minim Invasive Ther Allied Technol. 2020;31(4):487-95. https://doi.org/10.1080/13645706.2020.1845210
  » https://doi.org/10.1080/13645706.2020.1845210
• ³ Ashktorab H, Pizuomo A, González NAF, Villagrana EDC, Herrera-Solís ME, Cardenas G, et al. A comprehensive analysis of COVID-19 impact in Latin America. Res Sq. 2021;rs.3.rs-141245. https://doi.org/10.21203/rs.3.rs-141245/v1
  » https://doi.org/10.21203/rs.3.rs-141245/v1
• ⁴ Bachmann C, Paz Hernandez AL, Müller S, Khalatbarizamanpoor S, Tschiesche T, Reißmann F, et al. Digital teaching and learning of surgical skills (not only) during the pandemic: a report on a blended learning project. GMS J Med Educ. 2020;37(7):Doc68. https://doi.org/10.3205/zma001361
  » https://doi.org/10.3205/zma001361
• ⁵ Boza C, León F, Buckel E, Riquelme A, Crovari F, Martínez J, et al. Simulation-trained junior residents perform better than general surgeons on advanced laparoscopic cases. Surg Endosc. 2017;31(1):135-41. https://doi.org/10.1007/s00464-016-4942-6
  » https://doi.org/10.1007/s00464-016-4942-6
• ⁶ Cabrera-Vargas LF, Luna Jaspe C, Pedraza Ciro M. Adaptación de la residencia de Cirugía General en Colombia a la pandemia del COVID-19: programa de enseñanza quirúrgica virtual. Rev Colomb Cir. 2020;35(2):256-63. https://doi.org/10.30944/20117582.632
  » https://doi.org/10.30944/20117582.632
• ⁷ Chao TN, Frost AS, Newman JG. Interactive Virtual Surgical Education During COVID-19 and Beyond. Acad Med. 2020;95(11):e9. https://doi.org/10.1097/ACM.0000000000003609
  » https://doi.org/10.1097/ACM.0000000000003609
• ⁸ Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, et al. Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic. J Surg Educ. 2020;77(4):729-32. https://doi.org/10.1016/j.jsurg.2020.03.018
  » https://doi.org/10.1016/j.jsurg.2020.03.018
• ⁹ Cifuentes IJ, Dagnino BL, Pérez ME, Yañez RA, Varas J, Salisbury C. Entrenamiento microquirúrgico a distancia. Cir Plástica Ibero-Latinoam. 2018;44(4):409-15. https://doi.org/10.4321/S0376-78922018000400009
  » https://doi.org/10.4321/S0376-78922018000400009
• ¹⁰ Co M, Chu KM. Distant surgical teaching during COVID-19 - A pilot study on final year medical students [published online ahead of print, 2020 Jul 10]. Surg Pract. 2020;24(3):105-9. https://doi.org/10.1111/1744-1633.12436
  » https://doi.org/10.1111/1744-1633.12436
• ¹¹ Co M, Chung PH, Chu KM. Online teaching of basic surgical skills to medical students during the COVID-19 pandemic: a case-control study. Surg Today. 2021;51(8):1404-9. https://doi.org/10.1007/s00595-021-02229-1
  » https://doi.org/10.1007/s00595-021-02229-1
• ¹² COVID-19 Data Explorer [Internet]. Our World in Data. Available at: https://ourworldindata.org/coronavirus-data-explorer Accessed: Feb. 3, 2022.
  » https://ourworldindata.org/coronavirus-data-explorer
• ¹³ COVID-19 Map [Internet]. Johns Hopkins Coronavirus Resource Center. Available at: https://coronavirus.jhu.edu/map.html Accessed: Nov. 7. 2021.
  » https://coronavirus.jhu.edu/map.html
• ¹⁴ Das De S, Puhaindran ME, Sechachalam S, Wong KJH, Chong CW, Chin AYH. Sustaining a national surgical training programme during the COVID-19 pandemic. Bone Jt Open. 2020;1(5):98-102. https://doi.org/10.1302/2633-1462.15.BJO-2020-001924
  » https://doi.org/10.1302/2633-1462.15.BJO-2020-001924
• ¹⁵ Dominguez Torres LC, Torregrosa Almonacid L, Sánchez Maldonado W, Lasprilla N, Vargas Barato F, Niño Rodríguez ÁE, et al. Educación quirúrgica durante la Pandemia COVID-19: primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía. Rev Colomb Cir. 2020;35(3):363-72. https://doi.org/10.30944/20117582.739
  » https://doi.org/10.30944/20117582.739
• ¹⁶ Doulias T, Gallo G, Rubio-Perez I, Breukink SO, Hahnloser D. Doing more with less: surgical training in the COVID-19 era. J Invest Surg. 2022;35(1):171-9. https://doi.org/10.1080/08941939.2020.1824250
  » https://doi.org/10.1080/08941939.2020.1824250
• ¹⁷ Erridge S, Yeung DKT, Patel HRH, Purkayastha S. Telementoring of surgeons: a systematic review. Surg Innov. 2019;26(1):95-111. https://doi.org/10.1177/1553350618813250
  » https://doi.org/10.1177/1553350618813250
• ¹⁸ Fabiani MA, Gonzalez-Urquijo M, Cassagne G, Dominguez A, Hinoja-Gonzales DE, Lozano-Balderas G, et al. Thirty-three vascular residency programs among 13 countries joining forces to improve surgical education in times of COVID-19: a survey-based assessment. Vascular. 2022;30(1):146-50. https://doi.org/10.1177/1708538121991268
  » https://doi.org/10.1177/1708538121991268
• ¹⁹ Faiz T, Marar O, Kamel MK, Vance S. Teaching operative surgery to medical students using live streaming during COVID-19 pandemic. Surg Innov. 2021;28(2):253-4. https://doi.org/10.1177/1553350620967242
  » https://doi.org/10.1177/1553350620967242
• ²⁰ Figueroa-Gutiérrez LM, Franco-Agredo O, Palta-Uribe DA, Dueñas-Ramírez JC, Solarte-Henao JA, Marín-Giraldo AF, et al. Estrategias de educación en un programa de formación en cirugía pediátrica, como respuesta a la pandemia COVID-19. Rev Colomb Cir. 2020;35(4):553-7. https://doi.org/10.30944/20117582.780
  » https://doi.org/10.30944/20117582.780
• ²¹ Gorgen ARH, Diaz JO, Silva AGT, Paludo A, Oliveira RT, Tavares PM, et al. The impact of COVID-19 pandemic in urology practice, assistance and residency training in a tertiary referral center in Brazil. Int Braz J Urol. 2021;47(5):1042-9. https://doi.org/10.1590/S1677-5538.IBJU.2020.0761
  » https://doi.org/10.1590/S1677-5538.IBJU.2020.0761
• ²² Gutiérrez Ochoa JA, Vidrio Duarte R, Sánchez Mejía JC, Solís Rojas C, Vidrio Duarte E, Sánchez Sánchez R, et al. Impacto de la pandemia por SARS-CoV-2 en la residencia de cirugía general en el Hospital General de México. Cir Gen. 2020;42(2):165-9. https://doi.org/10.35366/95376
  » https://doi.org/10.35366/95376
• ²³ Hamidian Jahromi A, Arnautovic A, Konofaos P. Impact of the COVID-19 pandemic on the education of plastic surgery trainees in the United States. JMIR Med Educ. 2020;6(2):e22045. https://doi.org/10.2196/22045
  » https://doi.org/10.2196/22045
• ²⁴ Harrysson IJ, Cook J, Sirimanna P, Feldman LS, Darzi A, Aggarwal R. Systematic review of learning curves for minimally invasive abdominal surgery: a review of the methodology of data collection, depiction of outcomes, and statistical analysis. Ann Surg. 2014;260(1):37-45. https://doi.org/10.1097/SLA.0000000000000596
  » https://doi.org/10.1097/SLA.0000000000000596
• ²⁵ Hasan O, Ayaz A, Jessar M, Docherty C, Hashmi P. The need for simulation in surgical education in developing countries. The wind of change. Review article. J Pak Med Assoc. 2019;69(Suppl 1)(1):S62-8. PMID: 30697022.
• ²⁶ Hau HM, Weitz J, Bork U. Impact of the COVID-19 pandemic on student and resident teaching and training in surgical oncology. J Clin Med. 2020;9(11):3431.https://doi.org/10.3390/jcm9113431
  » https://doi.org/10.3390/jcm9113431
• ²⁷ Higgins M, Madan C, Patel R. Development and decay of procedural skills in surgery: A systematic review of the effectiveness of simulation-based medical education interventions. Surgeon. 2021;19(4):e67-e77. https://doi.org/10.1016/j.surge.2020.07.013
  » https://doi.org/10.1016/j.surge.2020.07.013
• ²⁸ Huamanchumo-Suyon ME, Urrunaga-Pastor D, Ruiz-Perez PJ, Rodrigo-Gallardo PK, Toro-Huamanchumo CJ. Impact of the COVID-19 pandemic on general surgery residency program in Peru: A cross-sectional study. Ann Med Surg (Lond). 2020;60:130-4. https://doi.org/10.1016/j.amsu.2020.10.031
  » https://doi.org/10.1016/j.amsu.2020.10.031
• ²⁹ Ibrahim AM, Varban OA, Dimick JB. Novel uses of video to accelerate the surgical learning curve. J Laparoendosc Adv Surg Tech A. 2016;26(4):240-2. https://doi.org/10.1089/lap.2016.0100
  » https://doi.org/10.1089/lap.2016.0100
• ³⁰ Inzunza M, Besser N, Bellolio F. Decrease in operative volume in general surgery residents in Chile: effects of the COVID-19 pandemic. Br J Surg. 2021;108(6):e226-7. https://doi.org/10.1093/bjs/znab082
  » https://doi.org/10.1093/bjs/znab082
• ³¹ Jack MM, Gattozzi DA, Camarata PJ, Shah KJ. Live-streaming surgery for medical student education – educational solutions in neurosurgery during the COVID-19 pandemic. J Surg Educ. 2021;78(1):99-103. https://doi.org/10.1016/j.jsurg.2020.07.005
  » https://doi.org/10.1016/j.jsurg.2020.07.005
• ³² Jarry Trujillo C, Achurra Tirado P, Escalona Vivas G, Crovari Eulufi F, Varas Cohen J. Surgical training during COVID-19: a validated solution to keep on practicing. Br J Surg. 2020;107(11):e468-9. https://doi.org/10.1002/bjs.11923
  » https://doi.org/10.1002/bjs.11923
• ³³ Jetpack. 3-Dmed. Medical simulation training equipment 3-Dmed. [Internet]. Available at: https://www.3-dmed.com/about/shop/ Accessed: Feb. 3, 2022.
  » https://www.3-dmed.com/about/shop/
• ³⁴ Joos E, Zivkovic I, Shariff F. Virtual learning in global surgery: current strategies and adaptation for the COVID-19 pandemic. Int J Surg Glob Health. 2021;4(1):e42-e42. https://doi.org/10.1097/GH9.0000000000000042
  » https://doi.org/10.1097/GH9.0000000000000042
• ³⁵ Juanz-González A, Barreras-Espinoza JA, Soualhi A, Leyva-Moraga E, Leyva-Moraga FA, Leyva-Moraga F, et al. COVID-19: an opportunity to restructure surgical education. Eur Surg. 2020;52(5):243-4. https://doi.org/10.1007/s10353-020-00651-2
  » https://doi.org/10.1007/s10353-020-00651-2
• ³⁶ Kogan M, Klein SE, Hannon CP, Nolte MT. Orthopaedic education during the covid-19 pandemic. J Am Acad Orthop Surg. 2020;28(1):e456-54. https://doi.org/10.5435/JAAOS-D-20-00292
  » https://doi.org/10.5435/JAAOS-D-20-00292
• ³⁷ Kurashima Y, Hirano S. Systematic review of the implementation of simulation training in surgical residency curriculum. Surg Today. 2017;47(7):777-82. https://doi.org/10.1007/s00595-016-1455-9
  » https://doi.org/10.1007/s00595-016-1455-9
• ³⁸ Kwon YS, Tabakin AL, Patel HV, Backstrand JR, Jang TL, Kim IY, et al. Adapting urology residency training in the COVID-19 era. Urology. 2020;141:15-9. https://doi.org/10.1016/j.urology.2020.04.065
  » https://doi.org/10.1016/j.urology.2020.04.065
• ³⁹ Li MM, George J. A systematic review of low-cost laparoscopic simulators. Surg Endosc. 2017;31(1):38-48. https://doi.org/10.1007/s00464-016-4953-3
  » https://doi.org/10.1007/s00464-016-4953-3
• ⁴⁰ Luu NN, Yver CM, Douglas JE, Tasche KK, Thakkar PG, Rajasekaran K. Assessment of YouTube as an educational tool in teaching key indicator cases in otolaryngology during the COVID-19 pandemic and beyond: neck dissection. J Surg Educ. 2021 Jan-Feb;78(1):214-31. https://doi.org/10.1016/j.jsurg.2020.06.019
  » https://doi.org/10.1016/j.jsurg.2020.06.019
• ⁴¹ Mastroianni G, Busnelli VMC, Santibañes M, Huespe PE, Dietrich A, Beskow A, et al. Changing our training paradigms in general surgery residency during the covid-19 outbreak. Short communication. Ann Med Surg (Lond). 2020;59:10-3. https://doi.org/10.1016/j.amsu.2020.08.049
  » https://doi.org/10.1016/j.amsu.2020.08.049
• ⁴² McKechnie T, Levin M, Zhou K, Freedman B, Palter VN, Grantcharov TP. Virtual surgical training during COVID-19: operating room simulation platforms accessible from home. Ann Surg. 2020;272(2):e153-4. https://doi.org/10.1097/SLA.0000000000003999
  » https://doi.org/10.1097/SLA.0000000000003999
• ⁴³ Meling TR, Meling TR. The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis. Neurosurg Rev. 2021;44(2):843-54. https://doi.org/10.1007/s10143-020-01314-2
  » https://doi.org/10.1007/s10143-020-01314-2
• ⁴⁴ Mota P, Carvalho N, Carvalho-Dias E, João Costa M, Correia-Pinto J, Lima E. Video-based surgical learning: improving trainee education and preparation for surgery. J Surg Educ. 2018;75(3):828-35. https://doi.org/10.1016/j.jsurg.2017.09.027
  » https://doi.org/10.1016/j.jsurg.2017.09.027
• ⁴⁵ Mullins JK, Borofsky MS, Allaf ME, Bhayani S, Kaouk JH, Rogers CG, et al. Live robotic surgery: are outcomes compromised? Urology. 2012;80(3):602-7. https://doi.org/10.1016/j.urology.2012.03.050
  » https://doi.org/10.1016/j.urology.2012.03.050
• ⁴⁶ Navia A, Parada L, Urbina G, Vidal C, Morovic CG. Optimizing intraoral surgery video recording for residents’ training during the COVID-19 pandemic: comparison of 3 point of views using a GoPro. J Plast Reconstr Aesthet Surg. 2021;74(5):1101-60. https://doi.org/10.1016/j.bjps.2020.10.068
  » https://doi.org/10.1016/j.bjps.2020.10.068
• ⁴⁷ Palacios Huatuco RM, Liaño JE, Moreno LB, Ponce Beti MS. Analysis of the impact of the pandemic on surgical residency programs during the first wave in Argentina: a cross – sectional study. Ann Med Surg (Lond). 2021;62:455-9. https://doi.org/10.1016/j.amsu.2021.01.065
  » https://doi.org/10.1016/j.amsu.2021.01.065
• ⁴⁸ Quezada J, Achurra P, Jarry C, Asbun D, Tejos R, Inzunza M, et al. Minimally invasive tele-mentoring opportunity-the mito project. Surg Endosc. 2020;34(6):2585-92. https://doi.org/10.1007/s00464-019-07024-1
  » https://doi.org/10.1007/s00464-019-07024-1
• ⁴⁹ Raborn LN, Janis JE. Overcoming the impact of covid-19 on surgical mentorship: a scoping review of long-distance mentorship in surgery. J Surg Educ. 2021;78(6):1948-64. https://doi.org/10.1016/j.jsurg.2021.05.001
  » https://doi.org/10.1016/j.jsurg.2021.05.001
• ⁵⁰ Rapp AK, Healy MG, Charlton ME, Keith JN, Rosenbaum ME, Kapadia MR. YouTube is the most frequently used educational video source for surgical preparation. J Surg Educ. 2016;73(6):1072-6. https://doi.org/10.1016/j.jsurg.2016.04.024
  » https://doi.org/10.1016/j.jsurg.2016.04.024
• ⁵¹ Research Education INnovation in Surgery (REINS) initiative COVID-19 group. Impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: global survey and a proposed framework for recovery. BJS Open. 2021;5(2):zraa051. https://doi.org/10.1093/bjsopen/zraa051
  » https://doi.org/10.1093/bjsopen/zraa051
• ⁵² Rodriguez HA, Young MT, Jackson HT, Oelschlager BK, Wright AS. Viewer discretion advised: is YouTube a friend or foe in surgical education? Surg Endosc. 2018;32(4):1724-8. https://doi.org/10.1007/s00464-017-5853-x
  » https://doi.org/10.1007/s00464-017-5853-x
• ⁵³ Schlégl ÁT, Pintér Z, Kovács A, Kopjár E, Varga P, Kardos D, et al. Teaching basic surgical skills using homemade tools in response to COVID-19. Acad Med. 2020;95(11):e7. https://doi.org/10.1097/ACM.0000000000003586
  » https://doi.org/10.1097/ACM.0000000000003586
• ⁵⁴ Schlick CJR, Bilimoria KY, Stulberg JJ. Video-based feedback for the improvement of surgical technique: a platform for remote review and improvement of surgical technique. JAMA Surg. 2020;155(11):1078-9. https://doi.org/10.1001/jamasurg.2020.3286
  » https://doi.org/10.1001/jamasurg.2020.3286
• ⁵⁵ Seeburger J, Diegeler A, Dossche K, Rüdiger L, Mohr FW, Schreiber C, et al. Live broadcasting in cardiac surgery does not increase the operative risk. Eur J Cardiothorac Surg. 2011;40(2):367-71. https://doi.org/10.1016/j.ejcts.2010.11.069
  » https://doi.org/10.1016/j.ejcts.2010.11.069
• ⁵⁶ Soriero D, Atzori G, Barra F, Pertile D, Massobrio A, Conti L, et al. Development and validation of a homemade, Low-Cost Laparoscopic Simulator for Resident Surgeons (LABOT). Int J Environ Res Public Health. 2020;17(1):323. https://doi.org/10.3390/ijerph17010323
  » https://doi.org/10.3390/ijerph17010323
• ⁵⁷ Spiliotis AE, Spiliotis PM, Palios IM. Transferability of simulation-based training in laparoscopic surgeries: a systematic review. Minim Invasive Surg. 2020;2020:5879485. https://doi.org/10.1155/2020/5879485
  » https://doi.org/10.1155/2020/5879485
• ⁵⁸ Suárez Sánchez A, Diaz Vico T, Fernández Hevia M, García Munar M, Ramos Montes C, Rodríguez García I, et al. Telementoring in times of COVID-19 for training in general surgery. Br J Surg. 2021 May;108(Suppl3):znab160.052. https://doi.org/10.1093/bjs/znab160.052
  » https://doi.org/10.1093/bjs/znab160.052
• ⁵⁹ Tejos R, Avila R, Inzunza M, Achurra P, Castillo R, Rosberg A, et al. Impact of a simulated laparoscopic training program in a three-year general surgery residency. ABCD Arq Bras Cir Dig. 2019;32(2):e1436. https://doi.org/10.1590/0102-672020190001e1436
  » https://doi.org/10.1590/0102-672020190001e1436
• ⁶⁰ Torres A, Inzunza M, Jarry C, Serrano F, Varas J, Zavala A. Development and validation of a new laparoscopic endotrainer for neonatal surgery and reduced spaces. ABCD Arq Bras Cir Dig. 2021;33(4):e1559. https://doi.org/10.1590/0102-672020200004e1559
  » https://doi.org/10.1590/0102-672020200004e1559
• ⁶¹ Tuma F, Kamel MK, Shebrain S, Ghanem M, Blebea J. Alternatives surgical training approaches during COVID-19 pandemic. Ann Med Surg (Lond). 2021;62:253-7. https://doi.org/10.1016/j.amsu.2021.01.057
  » https://doi.org/10.1016/j.amsu.2021.01.057
• ⁶² Uribe M, Salinas GAM, Sepúlveda R, Lanzarini E, García C, Cárcamo C, et al. Efectos de la pandemia en los programas de formación en cirugía. Problemas y soluciones. 2021;73(1):107-13. https://doi.org/10.35687/s2452-454920210011078
  » https://doi.org/10.35687/s2452-454920210011078
• ⁶³ Vela J, Contreras C, Jarry C, Varas J, Corvetto M. Recomendaciones generales para elaborar un programa de entrenamiento basado en simulación para desarrollar competencias en pregrado y postgrado. Rev Latinoam Simul Clínica. 2020;2(1):26-38. https://doi.org/10.35366/92936
  » https://doi.org/10.35366/92936
• ⁶⁴ Vergis A, Steigerwald S. Skill acquisition, assessment, and simulation in minimal access surgery: an evolution of technical training in surgery. Cureus. 2018;10(7):e2969. https://doi.org/10.7759/cureus.2969
  » https://doi.org/10.7759/cureus.2969

Publication Dates

• Publication in this collection
  19 Dec 2022
• Date of issue
  2022

History

• Received
  27 Apr 2022
• Accepted
  05 July 2022