Simulation of Management of Internal Carotid Artery Injury in Endoscopic Sinus Surgery
Notice bibliographique
Résumé
Rationale: Injury to the internal carotid artery (ICA) is a serious and devastating complication for the skull base surgeon. It is an uncommon injury and therefore limited training is received in the management of this complication. Our group aimed to develop a simulation scenario of an ICA injury during endoscopic surgery based on the principles of developing skills related to crisis resource management and interprofessional/interdisciplinary team communication. A modified Delphi approach was previously used to develop a protocol for management of ICA injury known as the alert–control–transfer protocol and we sought to develop this algorithm into an educational simulation teaching tool for post-graduate residents. Methods: A literature search of endoscopic surgical simulation, crisis resource management and multidisciplinary teamwork simulation in medicine as well and the development of ICA injury management protocols. A 20-minute simulation-based scenario based on the alert–control–transfer protocol was developed in a flow-chart model with structured learning objectives and debriefing session. A pre- and post-participation questionnaire was administered to collect information regarding each participant’s experience level using a 5-point Likert scale and qualitative feedback regarding the simulation. A global and task-specific structured checklist was developed that will serve to provide construct validity of the simulation model which was graded by two individual evaluators (N.V. and D.N.) evaluating situational awareness, decision making, communication and teamwork and leadership using a 5-point Likert scale. Otolaryngology residents in a postgraduate training program at a single institution were divided into two groups either junior (PGY1–3, n = 5) or senior (PGY4–5, n = 5) in two sessions between 2022 and 2023. A structured de-brief session was developed in accordance with educational objectives outlined in the study. Results: Situational awareness, decision making, and communication and teamwork, as well as leadership attributes were on average graded as 4/5, 3.7/5, 4.3/5, and 4.5/5 for senior residents, respectively, compared to 3/5, 3/5, 3.5/5, and 3.5/5 for junior residents ( p < 0.05). The average level of experience of senior residents versus junior residents in number of cases was 20 cases versus 5 cases, respectively. The pre-simulation and post-simulation comfort levels regarding steps in management of internal carotid artery injury was self-reported as 3/5 compared to 4/5 across all groups. Conclusion: ICA injury remains a devastating complication requiring complex interventions in order to manage appropriately in the acute settings with a wide range of expertise. This initial study suggests the predictive validity of the simulation station with differences seen across less and more experienced trainees with benefits noted by trainees of all experience levels. The implementation of an educational simulation tool would be useful for rare and complex scenarios in order to provide a safe learning environment for the trainee and receive appropriate feedback. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».