EUPSA - Training of the steps of the transanal endorectal pull-trough on a take home simulation model - Maja Joosten

So next up, we have Dr. Maya Juston and Dr. Joyce Mania from the Netherlands, and we're going to see their presentation on training of the steps of the transanal endorectal pull through on a take-home simulation model. Afterwards, we'll hear from Dr. Simon Eaton from UCL Great Ormond Street Institute of Child Health. Um, so let's take it away with that presentation. The transanal endorectal pull through or term procedure is a common surgical procedure in the treatment of Hirschsprung's disease. The turb consists of several component steps that require a structured approach. Sufficient training is needed to acquire the skills to perform this procedure. However, given the relatively rare nature of Hirschsprung's disease, this can be challenging. Our aim was to evaluate the use of a low cost model for the training of the turb procedure. A low cost three-dimensional model was developed. A reusable wooden frame serves as its base. The perineal body consists of a sponge. A silicone top layer mimics the skin, and a multi-layer balloon design simulates the different layers of the rectum and mesorectum. Participants were recruited during the pediatric colorectal surgery course in 2020 and 2021. Participants were invited to use the model to practice the different steps of the turb procedure systematically, as seen in this instructional poster. From placing traction sutures to performing the anasis itself. Both expert pediatric surgeons, experts, and residents and fellows, the target group were asked to complete questionnaire rating the realism, didactic value of the model and the use in a hands-on workshop using a five-point liket scale. There were all together 18 participants, two experts and 16 participants in the target group. The model scored well on haptics, visual aspects and realism, with a medium score of four. And with a medium score of 4.5, the mond scored even higher as a good tool to train the component steps of the term procedure. Participants regarded training on the model as a valuable use of time. The model was not only considered to be a useful exercise during the workshop with a medium score of five, but also regarded to be suitable for repetitive practice at home after the workshop. In conclusion, participants regarded this reusable take-home turb model as a potent training tool for the component steps of the turb procedure and as a suitable model for pre-clinical workshops and repetitive practice at home. Enjoy your training. So, um, this was a very interesting paper and obviously simulation is an important part of pediatric surgical training now. Um, but sometimes this is difficult because of the um, the inaccessibility of the training rigs. Um, however this is clearly a bit of a game changer and that you can take it home, um, which makes it accessible to not only to trainee pediatric surgeons but also um to other countries around the world that may not have access to these simulatory tools. Um, so I'm going to ask some quick fire questions here. Ultimately, obviously the success of this in terms of training is only success, it's only a success if it actually improves people's experience when they get into theater and when they actually operate on real life Hirschsprung's patients. Do you have any feedback on whether people actually who had been on the trainer actually found it useful when they were actually operating on a patient? Well, thank you for these very lovely compliments. Um, that that is the next step indeed because for this model as of yet, we haven't yet transferred it to the um to the clinical setting in the sense that we've developed a a formal critical assessment form where you can extrapolate your advances made on the model to uh evaluating your functioning in the operating theater. So even though we have asked people how confident they feel going forward having had this training, that is the next step using a critical assessment form to actually see how it improves people's operative functioning and also operative confidence. And and what was the feedback? I I saw that you had two experts who had uh used this at your your um training course. Was there some specific feedback from the two experts as to um what um how um what the fidelity was like in the model? Well, we have since elaborated um our study so that we've included more uh experts so I currently have five experts where the main feedback is that the um just the suitability of the training for the training of the different steps of the procedure that that's the true um uh strength that this model has that it's a good tool to train the component steps. So that's the most heard feedback mainly from the experts. And um a question regarding this is that can you train too much on this? I mean if you if you're so expert on this particular setup, does that mean that actually when faced with a a real procedure, you're expecting something that's quite different in terms of haptic feedback, etc, etc and actually it is a point at which you've trained too much. Well, I don't know whether you can train too much, but I do think it is important to acknowledge that there are some things such as the dissection of the um the the true dissection that just the haptic feedback, yes, that that you will need that uh operative experience as well. But for the training of the component steps, just to have those internalized that so you don't have to go through that part of um learning a procedure in the patient themselves. I think that that's the true um um additive value of this model. And in in the model is the way, is there a way you can evaluate the performance of the person doing it? Yes, so that's what I was just referring to the the the critical assess so the the assessment form. So where you look at the activity of each step that you do, the sequence of what you do, how efficient you are in your movement. Um, where my colleague Maya previously in the in another anorectal um um model also evaluated it looking at the um also the efficiency of the movements and for uh your own assessment, so self assessment but also through peer assessments as well. Okay, so that's And experts further study then. So, um, I don't know if I can see, uh, Dr. Makia, you can't see the the chatter, but the the chat is is is lighting up, um, with a huge number of comments. Everyone wants one of these. Uh, we finally have a link to get it. Um, this is fantastic. I already, this is why we're doing this. I mean, I couldn't make the meeting. These are so far two huge game changing papers that half of the world didn't see and now can see. So thank you for presenting that.