BOB in Ped Surg 2023 - CIPESUR Winner - Georgina Falcioni, MD

Okay, so we're ready for other um association. This is a new one and this is Sipasor, that's the association of the South American. And we have first, Dr. Georgina Falcioni with comparative effectiveness of telesimulation versus a standard simulation for MIS essential skills training. And this is a retrospective study that aim to compare the effectiveness of telesimulation versus a standard simulation program for essential skills training. Second, we have Dr. Maria Soledad Jala Valdivia from Hospital Luis Calvo Macquena in Santiago Chile with the work the immuno histochemical staining CD56 is useful in the diagnosis of biliary atresia. So this is a study that aim to evaluate the accuracy of CD56 to diagnose patients with biliary atresia. And last but not least, we have Dr. Maria Marcela Bailez, a pediatric surgeon also from Garoan Children's Hospital with the presentation tumor development in 46 XX DSD patients. This is a retrospective study that aim to report theological characteristics and immuno expression patterns ofl parenchyma in patients with 46 XX testicular and ovar testicular DSD. So, with those three presentations being the best from Sipasor, now it's time to start the poll. It's What do you say? Okay. We're we're struggling here. The polls are going crazy. Uh I think I I think just before we the blue one? Man, it's going crazy guys here. Uh I think at the last split second, um we were about to announce uh immuno histochemical, but at the last second it looks like comparative effectiveness of telesimulation is now winning. Okay, so we'll stop the poll now. And we are going to see then the comparative effectiveness of telesimulation versus standard simulation for MIS essential skills training. Comparative effectiveness of telesimulation versus standard simulation for minimal invasive surgery essential skills training. Experience in a pediatric surgical simulation center from Garahan Children's Hospital, Buenos Aires, Argentina. Nothing to disclose. In person proctor trainee simulation based education had been our standard choice for MIS skills training programs development since 2012. In the context of the Covid-19 pandemic and social distant protocols, we adapted the curricula to a telesimulation essential skills training model, which was reported in IPAC 2021. The aim of this presentation is to evaluate the comparative effectiveness of our telesimulation versus standard simulation for MIS essential skills training. Both standard and telesentials skills training model included academic lectures, tutorials for ergonomics and seven performance tasks. The hands on practice was scheduled into two sessions of three hours. We randomly selected 20 participants assessments from different institutions for each group. T group had access all the content through an online campus and completed their hands-on practice with a proctor through a virtual meeting platform. S group had attended conferences and hands on practice at the simulation Center with an onsite proctor. Both groups had the same educators giving summative feedback and debriefing. The assess tasks were three. Circle cutting pattern, extracorporeal reder knot and intracorporeal square knot. For each task, initial score adapted from goals and time and final score and time were registered. Data was analyzed with the R Studio software program. At precision cutting, we observed a significant improvement in the score as well as a significant decrease in time between the initial and final assessments independently for T and S groups. When comparing the achieve progress between both groups, there were no statistical significant differences between T and S groups. We observe a similar pattern for the extracorporeal rather not task, showing a considerable and almost parallel progress in the initial and final assessments for both DNS groups. And at the square not task, the result structures repeated from the improvement of the score and decrease in time. The comparative outcomes were relatively symmetric for T and S group after practice. For discussion, we observed statistically significant improvements in the scores and decrease in times for all the assess tasks in T and S groups. The comparative progression observed in T and S groups were also effective and accounted almost parallel. Data analysis show that close performance could be achieved with both strategies. This may support and highlight the capability of telesimulation to provide educational benefit in MIS essential skills training to learners who didn't have direct access to onsite simulation resources within a proctor training program. Thank you. All right. We're back. Um I love the the variety of the different presentations we have today. This is really great. Um so uh I know that the presenters are, I think they're coming from a case and they're running to their computer, so they may make it, but if not, we can talk about this. Um, we were very fortunate to bring Cecilia here to Cincinnati for a couple years, and she's introduced us to this concept of telesimulation. Um, I think that personally it's great when not only you may not have the simulation the simulation resources, but you may not also even have an expert mentor. Uh, and this allows you to learn from someone who may not live in your city, uh, and also internationally. So this has been really, really cool to to do and I know with IPAC, um, we did that during the the pandemic. Um, I guess, you know, Cecilia, given your experience, you and I were talking at the break, this is for for low fidelity. Low fidelity, yeah. What are your thoughts on high fidelity? Well, I think it's a little bit more complicated to do it in high fidelity because um the thing you rely on when you do telesimulations is that you can get things that they are going to simulate with to their houses. Yeah. So high fidelity maybe sometimes requires, I don't know, a pump to uh make the lungs breathe or things like that. So, I think it's possible, but we are not quite there uh to do a telesimulation for high fidelity. But um I think that low fidelity gives you a lot of um things like you can train a lot with that and and so it's And let me explain what we're talking about when we say high fidelity and low fidelity. There's basically two kind of training models. One is practicing a skill of movement, uh, a pegged, one peg to another, cutting, sewing. Uh, those are the low fidelity skills that simulation is very good for. Some people debate about the role of simulation in high fidelity, which is where you have a replica of the actual tissue where you're trying to simulate an esophageal atresia or a dual atresia repair. And not only do we question the role of simulation, but for sure telesimulation and as you're mentioning, sending this to the world may not be so possible. Yeah. I think it's possible, but I think um it's not quite there yet. There're multiple um places developing new things like this, so I think that uh it will get there soon. Okay. Um and and we're knowing new stuff release like uh in different parts of the world actually. Um, so I think we are getting there because um, you know, we're missing the haptics or missing things and maybe VR has to do with that, maybe, I don't know, AI. We we can like we are learning stuff. Um so right now it's a developing. Yep. Market. Tony, Allen, Britney, comments? Yeah, I don't have much to add. I was expecting that simulation would be better than telesimulation. So it was nice to see that it wasn't. It was kind of an interesting concept and a well- studied paper. Well, Tony, you know, imagine this, you're at your hospital, you might be have very skilled surgeons, but they may not necessarily be great at teaching techniques. There are people at these courses that have done this over and over. I know that I'm not going to be nearly as good at teaching uh these these courses as Cecilia who does it all the time. I might get frustrated and say, you you suck and you know, Cecilia will will So it's good to have to not limit your teachers to just those that live in the same building. So, Yeah, and and and it also gives you the advantage of maybe taking that model home and to do some stuff there because maybe, I know, you're in presents, you're in fellowship, you're all the time in your work, but when you're out, you may have some time home and it's good to have maybe an hour a week to do your Yeah. remember. All right, I think we should uh move on to the next presentation. Oh. Hey Marcela, we're sorry. Hi. Thanks for joining. We we loved your paper. A a lot of good discussion. No, I think I I was I was presenting the other paper I know the mentor and the author of this paper because I was representing the in the other paper. I'm sorry.. I I want Georgina is on call today and she's having trouble now. So every thank you for the votes and we are very glad because of pandemia, we try to develop this kind of essential way of training and we have been ready to to show the effectiveness and the comparative effectiveness and because it has to be like that, even we were sure, we needed to have data to prove that. It is a very low cost way because you use trainers that you can send as a toy. You don't need fancy stuff. You can use an iPad or a I'm sorry for the brand, a tablet or a phone, but the worst part is to find the educators and to do the communication effectively. So I I I always want to, you know, tell everyone that you don't need to underestimate the essentials because doing, this is not it's it is low fidelity, but doing a very good intracorporeal sturing in a very small space will translate to a high fidelity model of a newborn. So it is very nice that you can do this before arranging an advanced course and you can work online in different parts of the world. So I I think I encourage everyone just to start doing and we are willing to, you know, to share with anyone who who is willing to do it. Well, That's my message. Thank you. Thank you, Marcela. Thanks for stepping in for Georgina. Um, and I think the work you're doing is is is fantastic. Thank you. Uh and it's great to see you. Uh, hopefully we'll see you in the final round. All right, thank you.