Browsing by Author "Varas Cohen, Julián"
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- ItemA new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program(2022) Ortiz Koh, Catalina Alejandra; Contreras Bertolo, Caterina; Vela Ulloa, Javier Ignacio; Belmar, Francisca; Paul, Ivan; Achurra Tirado, Pablo; Varas Cohen, JuliánBackground Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents’ exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. Methods A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 diferent programs were recruited. Each station was videotaped in high defni tion and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specifc rating scales alongside procedural times. Self-confdence to perform the procedure as the leading surgeon was evaluated before and after training. Results Statistically signifcant diferences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants signifcantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A signifcant improvement in self-confdence was shown in all stations. Conclusion An OSCE scenario for training surgical skills in trauma was efective in improving profciency level and self confdence. Low pre-training scores and level of confdence in the cardiac and lung injury stations represent a defcit in resi dency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be benefcial when future surgeons face extremely severe trauma scenarios. Keywords Trauma surgery · Simulation training · Surgical training · Surgical education tec
- ItemAnatomic hepatectomy as a definitive treatment for hepatolithiasis: a cohort study(2012) Jarufe Cassis, Nicolás; Figueroa, Eduardo; Muñoz Castro, César; Moisan Paravic, Fabricio Robertino; Varas Cohen, Julián; Valbuena Mora, José Rafael; Bambs S., Claudia; Martínez Castillo, Jorge; Pimentel Müller, Fernando
- ItemDesarrollo y evaluación de modelo ex vivo para entrenamiento de anastomosis intracorpórea en hemicolectomía derecha laparoscópica(2020) Jarry T., Cristián; Inzunza A., Martín; Bellolio R., Felipe; Marino C., Carlo; Achurra Tirado, Pablo; Varas Cohen, Julián; Larach Kattan, José TomásIntroducción: Si bien la anastomosis intracorpórea (AI) ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje más larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Materiales y Método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semiestructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento.
- ItemLobectomía video-asistida por puerto único utilizando un nuevo modelo de simulación ex vivo perfundido(2016) Ávila Sepúlveda, Rubén; Achurra Tirado, Pablo; Tejos, Rodrigo; Varas Cohen, Julián; Solovera Rozas, María; Salas Villarroel, Patricio; Pontificia Universidad Católica de Chile. Escuela de MedicinaLa simulación puede proporcionar una solución para adquirir habilidades avanzadas en cirugía torácica, sin embargo, hasta la fecha de publicación de este artículo no hay informes sobre un modelo ex vivo perfundido. Desarrollamos un modelo de bajo costo y alta fidelidad utilizando una muestra ex vivo en bloque de corazón y pulmón de un cerdo. El cerdo se usó previamente en un experimento no torácico, por lo que extrajimos el pulmón y el corazón para este modelo basado ex-vivo para reducir el uso de animales. El costo del modelo completo es de 70 USD y se puede reutilizar muchas veces cambiando el tejido ex vivo, por lo que este modelo puede ayudar a reducir los costos y el uso de animales asociados a esta cirugía de alta complejidad.
- ItemRemote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students(2023) Villagrán Gutiérrez, Ignacio Andrés; Rammsy, Francisca; Del Valle, Javiera; Gregorio De Las Heras Moreau, Sofia Ignacia; Pozo, Liliana; García, Patricio; Torres, Gustavo; Varas Cohen, Julián; Mandrusiak, Allison; Corvetto Aqueveque, Marcia Antonia; Fuentes-Cimma, JavieraDuring the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. Methods Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. Results Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. Conclusion The remote, asynchronous training and feedback model proved to be an effective strategy for students’ development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
- ItemSelf-Confidence on acquired surgical skills to deal with severe trauma patients in recently graduated surgeons(2022) Vela Ulloa, Javier; Cárcamo Gruebler, Leonardo; Contreras Bartolo, Caterina; Rebolledo Acevedo, Rolando; Varas Cohen, Julián; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Achurra Tirado, Pablo; Pontificia Universidad Católica de Chile. Escuela de MedicinaTrauma is one of the leading causes of death in the world and proper surgical care is critical to impact mortality. In Chile, trauma associated death ranks first as mortality cause in population between 20 and 59 years old. Appropriate surgical skills are required to deal with these complex patients. Self-confidence to practice trauma procedures after the General Surgery Residency have not been reported in our country. Aim: Describe the level of self-confidence to deal with trauma procedures of surgeons who recently graduated from a General Surgery Residency. Method: Descriptive cross-sectional study. We designed and applied a survey in 2015, 2016 and 2017 to recently graduated surgeons, to inquire about self-confidence of surgical skills to deal with trauma scenarios. Eighteen trauma surgery procedures (including cervical, thoracic, abdominal and vascular procedures) were evaluated using a 5-grade Likert scale. The number of procedures performed during the residency was also queried. Results: Eighty-eight recently graduated surgeons from 11 different training programs in Chile were included. The report of competencies was high in procedures such as intestinal injuries, were 98% felt competent or very competent in their repair. On the other hand, in complex traumas such as major vessel injury, up to 76% reported not being competent. Self-confidence on procedures was directly associated with the number of procedures performed during residency. Conclusions: Recently graduated surgeons from General Surgery Programs report high levels of confidence to deal with low and intermediate complexity traumas, but a lower level of confidence to treat high complexity cases.
- ItemTaking advantage of asynchronous digital feedback: development of an at‑home basic suture skills training program for undergraduate medical students that facilitates skills retention(2023) Belmar Riveros, Francisca; Gaete Dañobeitia, María Inés; Durán Espinoza, Valentina; Chelebifski Vargas, Slavka; Jarry Trujillo, Cristián; Ortiz Koh, Catalina; Escalona, Gabriel; Villagrán Gutiérrez, Ignacio Andrés; Alseidi, Adnan; Zamorano Rivera, Elga; Pimentel Muller, Fernando; Crovari Eulufi, Fernando; Varas Cohen, Julián; Pontificia Universidad Católica de Chile. Centro de Cirugía Experimental y Simulación. Departamento de Cirugía Digestiva; Pontificia Universidad Católica de Chile. Departamento de Cirugía DigestivaPurpose to date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the efectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsu pervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In<72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and fve video-based assessments, where trainees performed diferent suturing exercises. For the assessment, a global (GRS) and specifc rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the fnal assessment, showing signifcantly higher scores (p<0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value=0.06) and SRS (18.59 vs 19, p value=0.07). Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.