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Quantifying the performance level of surgeons with digital virtual reality (VR) simulators can help ensure that quality requirements in healthcare are met. In order to better understand integration amongst quality principles, practices and technologies in the adoption and diffusion of VR simulators, the authors applied a technological innovation system (TIS) framework. The purpose of this study is to understand how the adoption and diffusion of VR surgical simulators in a Swedish healthcare context is influenced by various system factors.

In this study, single-case holistic design based on innovation system theory was used to analyse the adoption of digital quality technologies related to surgical performance in Swedish hospitals. The case employs a mixed methods approach triangulating data longitudinally from published documents and expert interviews.

Adoption of digital technologies regarding surgical performance is restricted by system factors relating to inconsistent normative and regulatory requirements for quantified performance criteria to judge surgical expertise. Addressing these systems' weaknesses with evidence-based training programmes can have a significant impact on the further development of the innovation system and can ultimately affect healthcare reliability and quality.

This paper explores quality management (QM) challenges in the context of digital transformation in healthcare. The paper attempts to fill the gap for TIS studies in a healthcare context and highlight the role of innovation function strength along the value chain and in relation to technology cycles to increase the understanding of adoption of digital technologies relating to surgical performance.

Within the framework of learning from errors, this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The purpose of this paper is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated.

The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together.

The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision-making. The findings showed that optimal context of learning about risks and potential errors of surgical operation are not always the authentic operation context.

The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment – including powerful guidance – for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

The aim of this research is the development of a problem-based curriculum for robotic surgical training and its evaluation.

First, the aim and objectives of the curriculum are defined and the background learning theories that guide our work are introduced. The methodology for designing the simulator-based training is presented and finally the output of this work is reported, that is the SAFROS training paradigm, resulted as a balanced synthesis of behavioural and constructivist learning theories.

The evaluation of basic skills tasks of the curriculum revealed a high acceptance among the trainees.

Within this paper, a first implementation and evaluation of the basic skills tasks is described. Further cooperation between pedagogues and software engineers is required in order to put in practice the whole curriculum. Then, further training experiments with surgeons are necessary to check the validity of the whole curriculum. The authors also need to establish proficiency criteria that can come from the achievements of expert surgeons using the simulator and the robot and use them as final goals to be achieved by trainees in future courses. In the field of subjective evaluation, a possible future extension might be a bigger number of questions. Moreover, the innovative method of text mining in its application to opinion mining decisions can be further applied.

In this paper, an innovative approach for the development of a simulator-based curriculum for robotic surgical training is presented and first evaluation results based on ratings from trainees are also presented. The value of this paper is relevant to medical trainers and curriculum designers.

Education of the surgeon and development of surgical expertise have been debated for centuries. Today, research in surgical education applies terms and methods from other performance domains such as sport and music. However, there still seems to be a lack of consensus as to how talent may be brought into the discourse about surgical education. Especially, when it comes to identifying and developing trainees who in the future will perform better than the average surgeon.

This five-step scoping study aims to map existing literature about talent identification, talent development and development of expertise in the domains of surgery, sport and music in the period of 1985-2014.

A total of 242 studies, divided in the four domains of surgery (69 studies), sport (115 studies), music (34 studies) and cross-disciplinary studies (24 studies) published in the period 1985-2014 were included.

Informed by the performance domains of sports and music and their inclusion of a holistic, ecological approach to research, this study suggests that research in surgical education may benefit from broadening its view on talent by including psychosocial variables and environmental, demographic and structural influencers when considering how surgical talent may be identified and developed.

The purpose of this paper is to determine the effect of video game and surgical experience on the ability to adapt to and use the neuroArm virtual reality (VR) simulator.

A total of 48 participants, comprising video gamers, medical students, surgical residents, and qualified surgeons, were recruited. Subjects played three video games and completed a questionnaire. Three pre‐determined tasks simulating surgical procedures were performed using the simulator. Performance was measured by time for task completion, number of errors, and quality of outcome.

Gamers outperformed other groups on all measures of performance at almost every task on the VR simulator. All groups showed interval improvement in performance. As age of participants increased, irrespective of their sex and group, their quality of performance decreased and time to complete tasks increased. Initially, the men outperformed the women at every task, however, the difference decreased with repetition.

More participants are needed to increase statistical significance of the results, in particular female participants.

This study showed that gamers adapted rapidly to the neuroArm trainer, which could be attributed to enhanced visual attention and spatial distribution skills from video game play. Therefore, visuospatial skills may become strong elements in the selection criterion for future generations of surgical trainees.

This study evaluated performance on the neuroArm trainer for the first time. The results provide insight into the design of a training program that helps select and prepare future surgeons for robotic surgery.

Aims to investigate medical rapid prototyping (medical RP) technology applications and methods based on reverse engineering (RE) and medical imaging data.

Medical image processing and RE are applied to construct three‐dimensional models of anatomical structures, from which custom‐made (personalized) medical applications are developed.

The investigated methods were successfully used for design and manufacturing of biomodels, surgical aid tools, implants, medical devices and surgical training models. More than 40 medical RP applications were implemented in Europe and Asia since 1999.

Medical RP is a multi‐discipline area. It involves in many human resources and requires high skills and know‐how in both engineering and medicine. In addition, medical RP applications are expensive, especially for low‐income countries. These practically limit its benefits and applications in hospitals.

In order to transfer medical RP into hospitals successfully, a good link and close collaboration between medical and engineering sites should be established. Moreover, new medical applications should be developed in the way that does not change the traditional approaches that medical doctors (MD) were trained, but provides solutions to improve the diagnosis and treatment quality.

The presented state‐of‐the‐art medical RP is applied for diagnosis and treatment in the following medical areas: cranio‐maxillofacial and dental surgery, neurosurgery, orthopedics, orthosis and tissue engineering. The paper is useful for MD (radiologists and surgeons), biomedical and RP/CAD/CAM engineers.

Robotic systems for laparoscopic minimally invasive surgery (MIS) always end up with highly sophisticated mechanisms and control schemes – making it a long and hard development process with a steep price. This paper aims to propose and realize a new, efficient and convenient strategy for building effective control systems for surgical and even other complex robotic systems.

A novel method that takes advantage of the modularization concept by integrating two middleware technologies (robot operating system and robotic technology middleware) into a common architecture based on the strengths of both was designed and developed.

Tests of the developed control system showed very low time-delay between the master and slave sides; good movement representation on the slave manipulator; and high positional and operational accuracy. Moreover, the new development strategy trial came with much higher efficiency and lower costs.

This method results in a modularized and distributed control system that is amenable to collaboratively develop; convenient to modify and update; componentized and easy to extend; mutually independent among subsystems; and practicable to be running and communicating across multiple operating systems. However, experiments show that surgical training and updates of the robotic system are still required to achieve better proficiency for completing complex minimally invasive surgical operations with the proposed and developed system.

This research proposed and developed a novel modularization design method and a novel architecture for building a distributed teleoperation control system for laparoscopic MIS.

A clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.

This was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.

Of the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.

This study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

To explore why women paediatricians have chosen paediatrics as their specialty when previous research has shown that this was the least favourite career option.

In this qualitative study ten semi‐structured interviews with open‐ended questions were carried out. The interviews were taped and transcribed by a professional transcriber. Two tapes could not be transcribed because of technical problems. This dissertation focuses on the responses of the eight women in relation to the research question. Interviews were carried out face‐to‐face. There were no additional questionnaires. Common themes were identified and content analysis used for data analysis.

All the women felt that they had chosen paediatrics because of the good work atmosphere, supportive colleagues and the attraction of working in a multi‐disciplinary team. All had pursued their career in a dedicated way working full‐time for most of their careers. The women paediatricians interviewed were happy with their career but they realised that they had made sacrifices in terms of family and personal commitments. The work environment has to change for everybody, not just for women, to improve quality of life. Career advice is still thought to be poor and many doctors enter a career without knowing what is expected of them. Modernising medical careers will considerably shorten medical training and the time individuals can spend in a particular specialty.

A qualitative study like this can give both male and female students an insight into what it is like to have a career in paediatrics.

The purpose of this study is to describe the design and validation of a three-dimensional (3D)-printed phantom of a uterus to support the development of uterine balloon tamponade devices conceived to stop post-partum haemorrhages (PPHs).

The phantom 3D model is generated by analysing the main requirements for validating uterine balloon tamponade devices. A modular approach is implemented to guarantee that the phantom allows testing these devices under multiple working conditions. Once finalised the design, the phantom effectiveness is validated experimentally.

The modular phantom allows performing the required measurements for testing the performance of devices designed to stop PPH.

PPH is the leading obstetric cause of maternal death worldwide, mainly in low- and middle-income countries. The proposed phantom could speed up and optimise the design and validation of devices for PPH treatment, reducing the maternal mortality ratio.

To the best of the authors’ knowledge, the 3D-printed phantom represents the first example of a modular, flexible and transparent uterus model. It can be used to validate and perform usability tests of medical devices.