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Validation and educational impact study of the NANEP high-fidelity simulation model for open preperitoneal mesh repair of umbilical hernia

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Abstract

Objective

The aim of the study was to develop, validate and analyze the educational impact of a high-fidelity simulation model for open preperitoneal mesh repair of an umbilical hernia.

Summary of background data

The number of surgical simulators available for training residents is limited. Primary for ethical reasons and secondary for the emerging pay-per-quality policies, practicing-on simulators rather than patients is considered gold standard. Validated full-procedural surgical models will become more and more important in training residents. Such models may assure that evidence-based standards regarding technical aspects of the procedures become integral part of the curriculum. Furthermore, they can be employed as a quality control of residents’ skills (Fonseca et al. in J Surg Educ 70:129–137, 2013).

Methods

In a repeated measures design, medical students, residents in their last year of training and attending surgeons performed an open preperitoneal mesh repair on the NANEP model [NANEP stands for the German acronym Nabelhernien-Netzimplatation-Präperitonal (English: Umbilical hernia mesh implantation preperitoneal)]. Subjects were categorized as “Beginners” (internship students) or “Experts” (residents and surgeons). Content validity was analyzed by criteria of subject-matter-experts. Blinded raters assessed surgical skills by means of the Competency Assessment Tool (CAT) using the online platform “CATLIVE”. Differential validity was measured by group differences. Proficiency gain was analyzed by monitoring the learning curve (Gallagher et al. in Ann Surg 241:364–372, 2005). Post-operative examination of the simulators shed light on criterion validity.

Results

The NANEP model-proofed content and construct-valid significant Bonferroni-corrected differences were found between beginners and experts (p < 0.05). Beginners showed a significant learning increase from the first to the second surgery (p < 0.05). Post-operative examination data confirmed criterion validity.

Conclusion

The NANEP model is an inexpensive, simple and efficient simulation model. It has highly realistic features, it has been shown to be of high-fidelity, full-procedural and benchtop-model. The NANEP model meets the main needs of surgical educational courses at the beginning of residency.

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Acknowledgements

Dr. Alexander Wierlemann supported assessment as one of the raters (Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg). Simone Menzel (Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg) was of great help in developing the CATLIVE software and Hannah Gebhardt (Hernia-Group, University Hospital of Wuerzburg) provided morphological insights of clinical MRI findings of visible meshes implanted in patients according to the methodology presented in this study.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany

    U. Friedrich, C. T. Zipper, A. Wiegering & U. A. Dietz

  2. Department of Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Baselstrasse 150, 4600, Olten, Switzerland

    U. A. Dietz

  3. Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany

    J. Backhaus & S. König

  4. Imperial College London, South Wharf Road, Paddington, London, W2 1BL, UK

    S. Mavroveli

  5. Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany

    S. Olbrecht & F. Puppe

  6. Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany

    A. Wiegering

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  1. U. Friedrich
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Contributions

All the authors contributed to the final preparation of this article, including approval of the final version of the manuscript. UF and CZ equally contributed to this study. UF, CZ and UAD developed the surgical simulator based on the work of SM. UF, SK and UD conceived and designed the study. UF, JB and UAD wrote the final study protocol and together with SM drafted the manuscript. UF and UAD implemented and ran the study, and collected the results. UF and JB analyzed the data and performed the statistical analyses. UF, UlAD, SO and FP developed the online platform.

Corresponding author

Correspondence to U. A. Dietz.

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Conflict of interest

No conflict of interest is declared. The study was founded by the Medical Faculty Wuerzburg, Germany (Grant no. 620-2015) and third-party funds of working group of the Division of Hernia Repair and Abdominal Wall Reconstruction of the University Hospital Wuerzburg. The authors disclose that there are no conflicts of interest.

Ethics approval

The local institutional review and ethics board judged the project as not representing medical or epidemiological research on human subjects and as such adopted a simplified assessment protocol. The project was approved without any reservation under the proposal number 2016101302. Participation was voluntary and the results not accessible to the public.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.

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Friedrich, U., Backhaus, J., Zipper, C.T. et al. Validation and educational impact study of the NANEP high-fidelity simulation model for open preperitoneal mesh repair of umbilical hernia. Hernia 24, 873–881 (2020). https://doi.org/10.1007/s10029-019-02004-9

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