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Introducing In Vivo Dissection Modules for Undergraduate Level Trainees: What Is the Actual Benefit and How Could We Make It More Efficient?


Essential Skills in the Management of Surgical Cases (ESMSC) is an international wet lab simulation course aimed at undergraduate students. It combines basic science workshops, case-based lectures and ex vivo skills modules, as well as in vivo dissections using a swine model. This study aims to evaluate the effectiveness of high-fidelity In Vivo Simulation-Based Learning for undergraduate level trainees. Also our goal was to compare the skill-based performance of final year students vs. more junior-level ones. Forty undergraduate delegates at clinical rotation level (male = 28, female = 12, mean age = 23.12, 22–24, SD = 0.69) attended this 2-day course in Athens. N = 1 (2.5 %) was year 3, N = 4 (10 %) were year 4, N = 23 (57.5 %) were year 5 and N = 12 (30 %) were year 6. N = 30 (75 %) came from Hellenic universities, N = 8 (20 %) from the UK and N = 2 (5 %) from Germany. N = 20 (50 %) attended the in vivo dissections module first, and then the ex vivo one (type A rotation), whereas N = 20 followed the reverse training sequence with the ex vivo dissection first, followed by the in vivo one (type B rotation). The mean global rating scores for type A rotation were better in both the in vivo by 0.10 (2.40 vs. 2.30) and ex vivo modules by 0.15 (2.85 vs. 2.70), though it did not reach statistical significance (p > 0.05). Furthermore, the mean improvement of performance, in the laparoscopic skills station for the type A rotation, was better compared to type B by 0.351 (2.00 vs. 1.65, p = 0.003). Year 6 students performed better in the laparoscopic station (2.00 vs. 1.75, p = 0.059), whereas years 3, 4 and 5 performed better in the in vivo (2.42 vs. 2.16, p = 0.157) as well as the ex vivo dissections (2.78 vs. 2.75, p = 0.832), though none of those comparisons reached statistical significance. Delegates seemed to appreciate and enjoy the in vivo dissections as reflected in the feedback (8.67/10, min = 6 and max = 10, SD = 1.79). Although medical students seem to appreciate in vivo dissections modules, currently, further evidence is needed to support their recommendation in the undergraduate level. Surgical skills should be part of the undergraduate curriculum to improve final year students’ performance in the theatre.

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We would like to thank all the staff of the E.R.C. ELPEN and especially Georgios Stagias—Felasa C and Nikolaos Psychalakis—Felasa C, and the rest of the medical students’ committee—Efstratia Georgopoulou and Stefanos Karamaroudis.

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Correspondence to Michail Sideris.

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This study was performed according to the European and National Legislation, Directive 63/2010, PD 56/Αpril 2013 [reference number of the license: Michail Ch. Sideris and Apostolos Papalois 7095/05-11-2014 (revised 884 28/4/2015)].

Authors’ Contribution

Main contribution—all the authors have approved the current submission.

Michail Ch. Sideris and Apostolos E. Papalois: equal contribution, lead of the project, and designers of the course curriculum, main editors of the manual. MS and AP drafted and edited the manuscript (discussion drafted by KT and edited by MS and AP), and statistical analysis by MS.

Georgios Tsoulfas: faculty of the course, lead for the in vivo dissections (anatomy demonstration of the abdomen), conception and senior author of the study

Korina Theodoraki: faculty member, literature search and editing of the discussion part of the manuscript

Efstratios Koletsis: faculty of the course, lead for ex vivo dissections—ex vivo graft suturing

Panagiotis Dedeilias: faculty of the course, lead for heart and transplant in vivo module

Nikolaos Lymperopoulos and Konstantinos Imprialos: members of the faculty

Savvas Papagrigoriadis: senior advisor of the course curriculum and manual

Vassilios Papalois: senior advisor of the course curriculum and manual

Georgios Zografos: senior advisor of the course curriculum and manual, lead of the scientific committee of the course

All the qualified authors have contributed to data collection as well as assessors (workplace-based assessments of the medical students).

Georgios Paparoidamis, Nikolaos Staikoglou and Ismini Tsagkaraki: medical students who set up promotion and smooth run of the course, data collection and assistants to senior assessors. GP has contributed with GT to the protocol.

Funding of the Project

Essential Skills in the Management of the Surgical Patient—ESMSC is funded by the Experimental Research Centre ELPEN, and it is provided for free to medical students around Europe.

Conflict of Interest

The authors declare that they have no competing interests.

Additional information

Manual of the Course

Essential Skills in the Management of Surgical Cases – ESMSC, Scientific Publications Parisianou S.A., ISBN: 978-960-583-063-2

Place of the Study

Experimental Research Centre ELPEN

95 Marathonos Av., 19009, Pikermi

Michail Sideris and Apostolos Papalois have equal contribution.

Appendix I: Direct Observation of Procedural Skills (DOPS)

Appendix I: Direct Observation of Procedural Skills (DOPS)

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Sideris, M., Papalois, A., Theodoraki, K. et al. Introducing In Vivo Dissection Modules for Undergraduate Level Trainees: What Is the Actual Benefit and How Could We Make It More Efficient?. Indian J Surg 80, 68–76 (2018).

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  • Surgical education
  • Wet lab
  • Undergraduate
  • Surgical science
  • In vivo
  • Ex vivo
  • Simulation