Publications
79 results found
Wang H, Sugand K, Newman S, et al., 2019, Are multiple views superior to a single view when teaching hip surgery? A single-blinded randomized controlled trial of technical skill acquisition, PLoS ONE, Vol: 14, ISSN: 1932-6203
s Metrics Comments Media Coverage Abstract Introduction Materials and methods Results Discussion Conclusion Supporting information References Reader Comments (0) Media Coverage (0) FiguresAbstractPurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.
Bhattacharyya R, Davidson DJ, Sugand K, et al., 2018, Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool., JBJS Essent Surg Tech, Vol: 8, Pages: e32-e32, ISSN: 2160-2204
Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applic
Bhattacharyya R, Sugand K, Al-Obaidi B, et al., 2018, Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674
Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.
Sugand K, Wescott RA, Carrington R, et al., 2018, Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery., Acta Orthopaedica, Vol: 89, Pages: 1-6, ISSN: 1745-3674
Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators. We introduce FluoroSim, an inexpensive digital fluoroscopy simulator without the need for radiation. Patients and methods - This was a multicenter study with 26 surgeons in which everyone completed 1 attempt at inserting a guide-wire into a femoral dry bone using surgical equipment and FluoroSim. 5 objective performance metrics were recorded in real-time to assess construct validity. The surgeons were categorized based on the number of dynamic hip screws (DHS) performed: novices (< 10), intermediates (10-39) and experts (≥ 40). A 7-point Likert scale questionnaire assessed the face and content validity of FluoroSim. Results - Construct validity was present for 2 clinically validated metrics in DHS surgery. Experts and intermediates statistically significantly outperformed novices for tip-apex distance and for cut-out rate. Novices took the least number of radiographs. Face and content validity were also observed. Interpretation - FluoroSim discriminated between novice and intermediate or expert surgeons based on tip-apex distance and cut-out rate while demonstrating face and content validity. FluoroSim provides a useful adjunct to orthopedic training. Our findings concur with results from studies using other simulation modalities. FluoroSim can be implemented for education easily and cheaply away from theater in a safe and controlled environment.
van Duren BH, Sugand K, Wescott R, et al., 2018, Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study, MEDICAL ENGINEERING & PHYSICS, Vol: 55, Pages: 52-59, ISSN: 1350-4533
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- Citations: 21
Gupte CM, 2017, Knee Arthroscopy SimulationA Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool, Journal of Bone and Joint Surgery, American Volume, ISSN: 0021-9355
Metcalfe D, Sugand K, Thrumurthy SG, et al., 2016, Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study, EUROPEAN JOURNAL OF EMERGENCY MEDICINE, Vol: 23, Pages: 386-390, ISSN: 0969-9546
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- Citations: 9
Sugand K, Mawkin M, Gupte C, 2016, Training effect of using Touch Surgery™ for intramedullary femoral nailing, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 47, Pages: 448-452, ISSN: 0020-1383
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- Citations: 25
Sugand K, Akhtar K, Khatri C, et al., 2015, Training effect of a virtual reality haptics-enabled dynamic hip screw simulator., Acta Orthopaedica, Vol: 86, Pages: 695-701, ISSN: 1745-3682
Background and purpose - Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics. Patients and methods - 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05. Results - The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training. Interpretation - We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.
Sugand K, Mawkin M, Gupte C, 2015, Validating Touch Surgery™: A cognitive task simulation and rehearsal app for intramedullary femoral nailing, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 46, Pages: 2212-2216, ISSN: 0020-1383
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- Citations: 40
Akhtar K, Sugand K, Wijendra A, et al., 2015, The Transferability of Generic Minimally Invasive Surgical Skills: Is There Crossover of Core Skills Between Laparoscopy and Arthroscopy?, JOURNAL OF SURGICAL EDUCATION, Vol: 73, Pages: 329-338, ISSN: 1931-7204
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- Citations: 9
Akhtar K, Sugand K, Sperrin M, et al., 2015, Training safer orthopedic surgeons Construct validation of a virtual-reality simulator for hip fracture surgery, ACTA ORTHOPAEDICA, Vol: 86, Pages: 616-621, ISSN: 1745-3674
Background and purpose — Virtual-reality (VR) simulation inorthopedic training is still in its infancy, and much of the work hasbeen focused on arthroscopy. We evaluated the construct validityof a new VR trauma simulator for performing dynamic hip screw(DHS) fixation of a trochanteric femoral fracture.Patients and methods — 30 volunteers were divided into 3groups according to the number of postgraduate (PG) years andthe amount of clinical experience: novice (1–4 PG years; less than10 DHS procedures); intermediate (5–12 PG years; 10–100 procedures);expert (> 12 PG years; > 100 procedures). Each participantperformed a DHS procedure and objective performancemetrics were recorded. These data were analyzed with each performancemetric taken as the dependent variable in 3 regressionmodels.Results — There were statistically significant differences inperformance between groups for (1) number of attempts at guidewireinsertion, (2) total fluoroscopy time, (3) tip-apex distance,(4) probability of screw cutout, and (5) overall simulator score.The intermediate group performed the procedure most quickly,with the lowest fluoroscopy time, the lowest tip-apex distance,the lowest probability of cutout, and the highest simulator score,which correlated with their frequency of exposure to running thetrauma lists for hip fracture surgery.Interpretation — This study demonstrates the construct validityof a haptic VR trauma simulator with surgeons undertakingthe procedure most frequently performing best on the simulator.VR simulation may be a means of addressing restrictionson working hours and allows trainees to practice technical taskswithout putting patients at risk. The VR DHS simulator evaluatedin this study may provide valid assessment of technical skill.
Thrumurthy S, Metcalfe D, Sugand K, 2015, Factors Influencing Misdiagnosis of Ruptured Abdominal Aortic Aneurysm: a Multi-centre Cohort Study, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 129-129, ISSN: 0007-1323
Sugand K, Boyer N, Sarraf K, et al., 2015, Using online mutlimedia to teach orthopaedic trauma emergencies, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 34-34, ISSN: 0007-1323
Bahsoun AN, Sugand K, Mawkin M, et al., 2015, Validation of touch surgery, a surgical cognitive task trainer, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 20-20, ISSN: 0007-1323
Akhtar K, Sugand K, Wijendra A, et al., 2015, Training safer surgeons: How do patients view the role of simulation in orthopaedic training?, Patient Safety in Surgery, Vol: 9, ISSN: 1754-9493
BACKGROUND: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. FINDINGS: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. CONCLUSIONS: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance.
Krishnan H, Sugand K, Ali I, et al., 2015, 'Pseudotumour' invading the proximal femur with normal metal ions following metal on metal hip resurfacing., BMJ Case Rep, Vol: 2015
A 75-year-old woman who had undergone hybrid metal-on-metal hip resurfacing 8 years earlier underwent revision arthroplasty because of hip, groin and lateral thigh pain. The main differential was aseptic loosening; however, serum cobalt and chromium levels were normal. Multiple imaging modalities revealed a periprosthetic, cystic soft tissue mass adjacent to the proximal femur. A large 'pseudotumour' with proximal femoral invasion was found at revision arthroplasty. We report the first finding of a 'pseudotumour' invading the proximal femur with normal metal ions following metal on metal hip resurfacing.
Sugand K, 2014, The Impact Of Video Gaming On Training Future Orthopaedic Surgeons – Does Play Correlate With Skill?
Arshad M, Sugand K, 2014, Auditing secondary prevention prescribing following Coronary Artery Bypass Grafting (CABG) (vol 11, pg 612, 2013), INTERNATIONAL JOURNAL OF SURGERY, Vol: 12, Pages: 1245-1245, ISSN: 1743-9191
Khatri C, Sugand K, Anjum S, et al., 2014, Does Video Gaming Affect Orthopaedic Skills Acquisition? A Prospective Cohort-Study, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 6
Lelos N, Campos P, Sugand K, et al., 2014, AUGMENTED REALITY DYNAMIC HOLOGRAPHY FOR NEUROLOGY, Meeting of the Associatiion-of-British-Neurologists, Publisher: BMJ PUBLISHING GROUP, ISSN: 0022-3050
Yousaf S, Sugand K, Raza M, et al., 2014, Simultaneous Bilateral Stress Fractures in a Homemaker <i>A Case Report and Literature Review</i>, JOURNAL OF THE AMERICAN PODIATRIC MEDICAL ASSOCIATION, Vol: 104, Pages: 518-521, ISSN: 8750-7315
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- Citations: 1
Rabiu A-R, Sugand K, 2014, Has the sanctity of life law 'gone too far'?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not 'gone too far', PHILOSOPHY ETHICS AND HUMANITIES IN MEDICINE, Vol: 9, ISSN: 1747-5341
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- Citations: 6
Sugand K, 2013, Medical School: The Undergraduate's Guide, Publisher: Doctor's Academy, ISBN: 978-9380573281
Medicine is widely known to be one of the most competitive and demanding degrees in the world. This practical guide provides invaluable information and advice from over thirty students, doctors and professors in the field, collating the essential insights you need to excel. It provides thorough and clear explanations on how to map your career and maximise your time at university. You will learn how to: • Settle smoothly into medical school • Succeed in medical exams • Manage your time and become an effective leader • Present and publish research • Make the most of clinical rotations • Plan your elective • Pick the specialty that's right for you "Contained in this guide is a treasure trove of invaluable information. The text is concise, lucid and readable. I recommend this book without reservation." Sir Graeme Catto, MD, DSc, FRCP, FMedSci, FRSE Current President of the College of Medicine Former President of the General Medical Council "This is a most thorough yet eminently readable guide to everything you would need to know about a career in medicine. I just wish it had been around when I was at medical school!" Mr Kash Akhtar, MBBS, BSc, Med, FRCS (Tr & Orth) Clinical Lecturer in Trauma & Orthopaedic Surgery, Imperial College Healthcare NHS Trust, London Deanery Fellow in Medical Education, Leadership & Management "This guide contains so much useful advice about not only succeeding at medical school, but also life afterwards. An essential insight, I would recommend it to anyone considering starting their medical career or wanting to make the most of their University experience." Ms Georgina Martin, BSc Medical Student, St George's University London
Sugand K, 2013, Medical School: The Applicant's Guide, Publisher: Doctor's Academy, ISBN: 978-9380573274
Medicine is widely known to be one of the most competitive and demanding degrees in the world. This practical guide provides invaluable information and advice from over sixty students, doctors and professors in the field, collating the essential insights one needs to excel. It provides thorough and clear explanations on how to maximise an individual's chances to gain entry into medical school in the United Kingdom. This book summarises the key facts surrounding medical school applications, and focuses on the personal journeys of medical students, graduates and renowned experts in the UK. Edited by doctors with a keen interest in academia, it is written by senior medical students and graduates while being edited by professors to ensure that all the information is up to date and relevant. This is a compendium of the best-kept secrets about how to get into UK medical schools. This book will help the user to: Optimally approach medical school applications Succeed in interviews Perform well in medical entry exams such as UKCAT, BMAT and GAMSAT Effectively manage ones finances Make the most of a gap year Consider alternative routes into medicine Peer review "Contained in this guide is a treasure trove of invaluable information. The text is concise, lucid and readable. I recommend this book without reservation" Sir Graeme Catto, MD, DSc, FRCP, FMedSci, FRSE Current President of the College of Medicine Customer review "An incredibly resourceful book for prospective medical applicants. Student testimonials and multiple links to further reading makes this book a very useful starting point." Mr Chetan Khatri Medical Student, Imperial College London
Sugand K, 2013, Pituitary Apoplexy, Pituitary Apoplexy, Editors: Turgut, Mahapatra, Powell, Muthukumar, Publisher: Springer Science & Business Media, ISBN: 9783642385087
This book provides an in-depth review of knowledge of the management of pituitary apoplexy, with an emphasis on clinical and neuroradiological findings and treatment modalities, medical and surgical.
Nazari D, Sugand K, Yates M, et al., 2013, An audit on the documentation of the interpretation of chest radiographs following thoracic surgery., Int J Surg, Vol: 11
Campos P, Sugand K, Mirza K, 2013, Holography in clinical anatomy education: A systematic review.
Sugand K, Metcalfe D, Jaiganesh T, 2013, Subarachnoid haemorrhage with pituitary adenoma, Pituitary Apoplexy, Pages: 55-67, ISBN: 9783642385070
Pituitary apoplexy is an uncommon syndrome typically resulting from ischaemic or haemorrhagic necrosis of an existing pituitary adenoma. Patients classically present with sudden-onset severe headache, reduced consciousness, and meningeal irritation. For this reason, the clinical picture is frequently mistaken as being caused by aneurysmal subarachnoid haemorrhage (SAH). It is necessary to distinguish preoperatively between pituitary apoplexy and SAH as there are reports of inappropriate craniotomy being performed with a view to clipping nonexistent aneurysms. Importantly, transsphenoidal excision of a pituitary adenoma risks rupture of an unidentified intracranial aneurysm. This is particularly significant given the established association between pituitary adenoma and development of intracranial aneurysms. This chapter reviews the epidemiology and pathophysiology underlying the relationship between pituitary tumours, intracranial aneurysms, and SAH. It also makes evidence-based recommendations for the investigation of patients with suspected pituitary apoplexy to identify associated conditions preoperatively and manage the risk of iatrogenic aneurysm rupture.
Akhtar K, Sugand K, Sarvesvaran M, et al., 2013, The transferability of generic laparoscopic and arthroscopic simulator skills: A prospective randomised controlled study, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 163-163, ISSN: 0007-1323
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