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So, without further ado, our final speaker of this post resection is for the non M I C. Uh, prize category. And I'd like to welcome to the stage Mr Tissue Karki. Uh, this is an S T two general surgery trainee currently at HP and transplant surgery. He has an avid interest in health, leadership, medical education and surgical innovation. He moved to the UK after completing his undergraduate training in Nepal and Bangladesh, representing the I MG community has led surgical courses, mentorship schemes and international medical Teaching series tailored for the MGs. So he's currently working on the Nepalese doctors Assertion UK to organize Various surgical course is, um he is fantastic. Next morning, everyone, my name is fish Currently, um, substitute general says you're training athletes and today I will be presenting on designing low cost laproscopic appendicectomy simulation model, also known as labs the model and it's application for the surgical training in low middle income countries. 61. Yeah, All right. So start with I've got no conflict of interest to declare and basically I will be discussing about bit of background on the laproscopic simulation and its relevance in the surgical training. Um in the UK and also in the low middle income countries. I'll be discussing about how the model was developed and what was the story behind it. It's a mom and what led to its development. I'll be also discussing about the outcomes of the efficacy Testings and I will be sharing the results from the recent works up in laparoscopic surgery in Kathmandu, Nepal. So, uh, as we all know, surgical simulation has evolved as an important part of the post graduate surgical education and has a huge benefit potential in the post graduate training. Also, despite the huge potential benefits in the low middle income settings, it is mostly confined to the high income setting due to the cost involvement in it. So we'll be discussing the main aim, uh will be to develop the local stimulation model for the laproscopic appendicectomy to enhance the clinical performance of the trainees here by three ways by decreasing the time required for the performance, decreasing the errors and also just to enhancing their skills. We'll also be, uh, will be to empower the surgical simulation training in the low mid countries, so the whole process is divided into three phases pre development, development and post development phase. So having finished undergraduate training in low middle income countries, I've had firsthand experience difficulties in gaining the surgical simulation of the surgical training because of the result, limitations and the high cost involvement. Also, after starting my surgical training UK, I felt a bit behind in terms of the surgical skills. So I started thinking about how I can develop a cost effective models where I can practice and enhance my skills. That led to the development of this lapse. The model So in the development phase or what we did was we took the dimensions after the post laproscopic appendicectomy models and then three d printed the negative mold with the multi maker pro and on that negative mold. We injected silicon 20 and then produced this model and the post development phase. We did efficacy testing by assessing the quantitative assessment and face validated by using the liquid scale after gaining the feedback from the simulation course is using the questionnaires. So, uh, this is a short video of three D printing of the mold. If not, we can go ahead. It doesn't matter. Um, it's not playing so Yeah, let's go ahead. So this is just the negative molds that we are trying to print using the ultimate a pro, uh, next slide, Yeah. Yeah. This is the negative mold that we've made from the Dimension thing during which, uh, we had a cohort of 10 people samples where the model specification safe size. And by using the step of laproscopic appendicectomy where 1 to 5 was used 11 being the lowest in terms of in terms of the simulation. So results in terms of the first prototype testing that we did in the whole Institute of Learning and Simulation. As you can see, mostly the model specification safe side and Texas all above 90%. However, um, in terms of the steps of laproscopic appendicectomy especially mobilizing of there index using the interloop cutting these were a bit lower in terms of the rating given by the trainees just because our first version of the model had a thicker mesoappendix again, which is rectified for the further version two point Oh yeah. So recently we had a chance to send our laps see models 25 laps. The models in Kathmandu, Nepal, which was in the works of laparoscopic work organized by Nepalese Doctors Association alongside health extent Nepal, which was again endorsed by Royal College of Surgeon. There was a huge participation, uh, in that works, uh, usually the participants where the masters of surgery residents first year or second year from all around Nepal I cannot go to the previous list. So again, the questionnaire where develop using the further quantitative assessment of the model like the one that I described earlier and laproscopic appendicectomy um, steps. However, the most important thing that we found during this works of where the participants were from all around Nepal as far as far western reason of Nepal. So the M s residents We're working in the government hospitals over there, traveling almost 500 miles, which take 16 hours if you you're lucky if there's no landslide on the road. So they had very limited surgical training over there. So they traveled to the center part Kathmandu do local hospitals and we had 18 amazing feedbacks, uh, from from that course. So uh, from that last model works up what we can see in terms of the product specifications, safe side and texture again more than 90% of the good things about this version two point oh, models where we had rectified the thicker mesoappendix problems. So that has caused dividing in the loop application excision of appendix and specimen specimen removal much easier. And there was a good feedback in those on those terms. Yeah, again, Uh, so from the labs, the models we were able to understand, the participants were able to understand the general steps involved, and that's more than 90%. You can see that in terms of the more confident in laproscopic appendicectomy after the Coast works helpful and workshop was relevant more over. We're happy that the M s residents, uh, they thought the Met their learning objectives, which which was the main aim of the whole project. And they can go back and practice again. The skills that they have learned. Yeah. In conclusion, we've got six take away points. One is the simulators can provide a safe and standardized method for training. No doubt on that one very realistic and high engaging, depending on the model itself and further development of the version. And also it enhances the psycho motor skills, hand eye coordination, most important thing is, there's an unmet need for the development of low cost simulation model as well, and the model that we have produced now is, uh, negative. Molds will cost less than 3 lbs, and the model in itself will cause less than five pounds. Uh, whereas in the conventional market models it's around 30 lbs. So there's as we can see from the results. There's a huge benefit potential for surgical simulation in law, middle income countries and also provides a justification for support from charities and industries. Technical collaboration as well. So what's what's what the future holds is We will be recording more three D visuals and sending it to the lower middle income countries where the trainees can actually experience the operation involved, and then they can practice on the set themselves. Also, we are bringing the simulation fellows from from the lower middle income countries training here in the simulation center in Hills, where they will be going there running the program, and we will be in the future going there and developing the faculties as well. So these are the references that I've used, I want to mention now. Charlie Atkinson's a simulation lead R N. D. A UK president and all all the hills members as well. And thank you very much for listening. I'm happy to answer any questions if you have great, fantastic, really good collection of talks there just to reiterate again. Please come and speak to our to Our presenters were here. Speak to them in person. Discuss their work. Go on to the post hole. Go look at it. And all the other work that's coming, which is all fantastic. I've been looking for it myself. Or just chat on metal program as well. So there's lots of opportunities to interact and discuss this work further, so thank you very much. But now do we want to reward you for your work? So let's got our president here will be old son who's going to present some certificates for our prize winners. So firstly okay. And, uh, of course is in Brazil. But thank you again to Anna. So just give it. Uh but here in person, we can present Doctor elevator. Oh, please. Fantastic. And mister Big issue Cocky again. Thank you very much. Brilliant. Thank you, Will and congratulations again to our winners in particular, but also to everyone who submitted, and it's a fantastic collection of work. And now academic program will go out with all the abstracts as well, which would conflict through as well. So there's plenty of opportunity to interact and discuss the work that's that's coming. So, uh, without, we'll just move on. So we'll we'll we'll skip any further questions and just please interact so thank you again to our poster winners.