Editorial
Development of a Surgical Simulation Curriculum on a Limited Budget. How can we survive with Minimal Resources?
Roberto Jose Rivero-Soto1, Vanita Ahuja1*, Ebondo Mpinga2, Zarrin Hossein-Zadeh1 and JoAnn
Coleman1
1Department of General Surgery, Sinai Hospital, USA
2Departement of General Surgery, Wellspan Health Trauma & Critical Care Surgery, USA
*Corresponding author: Vanita Ahuja, Department of General Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD 21215, USA
Published: 06 Feb, 2018
Cite this article as: Rivero-Soto RJ, Ahuja V, Mpinga
E, Hossein-Zadeh Z, Coleman J.
Development of a Surgical Simulation
Curriculum on a Limited Budget.
How can we survive with Minimal
Resources?. Clin Surg. 2018; 3: 1900.
Editorial
With increasing focus on safety in today’s Medicine, surgical trainees have limited time
and exposure to the operating room [1]. Furthermore, residents are required to demonstrate
competency and proficiency prior to participating in patient care including operations. This has led
to the development of simulation skill centers that can be used for both training and assessment of
competency of surgical trainees. In this paper, we focus on simulation skill development team based
training to enhance the learning experience of surgical trainees as well as determining the necessary
budget needed to establish a long-lasting organized educational system. This requires inspection of
the multiple characteristics required to create an outstanding program. Goals include development
of a cost effective simulation curriculum for all levels of surgical training. Designing low-budget
models that address all essential aspects of surgery education. Creation of team based training
clinical scenarios that allow participants to correlate simulated situations with real life clinical
scenarios. Simulation skill system is a way in which residents and fellows are exposed to clinical
situations prior to encountering them. The Food and Drug Administration has supported the role of
simulation over many years [2]. Simulation skill systems used in other fields such aviation, military
training and other medical subspecialties have shown beneficial outcomes and are well stablished
practices during training. Cardiopulmonary resuscitation is a great example of a simulation skill
system that has significantly changed the practice of ACLS as well as increased positive results in
patients. Other well stablished simulation skill models include laparoscopic surgery and orthopedics
surgery [3]. A recent study demonstrated a positive impact of simulation skill models and the
application of learned skills in the operating room. Performance in knee arthroscopy was evaluated
in 2 different groups, one exposed to simulated skill training and another group that was not
exposed. Motion analysis performed in the operating room and objective test identified the efficacy
and amount of hand movements as well as the utilization of single movements to accomplish the
goal of interest [4].
For a simulation skill development team based training system we propose an animal tissue,
cadaveric, and dry model that is cost-effective and attainable even on a fixed budget. Benefits of
a team based oriented training program ensures more experienced trainees to educate incoming
ones, further sub-dividing the learning phases into basic skills, advances procedures and team based
training (ACS Surgical Curriculum). Ideally, in order to have a satisfactory start, variables that need
to be taken into consideration include:
1. Developing a curriculum that is adequate for each PGY level as well as pre-determined
skill expectations to advance further to the next level.
2. Starting with the most basic tasks and skills and increment the complexity in a personalized
but uniform pace.
3. Allow self-practice time that helps individual trainees to work on specific weaknesses
identified during team based training.
4. Developing specific short and long term goals that can be accomplished with predetermined
budget and timeframe. This provides enough repetition and feedback for learners.
5. Development of checklists and objective test that can better measure both knowledge and skills.
6. Development of a system that can carry on with excellence
overtime requires significant dedication and preparation. One of the
major limitations for maintenance of simulation skills development
system is financial. Henry proposed an annual cost for animal tissue
$ 11.894, cadaveric models $ 72,050, and dry models $ 26,352. This
budget does not include the cost of simulators. In order to reduce
the cost and increase the productivity of the program some of the
following should be taken into consideration:
Identification and training of instructors: Including
engagement of an expert in the field, using PGY- IV and V as
instructors, understanding and mastering of the critical steps in the
different skills taught, clear goals and expectations.
Development of evaluation tools: Different levels of training
require different assessment tools. Student evaluations that include
formative criteria, improvement performance and learning pitfalls.
Also summative criteria to determine competency and theoretical
knowledge. Skills improvement that allow more practice and exercise.
Development of new areas of interest and recognition of needs to be
addresses and studied.
Instructor lectures and student presentations: To reinforce
teaching points inside and outside the lab, to answer questions or
topics not mentioned during training. Discussion of experiences and
possible suggestions.
Instructors debrief: To identify trainees’ deficiencies that may
require more lab training and possible measures to improve the
current simulation model being used.
Graduate learners to practice acquired skills in a higher level
of context: To combine clinical scenarios where learned skills can
be performed. This helps trainees to stay engaged, test the ability to
apply medical knowledge and acquired skills under a clinical setting,
allowing further analyzing results from simulation skill learning
models versus other techniques.
Repetition: Practice is the key to performance. Objective tests
should be used to assess exposure and repetition needs in individual
trainees.
Use of free resources: Re-use of equipment that does not
violate safety regulations. Use of donated equipment by company
representatives such sutures and staplers. Use of expired sutures
and supplies that would not be used otherwise. Use of clinical cases
seems in real life scenarios to recreate simulations. Use of interesting
imaging studies such CT scans, MRIs and X-rays to educate and
develop management and care if such scenarios.
Perseverance: Great performers spend great amount of time
behind the scenes improving skills and learning more. Motivate other
participants to develop an environment of healthy competition in
which everyone is pushed to move forward and be prepared for more
challenging cases.
Learning points: In order to create a long-lasting and efficient
simulation skill system, it is important to understand the amount
of resources available to be able to develop a system that it is selfsustained
based on team training in which trainees become the
trainers as they develop their surgical knowledge and skills. Also, it
is very important to develop a comprehensive evaluation system that
allows educators to assess the progress and development of residents.
References
- Akhtar KSN, Chen A, Standfield NJ, Gupte CM. The role of simulation in developing surgical skills. Curr Rev Musculoskelet Med. 2014;7(2):155-60.
- Scott DJ, Cendan JC, Pugh CM, Minter RM, Dunnington GL, Kozar RA. The changing face of surgical education: simulation as the new paradigm. J Surg Res. 2008;147(2):189-93.
- Butler A, Olson T, Koehler R, Nicandri G. Do the skills acquired by novice surgeons using anatomic dry models transfer effectively to the task of diagnostic knee arthroscopy performed on cadaveric specimens? J Bone Joint Surg Am. 2013;95(3):e15(1-8).
- Howells NR, Gill HS, Carr AJ, Price AJ, Rees JL. Transferring simulated arthroscopic skills to the operating theatre: a randomized blinded study. J Bone Joint Surg Br. 2008;90(4):494-9.