Simulation in Surgical Training
10.30 Hall 1A Tuesday 2nd July 2013
Dr Neil Ellis, Jr., MD, FACS, FASCRS, Chief of Surgery, VA Gulf Coast Veterans. Health Care System, Mississippi, USA
Simulation in medicine is used to compliment the education and training of medical practitioners. Its stated goal is to provide the methodology where a medical practitioner will never be faced with a situation in clinical practice that they have not practiced. Most believe that simulation will improve the quality of healthcare.
The governing body for the training of physicians in the United States has defined 6 core competencies that trainees must demonstrate proficiency with to complete their medical training. Technical skills are a component of the patient care competency that is of special interest to surgeons. When developing simulation for teaching and assessing technical skills, key elements include the curriculum, metrics and simulation platform. The curriculum is the first component. Controversies include partial vs whole task simulation and the role of playing video games. The best outcomes with simulation occurr when there is simulation based pre-training, concurrent simulation training to augment conventional instructional methods and periodic additional repetitions and post training reinforcement. Studies have shown no difference between instructor directed and self-directed learning or feedback provided by an instructor or by training software.
Once the curriculum has been determined, metrics and a simulation platform can be selected. Simulation can be based on cadaver or animal models, box trainers and augmented or virtual reality systems. As there is no one ideal simulation platform, a successful simulation program must use a different simulation platform for various aspects of the curriculum. Most training centers teach and assess basic technical skills using box or augmented/virtual reality platforms while augmented/virtual reality simulators and cadaver and animal models are used for teaching complex surgical skills to more advanced learners.
Ideally, a simulation program should be valid and reliable. Reliability is the extent to which a simulation program gives results that are reproducible while validity is the extent to which it achieves what it claims to achieve. Construct validity refers to the extent to which the simulation program does actually measure technical skill. Content validity involves the systematic examination of the program content to determine whether it is comprehensive. Face validity assesses whether a simulation program appears to measure technical skill. Criterion validity compares surgical simulation with other measures or outcomes already held to be valid. Predictive validity refers to the degree to which the results with the simulation program can predict other measures of surgical skill that are measured at some point in the future.
The value equation in medicine has 3 components; safety, efficacy and cost. Development and introduction of simulation based training into the education of medical practitioners has the potential to greatly enhance the safety of patients who receive care in our teaching hospitals. An effective simulation based program also has the potential to significantly decrease the time required and costs associated with the training of medical practitioners and provide value to the entire healthcare system. However, to achieve these goals, extensive research is needed to define the curriculum and metrics of a reliable and valid simulation program and to develop the technologies necessary for these programs.