Successful Implementation of the American College of Surgeons/Association of Program Directors in Surgery Surgical Skills Curriculum via a 4-Week Consecutive Simulation Rotation

Division of Surgery Education, Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, PA, USA.
Simulation in healthcare: journal of the Society for Simulation in Healthcare (Impact Factor: 1.48). 02/2012; 7(3):147-54. DOI: 10.1097/SIH.0b013e31824120c6
Source: PubMed


Increased patient awareness, duty hour restrictions, escalating costs, and time constraints in the operating room have revolutionized surgery education. Although simulation and skills laboratories are emerging as promising alternatives for skills training, their integration into graduate surgical education is inconsistent, erratic, and often on a voluntary basis. We hypothesize that, by implementing the American College of Surgeons/Association of Program Directors in Surgery Surgical Skills Curriculum in a structured, inanimate setting, we can address some of these concerns.
Sixty junior surgery residents were assigned to the Penn Surgical Simulation and Skills Rotation. The National Surgical Skills Curriculum was implemented using multiple educational tools under faculty supervision. Pretraining and posttraining assessments of technical skills were conducted using validated instruments. Trainee and faculty feedbacks were collected using a structured feedback form.
Significant global performance improvement was demonstrated using Objective Structured Assessment of Technical Skills score for basic surgical skills (knot tying, wound closure, enterotomy closure, and vascular anastomosis) and Fundamentals of Laparoscopic Surgery skills, P < 0.001. Six trainees were retested on an average of 13.5 months later (range, 8-16 months) and retained more than 75% of their basic surgical skills.
The American College of Surgeons/Association of Program Directors in Surgery National Surgical Skills Curriculum can be implemented in its totality as a 4-week consecutive surgical simulation rotation in an inanimate setting, leading to global enhancement of junior surgical residents' technical skills and contributing to attainment of Accreditation Council for Graduate Medical Education core competency.

Download full-text


Available from: Mayank Mittal, Jun 28, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Surgical skills laboratories have gained widespread use in surgery residency training. Although the availability of simulators and skills laboratories has expanded, little is known about their use and effect on residency training. Methods: An online survey consisting of 18 questions was distributed to all members of the Association of Program Directors in Surgery. The survey addressed surgical skills laboratory funding, types of simulators, curricula, tools for evaluation, and opinions on successful implementation of a skills laboratory. Statistical analysis was performed on data obtained from completed surveys. Results: A total of 248 programs were invited to respond to the survey, and 81 responses were obtained (33% response rate). Among programs that responded, most mandate time for residents to use their skills laboratory (76%), and most offer a formal curriculum (63%). Few programs require demonstrated proficiency before participating in the operating room (16%), and only 55% of responders believed that their resident's overall intraoperative technical skills had improved since the implementation of their skills laboratory. Respondents believed that interns derive the most benefit from their skills laboratory when compared with all other years of surgical training (P < 0.001). Faculty participation was most commonly considered as the most important factor for successful implementation of a surgical skills laboratory, regardless of program characteristics. Conclusions: Among surgical residency programs that responded to the survey, most programs schedule time for residents to use a skills laboratory, and most use a curriculum. Those surveyed report that interns derive the most benefit, whereas chief residents derive the least. They also believe that faculty participation is the most important aspect to successful implementation of a skills laboratory.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 01/2013; 8(2). DOI:10.1097/SIH.0b013e318276306e · 1.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The traditional surgical training in the operating room (OR) is often complemented by participation in workshops and on simulators. The foundation Vascular International offers basic courses for vascular surgery techniques with training on pulsatile circulation, lifelike anatomical models. The aim of this study was to assess the efficacy of a 2.5-day intensive course on basic skills in vascular surgery. MATERIAL AND METHODS: A total of 24 participants (67% male with an average age of 35 years) performed a vein patch-plasty before and after the basic vascular surgery instruction course. Endpoints of the study were the time needed for suturing and the technical quality, which were evaluated by two course trainers on a scale of 0-10. Furthermore, the participants were asked to evaluate their own technical competence. The statistical analysis was carried out using MS Excel (t-test and analysis of correlation). RESULTS: A significantly shortened time for the suturing (19.5 min versus 14.1 min, p < 0.001) and improved quality of the vein patch were found after the workshop (p < 0.05) with a high correlation between the two observers (r = 0.885). The participants also evaluated their own surgical competence better at the end of the training but there was no correlation between the self-assessment and the quality of the patch (r = 0.146 before and r = 0.109 after the workshop). CONCLUSIONS: A significant improvement in the time needed for suturing and the quality of the vein patch-plasty was shown in this study. Further studies are necessary to demonstrate the long-term success and possible shortening of the learning curve in hospitals with professional training. With regard to the current curriculum of surgical trainees in Germany basic vascular surgery courses should be considered as a potential valuable part of the surgical common trunk.
    Der Chirurg 01/2013; 84(2). DOI:10.1007/s00104-012-2395-6 · 0.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite its short history, surgical simulation has been successfully introduced into surgical residency programs in an effort to augment training. A wide range of simulator types and levels of complexity have proven an effective teaching method for surgical trainees. They have been used for training in areas such as general surgery, urology, gynecology, and ophthalmology among others. Coincident with the introduction of simulators is the need for objective evaluation of skills learned on them, which has led to the development and validation of multiple evaluation tools. This article evaluates the drivers for simulation, types of simulators, training, and evaluation of them especially as it pertains to laparoscopic colorectal surgery.
    Clinics in Colon and Rectal Surgery 03/2013; 26(1):47-55. DOI:10.1055/s-0033-1333661
Show more