Surgical simulation has come to the forefront of surgical education in recent years. The combination of new technology, the importance of surgical safety and the implementation of the ACGME duty hours have contributed to highlight the importance of surgical simulation as an adjunct to surgical training. The restrictions placed on resident duty hours have modified the quality of education received by residents and decreased the amount of exposure in the operating room, thus impacting on residents’ autonomy.
The traditional apprenticeship model of surgical training has been altered profoundly in modern training practices. There is a struggle present in modern surgical education between achieving high-quality patient care and providing high-quality education to surgical trainees. Surgical simulation offers a safe environment for trainees to perform new surgical skills and practice without fear of committing errors. Motor skills are learned and developed in a three stage approach:
- Cognitive
- Integrative
- Autonomous
The final, autonomous stage is reached when a learner can execute a task in a fluid manner without having to think about the distinct steps (Resnick RK, et al. Teaching Surgical Skills – Changes in the Wind. NEJM 2006;355:2664-9).
The RUSH Center for Clinical Skills and Simulation is devoted to providing resources for surgeons to train in established, minimally invasive methods and to develop and test incorporation of new technologies. In addition, it provides the ideal environment for multidisciplinary team training and for implementation of patterns of care leading to enhanced patient safety.
The surgical simulation program is specially designed to meet the need for surgical training with an exclusive focus on the learner. The program provides an expert resource to train in a laboratory, complete with multiple simulation opportunities, helping physicians to become adept at these new and sophisticated procedures even before they enter the operating room. The development of goals and objectives is done by faculty in collaboration with the simulation center personnel.
Cognitive and psychomotor skills are taught and assessed by the development and implementation of a curriculum that includes web based didactic components, videos, and checklists. Workshops carried out in the center allowed for formative and summative assessments.
Affective skills such as communication, interpersonal skills, and professionalism are taught in small groups. Assessment of learners in the HSSC is based primarily on direct observation of performance, rated by means of checklists and/or rating scales. Team training skills are taught by participating in simulation workshops and are multidisciplinary in nature. Anesthesia, nursing and surgery members participate in a simulated operative procedure where a crisis situation develops. Video recording of performance facilitates debriefing by faculty immediately following completion.
The RCCSS offers a series of laparoscopic training courses that are incorporated into the curriculum for general surgery residents and medical students. The surgical curriculum includes the following courses:
- Basics of Laparoscopy
- Update on the Management of Groin Hernias: Open and Laparoscopic
- Emergency Surgical Airway Management
- Ultrasound Guidance for Central Venous Access
- Techniques in Ultrasound Guided Procedures
- Open and Laparoscopic Basic Suturing Techniques: Intestinal Anastomosis, Vascular and Soft Tissue
- Fundamentals of Ultrasound for Surgeons: Abdomen, Thyroid, Breast
- FLS, FES
- Upper and Lower Gastrointestinal Endoscopy
- Team training and affective skills scenarios