Proficiency-Based Simulation Training for FLS and FES: A Dedicated Two-Week Simulation Curriculum for Junior Surgery Residents

Yangseon Park, MD, Amy Cha, MD, FACS, Gary Korus, MD, FACS, Raghavendra Rao, MD, Christopher Neylan, BA, Jon Morris, MD, FACS, Daniel Dempsey, MD, FACS, Noel Williams, MB, BCh, MCh, FRCSI, FRCS, Kristoffel Dumon, MD, FACS. Perelman School of Medicine University of Pennsylvania

Deliberate learning through simulation training is an essential component of a surgical residency program. The American Board of Surgery requires residents to complete Fundamentals of Laparoscopic Surgery (FLS) and Flexible Endoscopy Curriculum (FEC) training for board certification. However, due to time constraints placed on junior surgical residents, finding time for simulation practice is difficult. The lack of structured and program-tailored curricula utilizing laparoscopic and endoscopic training poses a challenge to residents who wish to maximize the value of their simulation experience. To address these challenges, we designed a dedicated two-week simulation curriculum for junior residents.

Nine PGY-2 residents were individually assigned to a four-week training period. Two weeks were spent on simulation and two weeks on a clinical endoscopic rotation. In the beginning of the program, personalized objectives were identified. Then, an individualized curriculum was developed wherein half of the simulation training time was dedicated for laparoscopic and the other half for endoscopic simulation training. Each trainee received a formative assessment by a dedicated surgical faculty member during his or her simulation practice. The content of the curriculum was built around didactic materials provided by the FLS and FEC, as well as peer-reviewed curriculum pathways for virtual reality training designed to help residents achieve proficiency-based benchmarks.

An individual curriculum was developed for each resident by tailoring a standard content framework to the particular resident’s needs. The two-week simulation curriculum included focused tasks such as the reading of material pertinent to endoscopic surgery, and the performing of simulated cases on a virtual reality trainer. Summative assessment followed each block. After the laparoscopic training block, all trainees reached passing scores of the FLS exam. Completion of simulated endoscopic training during designated simulation time was followed by a two-week clinical endoscopy rotation during which they were evaluated by faculty. To date, five residents who have completed the simulation curriculum and clinical endoscopy rotation passed the Fundamentals of Endoscopy Surgery test.

A structured, individually tailored, proficiency-based simulation curriculum was well received by junior residents and faculty. Dedicated time without clinical obligations enabled junior residents to focus on improving their technical skills in laparoscopic and endoscopic procedures. This simulation curriculum was designed to be feasible for varying degrees of resource and staff availability. A balanced curriculum which is structured and customizable to accommodate individual needs is ideal. Resident and attending assessments will be tracked over time to determine the impact of the curriculum.

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