Resident-led Deliberate Practice Utilizing Simulation

Caitlin A Halbert, DO, MS, Brian Frank, MD, Susan Coffey-Zern, MD. Christiana Care Health System.


Simulation training is becoming standard in most teaching institutions across the country. It is a valuable teaching technique which provides opportunities for residents to learn and practice skills without affecting patient care. Simulation allows residents to practice skills in a deliberate fashion with clear objectives, feedback from someone more expert in the skill set and with proper evaluation, the ability to advance to the next level of skill. This process of deliberate practice allows the resident to focus on their areas of strength and weaknesses. It affords them the opportunity to self-assess and therefore begin the process of life-long learning.

At our institution, residents voiced an interest in spending more time practicing in the simulation center. Deliberate practice sessions were developed by the chief residents based on junior resident self assessment.


General surgery residents were asked to perform a personal needs assessment for technical skills. It was felt that as adult learners, if they were able to identify their own learning needs they would be highly invested in the learning process. Their responses were used to create a series of sessions held in the simulation center. A senior resident and the simulation center education staff organized all sessions.

The sessions followed the American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) surgical skills curriculum, and were modified as needed for each session. A novel session was created for sessions without an appropriate ACS/APDS session.

Attending physicians were present for all sessions proctoring and providing contemporaneous feedback to the residents.


Over the span of six months, five sessions were developed. One session a “trocar placement lab,” utilized a torso box trainer containing a watermelon under the simulated skin as the abdominal wall. The junior residents were able to place the ports for a laparoscopic cholecystectomy with repetitive practice if needed under the guidance and coaching of the senior residents.

Wet labs were developed for many of the sessions. In one session, porcine carotids and jugulars were used to perform closures of arteriotomies with a vein patch.


All sessions were well received by the residents and attendings. Resident self-assessment led to focused deliberate practice sessions. Residents were highly invested in the sessions and given the immediate feedback for skill correction and advancement.

It is often difficult to garner attending participation in simulation sessions due to their busy clinical schedules. However it was clear that attending physicians were more eager to attend sessions when residents sought their participation. Perhaps it was the drive of the residents to further their own education that energized the attendings, making it easy to garner more than expected involvement. Or that they could begin lessons with the residents that would continue into the operating room.

The responsibility of the sessions will be handed down to new chief residents each year. Feedback and residents assessments will be tracked over time to determine the impact of this innovative teaching tool.

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