The Successful Development and Implementation of a Novel, Acute Care Surgical Simulation Pathway Training Curriculum

Kiyoyuki W Miyasaka, MD, Joseph M Buchholz, BS, Niels D Martin, MD, FACS, Denise LaMarra, MS, Noel N Williams, MB, BCh, MCh, FRCSI, FRCS, Jon B Morris, MD, Rajesh Aggarwal, MD, PhD, MA, FRCS. Perelman School of Medicine at the University of Pennsylvania.

The role of simulation in surgical education is to provide an efficient training method that improves patient safety by better preparing trainees prior to actual clinical encounters.  Integrating nontechnical skills, such as communication and decision-making, is equally important to teaching conventional technical skills. We designed and implemented a PGY-1 surgical simulation training curriculum concentrated on developing both technical and nontechnical surgical skills utilizing a dynamic acute care surgical patient across the entire care continuum: pre-op, intra-op, and post-op.

Over a 3 day period, trainees were exposed to case-based simulations and didactics using Standardized Patients (SP). At the beginning and end of the 3 day module, there was a comprehensive and summative session, providing proficiency assessments of resident performance in the pre-op, intra-op, and post-op phases of care. Residents completed each phase in succession. First, the resident interacted with a SP presenting with acute appendicitis in the emergency department. Following that encounter, they immediately went to the intra-op phase where they performed a laparoscopic appendectomy. This phase was held in a high-fidelity simulated operating room that included a confederate anesthesiologist, a confederate scrub tech, and utilized a synthetic retrocecal appendix model contained within a phantom abdomen. Following the intra-op phase, the resident performed a post-op visit with the SP presenting with a normal course on post-op day 1. Resident performance during each phase of the pathway was rated by a faculty member, resident self-assessment, and the SP. Bracketed by the summative pathway sessions were formative sessions designed to improve resident knowledge and skill when managing an acute care surgery patient. These sessions were comprised of didactic lectures, SP encounters, and hands-on technical skills sessions.

Five residents have completed the training module. Faculty perception of resident performance for each phase of care showed improvement. Mean overall improvements for each phase were (before training to after training): Pre-op 3.4 to 3.8 (out of 5); Intra-op 2.0 to 2.2 (out of 5); Post-op 5.8 to 7.2 (out of 9). The resident self-assessments also showed improvements: Pre-op 3.0 to 3.8; Intra-op 2.0 to 3.2; Post-op 6.2 to 7.4.

A pathway based surgical simulation training curriculum targets an important gap in current surgical simulation training methodologies by linking the individual components of a disease process and management. The results of our innovative and unique curriculum indicated an improvement in intern performance across the entire surgical care pathway, likely through stronger learning associations and retention of knowledge due to the more-realistic pathway experience.

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