U. P. Nag1, S. R. Sprinkle1, M. L. Cox1, M. C. Turner1, R. Sudan1 1Duke University Medical Center,General Surgery,Durham, NC, USA
Introduction: Simulation has become a critical adjunct for surgical education in an era of duty hour restrictions alongside increasing scrutiny on patient safety, quality, and cost containment. Varying modalities, including virtual reality simulators and tissue-based models, have been developed to recreate the operative experience in a low risk environment. We aim to assess resident perceptions of simulation curricula utilizing tissue-based activities compared to dry models.
Methods: A survey was created using Qualtrics (Provo, UT, http://www.qualtrics.com) and distributed to the general surgery residency cohort at a single institution. Anonymous responses were collected from January to February 2016. A mix of dry simulation models (virtual reality laparoscopic trainer, laparoscopic box trainer, vascular anastomosis model and robotic simulator) and tissue based activities (cadaver or live animal lab operations) were assessed. Most questions utilized a corresponding five point Likert scale with space for free-text commentary. Categorical variables were analyzed with chi-squared tests and ordered logistic regressions using SAS (version 9.4; SAS Institute Inc., Cary, NC).
Results: Thirty residents (68.2%) participated in the survey. Every post-graduate year was represented with an 86.7% (26/30) survey completion rate. In aggregate, most residents rated animal (88.5%, 23/26, p<0.0001) and cadaver based activities (80.8%, 21/26, p<0.002) as adequate to very adequate surrogates for assessing technical competencies. Conversely, virtual reality laparoscopic trainers (80.8%, 21/26, p<0.002) and endoscopic trainers (69.2%, 18/26, p<0.05) were rated as neutral to very inadequate surrogates. Among senior residents (clinical years 3-5), only 20% (2/10) rated upper-level simulation sessions as having greater than average value (p=0.06). Among all residents, a curriculum where simulation activities occur solely during junior and lab years was viewed favorable to extremely favorably (69%, 18/26, p<0.05). Subjective commentary reflected residents’ skepticism towards activities that potentially reduce time spent in the operating room, including simulation sessions during the senior operative years.
Conclusion: Resident acceptance of surgical simulation is important in developing a robust curriculum to enhance operative autonomy over the course of training. Based on our institutional survey, residents support the use of tissue-based models and favor concentrating simulation activities in the early clinical years. These resident preferred curricular features have the benefit of introducing core operative techniques in a manner that most closely replicates the operating room experience while allowing advanced techniques to be mastered prior to performing them in actual patients. Further longitudinal evaluation is necessary to correlate participation in such curricula with operative skill and patient outcomes.