B. P. Blackwood1, B. R. Veenstra1, A. Wojtowicz1, S. Pillai1, J. M. Velasco1 1Rush University Medical Center,General Surgery,Chicago, IL, USA
Introduction: Initially, simulation in surgical education merely focused on technical skills. Recently, the application of deliberate practice theory and individualized adult learning has been shown to be relevant in obtaining higher levels of performance, leading to skill acquisition and professional expert development. Our objective was to design, develop, and implement a novel syllabus to educate residents in the operative management of achalasia and pyloric stenosis.
Methods: Kern six-step approach was used to identify objectives, target learner needs and develop individualized learning opportunities. A syllabus, based on Kolb learning theory, was created which included both web based cognitive material and individual reflective assessment. We built an inanimate model replicating upper abdominal and chest structures with mesh and silicone based materials. A fresh, 2.5cm in diameter raw sausage, cored out to a 3mm layer was inserted in either the esophagus or the pylorus, representing the muscular layer. Finally an inflated balloon was placed within the core of the sausage. A senior pediatric surgeon, four general surgeons, and two thoracic surgeons reviewed, tested, and revised the model via an open myotomy simulation. We then evaluated fifteen senior surgery residents.
Results: The cost for construction and assembly of the base model was $289.53. The senior faculty felt that the model provided a reliable and realistic simulation of the key steps required to perform an open myotomy. Residents agreed that this was a high fidelity and realistic model for the practice of performing a myotomy. Furthermore, surgical residents felt inclusion of web based cognitive material followed by individualized assessment on a simulation model facilitated progressive surgical mastery.
Conclusion: Despite changes in surgical education leading to time constraints, surgical residents are still expected to perform advanced surgical procedures. Our model provides a low cost, reproducible, and realistic simulation for residents, easily adaptable to laparoscopy. Furthermore, it allowed us to successfully implement a novel curriculum to address performance of a myotomy as part of the operative management of achalasia and pyloric stenosis. This curriculum lends itself to individualized learning by applying deliberate practice principles in the acquisition of surgical skills in a stepwise fashion, to facilitate advancement to expert state.