Dear Sir
It is with great interest that I read the letter Ng et al. (2014) titled ‘Adapt surgical training to the European Working Time Directive', suggesting that there are various means to tackle the impending crisis in surgical training due to the impact of the European Working Time Directive (EWTD). The authors have correctly highlighted that simulation has been demonstrated to be of great value to surgical trainees. This has been suggested in literature, and is recommended by Ng et al. (2014) as a potential route to solving this issue.
Surgical trainees have in the past constructed a variety of low-tech DIY simulators for laparoscopic surgery, for example, as well as practicing various techniques in wet and dry lab settings for quite some years. While there is a trend in simulation training to use more technologically advanced and more complex simulation, this has not been shown to provide any increased benefit over the simpler models (Steigerwald et al. Citation2014). Furthermore, the burden of cost in establishing a valid simulation program, as well as maintaining it is often underestimated, and limits its practical application, especially when placed in the context of strict budgetary controls (Calhoon et al. Citation2014).
Finally, as a surgeon, my first priority is to the patient and to patient safety. I require my training to adequately prepare me for undertaking the operations as a consultant, in order to ensure competence and maintain standards. It is worth noting that there is an increasing trend for trainees to pursue post-training fellowships to achieve that requirement.
As the use of simulation training has increased, so has our understanding of them. I believe that the assumption that the reduced clinical training can be countered by increased simulation is not valid. They are a useful adjunct to training, but cannot replace clinical experience. This issue has arisen by a change in the structure of training due to the EWTD. In order to reach a satisfactory resolution it is necessary, in my view, to address the structure of the program as a whole, rather than make subtle adjustments of unproven efficacy.
Declaration of interest: The author reports no conflicts of interest.
References
- Calhoon JH, Baisden C, Holler B, Hicks GL, Bove EL, Wright CD, Merrill WH, Fullerton DA. 2014. Thoracic surgical resident education: A costly endeavor. Ann Thorac Surg 98:2012–2015
- Steigerwald SN, Park J, Hardy KM, Gillman LM, Vergis AS. 2015. Does laparoscopic simulation predict intraoperative performance? A comparison between the Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics. Am J Surg 209:34–39