Surgical simulation: Current practices and future perspectives for technical skills training

Abstract

Simulation-based training (SBT) has become a standard component of modern surgical education, yet successful implementation of evidence-based training programs remains challenging. In this narrative review, we use Kern’s framework for curriculum development to describe where we are now and what lies ahead for SBT within surgery with a focus on technical skills in operative procedures. Despite principles for optimal SBT (proficiency-based, distributed, and deliberate practice) having been identified, massed training with fixed time intervals or a fixed number of repetitions is still being extensively used, and simulators are generally underutilized. SBT should be part of surgical training curricula, including theoretical, technical, and non-technical skills, and be based on relevant needs assessments. Furthermore, training should follow evidence-based theoretical principles for optimal training, and the effect of training needs to be evaluated using relevant outcomes. There is a larger, still unrealized potential of surgical SBT, which may be realized in the near future as simulator technologies evolve, more evidence-based training programs are implemented, and cost-effectiveness and impact on patient safety is clearly demonstrated.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Flemming Bjerrum

Flemming Bjerrum is a M.D. and has completed a Ph.D in surgical simulation for laparoscopy with focus on the need for procedure-specific training. His research area is technical skills training with focus on minimal invasive surgery and instructional design.

Ann Sofia Skou Thomsen

Ann Sofia Skou Thomsen is a M.D. and has completed a Ph.D. in assessment and skill transfer in microsurgery. She is associated with CAMES and Department of Ophthalmology, Copenhagen, Denmark. Her research interests include identifying best practices in training and assessment of complex technical skills within simulation-based environments.

Leizl Joy Nayahangan

Leizl Joy Nayahangan is a registered nurse with a Master’s degree in Healthcare Management. She is a full time researcher at the Copenhagen Academy for Medical Education and Simulation (CAMES) where she studies curriculum development in simulation.

Lars Konge

Lars Konge is a certified cardio-thoracic surgeon and the head of research at the Copenhagen Academy for Medical Education and Simulation (CAMES). He has a Ph.D. in assessment and his main research areas are simulation-based training and certification of technical skills.