Integrating simulation into a busy residency program

Abstract

A mandatory program of computer‐driven simulation training was instituted in a medium‐sized surgical training program in order to achieve the goal of increased resident performance outside the setting of direct patient care. Postgraduate year (PGY) 1–5 residents received mentored instruction on a virtual reality (VR) laparoscopic surgical trainer in performance of specific tasks appropriate to training level. Training for PGY 1–2 residents consisted of basic manipulative VR tasks. Training for PGY 3–5 residents consisted of VR suturing and intracorporeal knot‐tying tasks. Each resident received two to four mentored one‐hour sessions, and was instructed to return for self‐directed practice during blocked and unscheduled time. PGY 3–5 residents had laparoscopic suturing and knot‐tying skills evaluated in an animal model prior to onset of VR training and two to four months after start of training. After seven months of availability of training, PGY 1–2 residents had undertaken significantly more training sessions than PGY 3–5 residents (18±3 vs. 9±2; p<0.01). All PGY 1–2 residents demonstrated improved task performance, and six achieved expert performance relative to experienced laparoscopic surgeons. The suturing task in the animal lab was accomplished faster post‐training (91±9 seconds vs. 154±16 seconds; p<0.01). Early results suggest that broadly applied VR training is of significant benefit in increasing resident technical skills. Based on early success, a broader program of computer‐based simulation has been implemented, using more advanced devices for technical skills training, and a human patient simulator for training critical decision‐making skills.

• Medical simulation
• virtual reality
• surgical education
• laparoscopic surgery
• skills training