Development and Implementation of an Animal Laparoscopic Simulation Curriculum for Urology Training Programs


Authors: A. C. Peterson
Authors‘ workplace: Lieutenant Colonel, Medical Corps, United States Army, Program Director, Urology Residency, Assistant Professor of Surgery, Uniformed Services University of the Health Sciences (USUHS), Madigan Army Medical Center, Tacoma, Washington
Published in: Urol List 2009; 7(4): 39-45

Overview

Purpose:
The Accreditation Council for Graduate Medical Education (ACGME) in the US work hours restrictions and the Calman report in Europe brought the end to the tradition of long hours in the career path for junior doctors. As a consequence, surgical skills may have to be acquired partly outside the operating room, in a simulated environment. Herein we provide an overview of the status of surgical simulation in medical education including inanimate simulators, computer based simulators, virtual reality simulators and the use of animals. We will discuss implementation of a surgical skills curriculum using a combination of inanimate, computer and animal models. We will also describe the use of animal models to augment surgical simulation for resident education.

Materials and Methods:
We developed a progressive surgical simulation curriculum involving didactic instruction, inanimate simulation with assessment of skills and animal simulation. Animals provide the advantages of natural tissue handling characteristics, difficult to emulate complications such as bleeding and physiologic movement and natural haptic feedback. We developed score sheets for all procedures performed including laparoscopic nephrectomy, partial nephrectomy, adrenalectomy, complications, and open urinary diversion. We record 360 degree evaluations from all ancillary staff involved in the realistic training, after action review results and surgical times for each procedure and all the steps within each procedure to record progress and skills improvement.

Results:
This progressive approach affords multiple opportunities for resident skills evaluations to address advancement and improvement throughout residency. Our data indicate significant resident progression throughout the curriculum. Senior and chief residents score higher than do junior residents obtaining “exceeds expectations” in all aspects of the 360 degree evaluations. Junior residents will have multiple “meets expectations” scores in all domains of the 360 degree evaluation. The time to complete a laparoscopic nephrectomy for senior and chief residents averages 188 minutes. The junior residents complete the procedure in 288 minutes. All components of the operation take longer without a specific improvement in one section of the operation.

Conclusions:
The airline industry, military and athletics all use simulation and there is increasing pressure to revamp medical education with simulation playing a larger role. Simulation may allow the trainee to progress significantly along the learning curve of an operation before they perform the procedure on a human patient. Additionally, training residents with simulation may allow us to better understand how surgeons acquire skills and therefore help us to more effectively train the next generation of surgeons.

Key words:
simulation in urology, rezident training, education curriculum


Sources

1. Nauta RJ: Five uneasy peaces: perfect storm meets professional autonomy in surgical education. J Am Coll Surg 2006; 202(6): 953–966.

2. Charlton BG. Service implications of the Calman re­port. BMJ 1993; 307(6900): 338–339.

3. Kelty C, Duffy J, Cooper G. Out-of-hours work in cardiothoracic surgery: implications of the New Deal and Calman for training. Postgrad Med J 1999; 75(884): 351–352.

4. Proposed General ACGME Requirements for Resi­dent Duty Hours and Supervision. Neurocirugia (Astur ) 2002; 13(2): 154.

5. Brasher AE, Chowdhry S, Hauge LS et al. Medical students' perceptions of resident teaching: have duty hours regulations had an impact? Ann Surg 2005; 242(4): 548–553.

6. Greenfield LJ. Limiting resident duty hours. Am J Surg 2003; 185(1): 10–12.

7. Richardson JD. Training of general surgical residents: what model is appropriate? Am J Surg 2006; 191(3): 296–300.

8. Kaiser LR, Mullen JL. Surgical education in the new millennium: the university perspective. Surg Clin North Am 2004, 84(6): 1425–1439.

9. Gomoll AH, Pappas G, Forsythe B et al. Individual skill progression on a virtual reality simulator for shoulder arthroscopy: a 3-year follow-up study. Am J Sports Med 2008; 36(6): 1139–1142.

10. Training and simulation. Minim Invasive Ther Allied Technol 2001; 10(2): 67–74.

11. Aggarwal R, Balasundaram I, Darzi A. Training opportunities and the role of virtual reality simulation in acquisition of basic laparoscopic skills. J Surg Res 2008; 145(1): 80–86.

12. Sewell C, Morris D, Blevins N et al. Quantifying risky behavior in surgical simulation. Stud Health Technol Inform 2005; 111: 451–457.

13. Korndorffer JR jr., Dunne JB, Sierra R et al. Simu­lator training for laparoscopic suturing using perfor­mance goals translates to the operating room. J Am Coll Surg 2005; 201(1): 23–29.

14. Heinrichs WL, Lukoff B, Youngblood P et al. Crite­rion-based training with surgical simulators: proficiency of experienced surgeons. JSLS 2007; 11(3): 273–302.

15. Sturm LP, Windsor JA, Cosman PH et al. A systematic review of skills transfer after surgical simulation training. Ann Surg 2008; 248(2): 166–179.

16. Gallagher AG, Ritter EM, Champion H et al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 2005; 241(2): 364–372.

17. Adrales GL, Chu UB, Hoskins JD et al. Develop­ment of a valid, cost-effective laparoscopic training program. Am J Surg 2004; 187(2): 157–163.

18. Fried MP, Satava R, Weghorst S et al. Identifying and reducing errors with surgical simulation. Qual Saf Health Care 2004; 13 Suppl 1: i19–26.

19. Aucar JA, Groch NR, Troxel SA et al. A review of surgical simulation with attention to validation methodology. Surg Laparosc Endosc Percutan Tech 2005; 15(2): 82–89.

20. Vlaovic PD, McDougall EM. New age teaching: beyond didactics. ScientificWorldJournal 2006; 6: 2370–2380.

21. Brunner WC, Korndorffer JR jr., Sierra R et al. Determining standards for laparoscopic proficiency using virtual reality. Am Surg 2005; 71(1): 29–35.

22. Matsumoto ED, Hamstra SJ, Radomski SB et al. A novel approach to endourological training: training at the Surgical Skills Center. J Urol 2001; 166(4): 1261–1266.

23. Chou B, Handa VL. Simulators and virtual reality in surgical education. Obstet Gynecol Clin North Am 2006; 33(2): 283–296.

24. Kenton K. How to teach and evaluate learners in the operating room. Obstet Gynecol Clin North Am 2006; 33(2): 325–332.

25. Lahtinen TM, Koskelo JP, Laitinen T et al. Heart rate and performance during combat missions in a flight simulator. Aviat Space Environ Med 2007; 78(4): 387–391.

26. McDougall EM. Validation of surgical simulators. J Endourol 2007; 21(3): 244–247.

27. Wignall GR, Denstedt JD, Preminger GM et al. Surgi­cal simulation: a urological perspective. J Urol 2008; 179(5): 1690–1699.

28. Paisley AM, Baldwin PJ, Paterson-Brown S. Validity of surgical simulation for the assessment of operative skill. Br J Surg 2001; 88(11): 1525–1532.

29. Spencer FC. Deductive reasoning in the lifelong continuing education of a cardiovascular surgeon. Arch Surg 1976; 111(11): 1177–1183.

30. Matsumoto ED, Kondraske GV, Ogan K et al. Asses­sment of basic human performance resources predicts performance of ureteroscopy. Am J Surg 2006; 191(6): 817–820.

31. Kopta JA. The development of motor skills in ortho­paedic education. Clin Orthop Relat Res 1971; 75: 80–85.

32. Coxon JP, Pattison SH, Parks JW et al. Reducing human error in urology: lessons from aviation. BJU Int 2003, 91(1): 1–3.

33. McClusky DA 3rd, Smith CD. Design and development of a surgical skills simulation curriculum. World J Surg 2008; 32(2): 171–181.

34. Afrin LB, Arana GW, Medio FJ et al. Improving oversight of the graduate medical education enterprise: one institution's strategies and tools. Acad Med 2006; 81(5): 419–425.

35. Gordon JA, Oriol NE, Cooper JB. Bringing good teaching cases "to life": a simulator-based medical education service. Acad Med 2004; 79(1): 23–27.

36. Dunkin B, Adrales GL, Apelgren K et al. Surgical simulation: a current review. Surg Endosc 2007; 21(3): 357–366.

37. Valentine RJ, Rege RV. Integrating technical competency into the surgical curriculum: doing more with less. Surg Clin North Am 2004; 84(6): 1647–1667.

38. MacDonald J, Williams RG, Rogers DA. Self-asses­sment in simulation-based surgical skills training. Am J Surg 2003; 185(4): 319–322.

39. Rowan AN. The concept of the three R's. An introduction. Dev Biol Stand 1980; 45: 175–180.

40. Traxer O, Gettman MT, Napper CA et al. The impact of intense laparoscopic skills training on the operative performance of urology residents. J Urol 2001; 166(5): 1658–1661.

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Paediatric urologist Urology

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