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


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.

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.

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


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