B. R. Veenstra2, A. Wojtowicz1, N. Walsh1, J. Velasco1,2 1Rush University Medical Center,Center For Clinical Skills And Simulation,Chicago, IL, USA 2Rush University Medical Center,Department Of General Surgery,Chicago, IL, USA
Introduction: With the current duty hour restrictions in effect for 10 plus years, the consequences in terms of resident training and skill acquisition, specifically those in the surgical disciplines, are just coming to light. In recent years, studies have suggested that some general surgery chiefs are graduating without the ability to independently complete routine general surgery cases (ie laparoscopic cholecystectomy). As academic surgeons, this should make us question our current system of training, that which was implemented by Halsted so many years ago. Gradually, this call is being answered by investing more time, effort, and money into surgical simulation. Various modalities are available, from trainer boxes to virtual reality simulators to cadaver and animal labs, but no clear consensus exists as to which is most effective. With healthcare becoming ever more cost conscious, it is important to take note of not only the effectiveness of each of these modalities, but the cost as well.
Methods: Using both surgical and moulage expertise, we constructed four inanimate models: a carotid endarterectomy, laparoscopic vena cava repair, laparoscopic inguinal hernia repair and laparoscopic para-esophageal diaphragmatic hernia repair. Our focus was to create a realistic and tactile experience in the lab for residents, while taking cost into consideration. All models were revised and validated by a core group of attending surgeons. Seven PGY-5, six PGY-4, and two PGY-3 residents participated in an inaugural inanimate simulation lab and provided feedback through pre and post surveys.
Results: All participants agreed that the four inanimate models were accurate representations of the anatomy, and were worthwhile in their surgical training. When looking at the cost of creating and using our inanimate models, we found our cost to be less than both those associated with virtual simulation and animate models (See Table 1). Compared to animate models (ie cadavers), all four inanimate models are a small fraction of the cost, a mere 8.5-22.5%. Similarly, our inanimate models are only 0.1-0.5% of the cost of virtual reality simulators, whose costs range from $94,000-$100,000.
Conclusion: As we continue to modify and improve upon the traditional, Halsted method of surgical training, it is clear that simulation will play an increasingly larger role. We propose that inanimate surgical models provide a cost effective avenue that help bridge the existent gap between cognitive learning and psychomotor skill training, as produced by the duty hour restrictions.
