J. Balaban1, L. Burkhalter3, D. Diesen2,3 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2University Of Texas Southwestern Medical Center,Department Of Surgery,Dallas, TX, USA 3Children’s Medical Center,Dallas, Tx, USA
Introduction:
Evidence shows simulation in surgical education improves laparoscopic and thoracascopic skills in a safe environment, while increasing physician competency and efficiency. Additionally, studies demonstrate simulation-based education improves patient safety and outcomes. Despite enhancing the learning curve and technical skill of the fellows, there is minimal data to show how the addition of a simulation curriculum changes practice patterns. The purpose of this study was to evaluate the impact of a simulation-based education curriculum on the volume of minimally invasive surgery (MIS) cases performed within a division.
Methods:
After IRB approval, we performed a retrospective review of MIS cases performed in children less than one year of age. Inclusion criteria were thoracascopic and laparoscopic cases performed in the 2 years pre (6/2013-6/2015) and post (6/2016-6/2018) implementation of a simulation-based education curriculum for fellows. Patients were identified by billing codes and verified in EPIC. Data points included demographics and outcome variables. For both groups, any thoracoscopic or laparoscopic case was considered MIS, while complex MIS cases excluded isolated inguinal hernia repairs, gastrostomy tube placements, and pyloromyotomies.
Designed to improve technical and nontechnical skills, this curriculum consisted of 8-10 simulation sessions covering different complex MIS procedures, all of which were proctored by two clinical faculty. The curriculum has since been integrated into the fellowship curriculum.
Results:
Between 2013- 2015, 1,407 children less than one year of age had operations. 261 (18.6%) of those were MIS. 51 (3.6%) were complex MIS. Between 2016 -2018, 1,348 children less than one year of age had procedures. 441 (32.7% of total) of those were MIS. 125 (9.3%) were complex MIS. Following the implementation of the curriculum, the amount of total MIS cases increased by 1.76-fold, while the amount of complex cases increased by 2.56-fold.
Conclusion:
Implementation of a simulation curriculum corresponded with an increase percentage of cases being performed minimally invasively in infants with a corresponding increase in the percentage of complex cases done minimally invasively. This suggests that SBE curriculum may have advantages to divisions, departments and hospitals, in addition to the educational benefits to the trainee
