Y. N. AlJamal1, N. Prabhakar1, H. Saleem1, M. Baloul1, D. R. Farley1 1Mayo Clinic,General Surgery,Rochester, MN, USA
Introduction: Surgical residents prefer to spend most of their training time doing operations on real patients. Little has been written about training and assessing senior surgical residents on low cost models for both open and laparoscopic surgery. While our simulation education efforts have concentrated on surgical interns, we do assess senior level residents biannually in our simulation center. The cost and educational utility of such an effort to assess open and laparoscopic skills has not been delineated.
Methods: Surgical residents biannually participate in a 59 minute OSCE (Surgical X-Games) consisting of 6 stations. Several stations involve open surgery low-cost task trainers (constructed from felt, yarn, cardboard, etc.) and laparoscopic task trainers (laparoscope, monitor, graspers, plastic box containing felt and cloth made to look like abdominal organs). Skills assessed were open inguinal hernia repair, small bowel anastomosis, and portal vein injury management, and laparoscopic abdominal exploration and enterotomy closure. Performance analysis utilized an objective checklist, and residents provided feedback (Likert Scale 1= negative through 5=positive) regarding the utility of the exercises.
Results: Forty-four GS residents (16 PGY-2s, 8 PGY-3, 10 PGY-4s and 10 PGY-5s) completed the assessment. Performance within and between PGY levels was variable, but PGY 5 trainees outperformed PGY-2s, 3s, and 4s (p<0.05). Although PGY-4 and 3 residents’ skills were comparable (p=NS), they outperformed PGY 2 residents (p<0.05). Material cost for constructing models (IH repair= $3, SB anastomosis=$1.10, PV injury=$1.05, lap abd exploration=$10.50, and lap enterotomy closure=$11.50) was reasonable. Medical student volunteers (free labor) required between 9 minutes (SB anastomosis) and 2 hours (Lap abdominal exploration) for model construction. Models were re-used. Resident feedback suggests the models and activities had utility (Likert scores: range of 3-5, mean=4.5); PGY-5s unanimously disliked the lap enterotomy closure station.
Conclusions: Low cost inanimate models facilitated assessment of surgical residents’ open and laparoscopic surgical skills. Residents felt the models were useful and realistic, and staff found them inexpensive, easy to set up, and durable. We will plan to look for new ways to use this low cost option in our surgical curriculum and specifically find a lap enterotomy closure model that is not so taxing on PGY-5s.