K. W. Miyasaka1, R. Aggarwal2 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 2McGill University,Department Of Surgery,Montreal, QC, Canada
Introduction: Approaches to simulation education in surgery have traditionally focused on technical skills, recreating isolated aspects of operative or procedural situations. However, clinical practice is a patient-centered continuum of care, and competence consists of a blend of both technical and non-technical skills. In order to deliver an educational experience that is realistic and relevant to clinical practice, we implemented a curriculum built around “pathways” – simulated sequences of preoperative, intraoperative, and postoperative encounters – for first-year general surgery residents.
Methods: The pathway simulation begins with residents seeing a standardized patient (SP) in clinic, performing a preoperative evaluation and consent. They proceed to an operating room containing a procedure-specific porcine or synthetic model. A confederate assistant and anesthesiologist are also present in this fully immersive operative simulation. The same SP reprises their role for the final postoperative encounter in a simulated ward or clinic setting.
Residents are observed and evaluated by attending faculty watching via video in a separate room. Evaluations utilize rating scales endorsed by the American Board of Surgery (Pre-op: CAMEO, Intra-op: OPRS, Post-op: Mini-CEX). Both faculty and the SP provide feedback to each resident at the conclusion of the pathway.
We developed a curriculum that was implemented as a series of three-day educational modules to complement these pathway simulations for four surgical divisions at our institution (biliary, foregut, colorectal, and acute care).
Results: Repeating the pathway on the first and final day of each module enabled serial assessment for efficacy of the educational intervention in addition to residents’ level of achievement. Furthermore, the modular nature of the curriculum allowed for multiple iterations, accommodating all 16 first-year surgery residents as small groups over the course of an academic year without undue disruption to clinical services.
Conclusion: Adopting a patient-centric approach to surgery simulation, we recreated a complete sequence of patient care encounters in a realistic clinical setting, encompassing a pathway of care. Relevant training as well as objective evaluation of clinical competence could be performed in a time-efficient manner. The role of a dedicated simulation program with leadership resources to provide structure and oversight to participating faculty and residents was critical in the success and sustainability of the curriculum, which is now in its second year and in the process of being deployed at a second institution.