Association for Academic SurgeryA Simulation-Based Curriculum Can Be Used to Teach Open Intestinal Anastomosis
Introduction
Surgical training has undergone significant changes in recent years. Contemporary factors have challenged the traditional apprenticeship model popularized by Dr. William Halstead. The rapid evolution of new surgical techniques and technologies, the advent of the 80-h workweek, and an increased public scrutiny on outcomes and patient safety are modern issues that must be addressed in surgical residencies. Simulation-based training allows educators to create curricula designed to lead to the development of a specific skill or set of skills in a measurable and reproducible manner. Surgical skills acquisition through simulation is more deliberate and efficient than the old method of 5 y of exposure to a volume of surgical cases.
Laparoscopic surgery is particularly well-suited to simulation training. Laparoscopic training curricula in low fidelity video trainers have been validated and demonstrated to lead to the development of surgical skills that translate into the operating theater 1, 2. Simulation as a method to develop and teach open surgical skills is less commonly described. We hypothesized that a structured, simulation-based curriculum to teach laparotomy opening, closing, and hand-sewn bowel anastomosis would result in improved knowledge of procedural steps, enhanced technical skill, and improved confidence in the ability to perform these procedures in first year general surgery residents.
Section snippets
Materials and Methods
Eleven categorical first-year general surgery residents from two consecutive classes participated in a standardized curriculum designed to develop the cognitive and manual skills necessary to make an abdominal fascia incision, perform a hand-sewn bowel anastomosis, and close the laparotomy. Didactic content included anatomic illustrations and a course manual describing the technical steps for laparotomy and hand-sewn end-to-end bowel anastomosis. The material was original to this curriculum but
Results
Subjects demonstrated significantly improved global rating scores for technical skills and knowledge used in laparotomy and hand-sewn bowel anastomosis in seven of the nine domains evaluated with the OSATS tool. There were statistically significant improvements in the domains of respect for tissues, efficiency of time and motion, instrument handling, appropriate use of assistant, flow of operation and forward planning, knowledge of the procedure, and quality of final product. There was no
Discussion
We have demonstrated that a structured, simulation-based curriculum designed to teach laparotomy opening and closing, hand-sewn bowel anastomosis, and skin closure is effective in first-year general surgery residents. Using a modified OSATS tool, subjects were shown to be more knowledgeable and technically proficient in laparotomy and hand-sewn bowel anastomosis techniques upon completion of this curriculum. Junior resident confidence in the performance of these skills and procedures was
References (10)
- et al.
Dry lab practice leads to improved laparoscopic performance in the operating room
J Surg Res
(2009) - et al.
The new ACS/APDS skills curriculum: Moving the learning curve out of the operating room
J Gastrointest Surg
(2008) FLS assessment of competency using simulated laparoscopic tasks
J Gastrointest Surg
(2008)- et al.
Training and transfer of colonoscopy skills: A multinational, randomized, blinded, controlled trial of simulator versus bedside training
Gastrointest Endosc
(2010) - et al.
Using objective structured assessment of technical skills to evaluate a basic skills simulation curriculum for first-year surgical residents
J Am Coll Surg
(2009)
Cited by (16)
Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator
2023, Journal of Surgical ResearchAcquisition and retention of surgical skills taught during intern surgical boot camp
2021, American Journal of SurgeryCurrent Status of Technical Skills Assessment Tools in Surgery: A Systematic Review
2020, Journal of Surgical ResearchCitation Excerpt :Forty studies did not specify a field, and three assessed medical students only. OSATS was the most frequently used tool (n = 137, 45.2%)14-50,51-90,91-125,126-150 (Table 1). Test content was assessed by 68 (50%) studies, and the response process was seen in 61 (45%).
Comparison of faculty versus structured peer-feedback for acquisitions of basic and intermediate-level surgical skills
2019, American Journal of SurgeryExperience of General Surgery Residents in the Creation of Small Bowel and Colon Anastomoses
2016, Journal of Surgical EducationCitation Excerpt :A tool has been developed and validated for the assessment of competence in creating simulated IAs in the laboratory called the objective structured assessment of technical skills method.35 It has been shown that including the creation of HS IAs in the simulation curriculum is effective in acquiring the necessary skills and in gaining confidence with the relevant techniques.36,37 However, in addition to simulation, GSRs should be exposed to both elective and emergency surgery cases for learning and practicing in live clinical scenarios as much as possible.
Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis
2016, International Journal of Surgery