Simulator training boosts confidence and skills for surgical residents at Temple University

Philadelphia 29 September 2004A pilot in training doesn't fly a plane at his first lesson. And so it goes for surgeons in training. To learn such complex skills, it's safer and more effective to practise first on a simulator. In a new study, researchers at Temple University School of Medicine found that a complete laparoscopic skills training curriculum based entirely in the laboratory enables residents to build confidence and perfect skills outside of the operating room.

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"With the mandated reduction of work hours last year, the use of laparoscopic skills training in the laboratory has become a greater necessity in ensuring the quality surgical education of residents", stated lead investigator Harsh Grewal, M.D. associate professor of surgery at Temple University School of Medicine and a paediatric surgeon at Temple University Children's Medical Center.

Last year, federal mandates capped the resident's work week at 80 hours, reducing the amount of time spent learning in the operating room and in the hospital treating patients. To ensure that residents still gain the necessary skills, medical educators have had to adapt teaching methods and are increasingly turning to virtual and laboratory training techniques.

Dr. Grewal's study, "Teaching Laparoscopic Skills to Surgical Residents: Can it be done in the Laboratory?" was presented at the Society of Laparo-endocscopic Surgeons Annual Meeting. While it has become a valuable, minimally invasive alternative to open surgery, laparoscopic surgery requires a great deal of practice to develop the requisite skills. During traditional open surgery, the surgeon works directly on an organ or part of the body. But with laparoscopic surgery, the surgeon inserts a camera and surgical tools through long thin tubes into the body and watches everything on a television monitor. It takes getting used to, especially to develop the necessary hand/eye co-ordination.

The objective of the Temple study was to develop a basic and advanced laparoscopic training curriculum to be used in the training of surgical residents in the laboratory. While other studies have looked at the value of surgical simulation training, this is the first study to examine a comprehensive curriculum.

Fifty surgical residents participated in a progressive laparoscopic training curriculum, learning everything from basic skills like grasping to more advanced skills like tying sutures and removing organs. Following completion, residents evaluated the curriculum. "Residents uniformly described the model as highly effective and valuable, the overwhelming majority expressing a desire to return for the next level of formal training", stated Dr. Grewal. "The exposure in the lab eliminates much of the initial learning curve that was once overcome in the operating room on patients."

Temple's School of Medicine is expanding its current surgical skills laboratory and putting the finishing touches on a new clinical simulation lab. The facility will allow medical students, residents and practising physicians to hone both their clinical judgment and their technical skills by practicing on sophisticated clinical simulators. Temple medical student Brian Steixner will present the study. Co-authors include Richard E. Milner, B.S.; Aaron Jenson, M.D.; Amy J. Goldberg, M.D.; and Harsh Grewal, M.D. More news on Temple University School of Medicine can be found in the VMW July 2004 article Sleep deficits do not hinder learning in surgical residents, according to Temple University researchers.


Leslie Versweyveld

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