It is one thing to have the surgical simulation tools available - but quite another to ensure their continued use. eoSurgical simulators have been the subject of extensive research assessing and confirming the utility of surgical simulation as a means of improving performance. One model for use is the self-motivated trainee or surgeon – someone who is independently driven to improve skills. Another model is the incorporation of take-home simulation into training programmes.
Scotland is at the forefront of exploring how to embed incentivised take-home laparoscopic practise into training. Here, we look at the Scottish Surgical Simulation Collaborative’s latest findings. The group, led by Prof Walker, has been exploring the issue for several years, iteratively working to improve the impact of simulation within surgical training.
In a prior study, engagement with a take-home simulation platform had been somewhat limited. Reasons cited by trainees included a lack of appreciation of the evidence base for simulation, a desire for individualised human feedback, and a perceived need to focus instead on ‘point scoring’ tasks that would enable downstream career progression. The latest work, published here, assessed the engagement of three subsequent years of new-start Core Surgical Trainees (147 trainees in total) - after making changes to the program. These changes were informed by prior local feedback and broader literature review.
All trainees were again loaned portable take-home simulators (eoSim). This time, all attended a Surgical Bootcamp prior to being issued with their simulator. The learning cycle was modified, with distributed practice punctuated by regular formative assessments and also enhanced faculty engagement. Importantly, completing the program and achieving a pass (via an OSATS task) was expected but not mandatory for progression through training. Pass rates ranged from 70-94% across the most recent three years, much improved compared with 26% in an earlier iteration of the programme.
The key message here is that merely providing good simulators (with curricula, performance metrics, and support) is not in itself adequate. To optimise engagement and impact, a broader program is required (see infographic above from their paper) with motivated learners, motivated trainers, periodic feedback, clear goals, and benchmarking.
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh
Walker KG et al. Scotland's “Incentivised Laparoscopy Practice” programme: Engaging trainees with take-home laparoscopy simulation, The Surgeon, 2022. ePub