A systematic review of methodological principles and delivery of surgical simulation bootcamps

Faculty development through higher degrees: AMEE Guide No. 180

Faculty development in medical education may take different forms and approaches ranging from standalone workshops and short courses up to longitudinal programs and postgraduate qualifications, such as Certificates, Diplomas, Master's and PhD degrees in health professions education (HPE). Many places offer staff development opportunities to help people to learn how to teach health professional students more effectively. Yet higher degrees in HPE are expected not only to enable graduates to be better teachers or assessors but also to act on a strategic level to support institutional directions to advance teaching, learning, assessment and scholarship in HPE. This guide is for people who wish to develop programmes to provide a more systematic and deeper training for those people that see themselves as professional health professions educators and indeed, the leaders of the future. The guide discusses the rationale, plans, process of implementation and evaluation of postgraduate programs in HPE in ten phases. Different variables should be considered with respect to the local context, institutional support, readiness of expertise, availability of resources, alignment with the strategic plan of the college/university and methods to measure the impact of these PG programs.

Scotland's internal medicine simulation strategy: A 5-year journey

In 2019, the internal medicine (IM) stage 1 curriculum was implemented in the UK. This introduced a revised 3-year training programme for physicians in training. The new IM stage 1 curriculum emphasised simulation-based education, triggering the integration of simulation training on a national scale in Scotland. Bespoke training courses were developed for IM trainees in Scotland, spanning all 3 years of their training programme. Each course was meticulously designed with input from key stakeholders and trainees, aligning learning objectives with curriculum outcomes. The Scottish IM simulation strategy encompasses a 3-day bootcamp in IM year 1, a 1-day skills day in IM year 2, and a 2-day 'registrar ready' course in IM year 3. These courses, delivered at central locations, focus on immersive simulation, communication workshops, and simulation-based mastery learning of procedural skills. Evaluation of the programme includes pre- and post-course questionnaires, data tracking over the training programme, interviews with trainees and faculty, and annual review days to gather feedback and make necessary adaptations. The impact of the programme for trainees includes transfer to clinical practice of communication skills, improved non-technical skills, and increased confidence in procedural skills. Alignment with the IM stage 1 curriculum supports trainees' annual reviews of competence progression. The IM simulation training also offers valuable social benefits and remains crucial, especially with increased pressure in the NHS. It is our belief that ongoing delivery of this training is invaluable to the IM stage 1 programme in Scotland.

Implementation of an Intensive Surgical Simulation Week for Medical Students in Rwanda

INTRODUCTION

Simulation-based training often fails to meet the needs of low- and middle-income countries with limited access to high-cost models. We built on an existing surgical simulation curriculum for medical students in Rwanda and assessed students' experience.

METHODS

Based on a contextual simulation-based education curriculum that was piloted in 2022, our team designed and delivered an intensive week-long surgical simulation course for medical students. We increased interactive clinical scenarios using high-fidelity mannequins, improved and added benchtop models for training, and incorporated a new postcourse assessment of students' experiences using a survey on the first Kirkpatrick level to determine sessions with the highest utility. Modules included informed consent, preoperative patient preparation, trauma simulations, and procedural skills. The final day focused on integrating and applying skills learned throughout the week in an interactive circuit.

RESULTS

Thirty-six students participated in the 5-d simulation course and 24 completed an end of course survey. When asked about their exposure to simulation prior to the course, 20/24 (83%) students reported "a lot" and 4/24 (17%) reported "a little", 24/24 (100%) strongly agreed that simulation is a valuable educational tool and 23/24 (96%) felt that the week enhanced their knowledge and skills to "a great extent". The modules with the highest self-rated level of engagement were the interactive trauma simulations, knot-tying and suturing practice and competition, and a model-based session on cutaneous lesions. The lowest ranked session was the interactive circuit on integrated skills.

CONCLUSIONS

Implementing a locally-informed and locally-sourced surgical simulation curriculum is feasible and effectively engages medical students in low-income settings.

What are the learning objectives in surgical training - a systematic literature review of the surgical competence framework

OBJECTIVE

To map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes.

BACKGROUND

Surgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies.

METHODS

A search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017-2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents.

RESULTS

Out of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored.

CONCLUSION

The shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.

Simulation training in urology

PURPOSE OF REVIEW

This review outlines recent innovations in simulation technology as it applies to urology. It is essential for the next generation of urologists to attain a solid foundation of technical and nontechnical skills, and simulation technology provides a variety of safe, controlled environments to acquire this baseline knowledge.

RECENT FINDINGS

With a focus on urology, this review first outlines the evidence to support surgical simulation, then discusses the strides being made in the development of 3D-printed models for surgical skill training and preoperative planning, virtual reality models for different urologic procedures, surgical skill assessment for simulation, and integration of simulation into urology residency curricula.

SUMMARY

Simulation continues to be an integral part of the journey towards the mastery of skills necessary for becoming an expert urologist. Clinicians and researchers should consider how to further incorporate simulation technology into residency training and help future generations of urologists throughout their career.

The need for a course to complete urological education for consultant practice using a simulated 'boot camp' structure at the end of specialist training: A survey-based study

BACKGROUND AND AIMS

To obtain opinions from urology trainees and consultants regarding the need for, and structure of, a post-specialty training Urology Simulation Boot Camp (USBC) for consultant practice.

METHODS AND RESULTS

A survey-based study was conducted, and 'Google Forms' were distributed electronically via social media. Urology specialist trainees (ST) in years 5-7 (ST5-ST7), post-certification of completion of training (CCT) fellows and ST3 boot camp faculty consultants in practice for ≤5 years and >5 years were included. One hundred and seven responses were received. 97.2% of responders thought a pre-consultant USBC was worthwhile; 55.1% selected the course duration to be 2 days. 47.7% felt that the USBC should be delivered post-exam in ST7. 91.6%, 43.9%, 73.8%, 87.9% and 74.8% considered that modules in emergency operative procedures, novel uro-technologies, delivering multidisciplinary team (MDT) meetings, non-clinical consultant roles and responsibilities, stress and burnout to be important, respectively. 62.6% and 31.8% felt that the course should be wholly or part-funded by Health Education England (HEE).

CONCLUSIONS

A post-specialty training, pre-consultant, USBC delivered post-exam in ST7, is worthwhile and should include modules on emergency operative procedures, leading MDTs, non-clinical roles and responsibilities and managing stress and burnout in consultant careers. Ideally, it should be fully/part-funded by HEE.

Simulation-based education in urology - an update

Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.

Preparatory surgical bootcamp: An effective form of training with a positive impact on self-confidence and procedural skills of the residents

Objectives

To evaluate the impact of a bootcamp for new residents in surgery, in terms of both knowledge and skills improvement and psychological support.

Design

Prospective inclusion of all the 59 new residents in surgery from 2018 to 2020. Analysis of their perception of the training and comparison of the bootcamp and control groups (n = 9, including the residents who could not attend the bootcamp) with respect to the results of their skills evaluations and surgical knowledge.

Setting

A two-day bootcamp is organized every year in October since 2013 at the All'Sims simulation center (University Hospital, Angers, France) just before the beginning of the internship. A subsequent skills evaluation takes place partly in the operating room and partly as an objective structured clinical examination (OSCE).

Participants

New residents from the different surgical specialties and gynecology, after having given their written consent.

Results

Among the 50 residents who attended the bootcamp, knowledge in surgical skills improved by 10% (p<0.001). The median skills score on each OSCE station was at least one point higher in the bootcamp group than in the control group, predominantly in the suturing task (13.9+/-3.0 vs 11.5 +/- 1.6, p = 0.03). The reported usefulness level of the different surgical skills training when evaluated in consideration of daily practice varied from 50% to 95%. Feelings of ease and competency were quite well correlated with the reported usefulness of a given skill, especially since the task was a more generic one.

Conclusion

Preparatory courses are of great interest for all surgical specialties as they improve procedural skills and knowledge as well as self-confidence during the first weeks of a resident's internship. As medical training continues to vary significantly between the different universities, such surgical curricula should be developed at a national level to standardize the surgical level of all new residents.