Surgical simulation is an emerging field that has the potential to revolutionize research and training in all surgical specialities. With haptic feedback and visual and tactile reality, simulation makes it possible to assess, quantify and improve technical skills, decreasing human error and improving patient outcomes.
Chronological training VS. Proficiency-based training
Proficiency-based training implies that the trainee has to fulfill achieve a set of predefined criteria during their training to move to the next level in a safe and controlled learning environment. However, in neurosurgery and other surgical specialties, technical skills learning is linked to chronology within an apprenticeship model. For example, a surgeon becomes an expert after he has spent 6-7 years in a residency program and the operating room. Proficiency-based training ensures that specific criteria have been met, while chronological-based training does not guarantee that a resident has achieved a certain degree of skill appropriate for an expert.
What is “competence” in surgery?
In their paper Competency in surgical residency training [full PDF], Bhatti and Cummings address the need to properly define surgical competence. This is a topic which is often described quite vaguely such “the ability to perform specific surgical skills successfully”. Interestingly, the definitions that are explored and discussed focus on “adequate” or “satisfactory” patient care, rather than “excellent” or “expert”.
The role of simulation
Simulation-based training can help raise the bar. Mechanical simulators, such as cadavers, are often used; however, with the absence of disease-related pathology and bleeding, and no limits on surgical exposure, they are unrealistic. On the other hand, learning through apprenticeship in the operating room offers a setting that is realistic, but in which surgical errors can have severe consequences. The utilization of virtual reality with appropriate metrics can address these shortcomings.
|Cadavers, animal models, synthetic phantoms||UNREALISTIC||SAFE|
|Apprenticeship in the operating room||UNSAFE||REALISTIC|
The ultimate goal of simulation-based training is to eliminate patient risks associated with technical skills learning. The learner achieves the desired learning outcome in a safe simulated environment where one can repeat the simulated procedure(s) with appropriate demonstrator and metric feedback.