"Blowing up the Barriers" in Surgical Training: Exploring and Validating the Concept of Distributed Simulation

TY - JOUR

T1 - "Blowing up the Barriers" in Surgical Training

T2 - Exploring and Validating the Concept of Distributed Simulation

AU - Kassab, Eva

AU - Tun, Jimmy Kyaw

AU - Arora, Sonal

AU - King, Dominic

AU - Ahmed, Kamran

AU - Miskovic, Danilo

AU - Cope, Alexandra

AU - Vadhwana, Bhamini

AU - Bello, Fernando

AU - Sevdalis, Nick

AU - Kneebone, Roger

PY - 2011/12

Y1 - 2011/12

N2 - Objectives: To explore face, content and construct validity of Distributed Simulation (DS), an innovative approach to low-cost, high-fidelity surgical simulation and compare technical performance in the DS with that on a standard surgical box trainer.Background: Immersive simulation is widely accepted as an important modality for surgical education. However, access and cost limit the uptake of full-scale simulation training. DS is a portable, simulated clinical environment aiming at widening access to immersive simulation.Methods: Ten novice and 10 expert surgeons performed a laparoscopic cholecystectomy on a porcine model in the DS and on a box trainer. Face and content validity were measured using 6-point Likert-type questionnaires. Construct validity was rated using the Objective Structured Assessment of Technical Skills (OSATS). Comparison of technical performance between DS and box trainer was measured using the Wilcoxon test.Results: Face validity was rated as 5.1 (SD = 0.54) by novices and 4.8 (SD = 0.64) by experts.Content validity was rated as 5.2 (SD = 0.40) by novices and 5.1 (SD = 0.56) by experts. Experts performed significantly better than novices in the DS (16.3 vs. 27.3, P <0.001) demonstrating construct validity. Experts' technical performance did not differ between DS and box trainer (26.5 vs. 27.3, P > 0.84) whereas novices performed better on the box trainer (19.8 vs. 16.3, P <0.01). Qualitative data analysis demonstrated that surgeons felt able to behave as if in a real operating room (OR).Conclusion: DS offers a valid, low-cost, accessible environment for training and assessing surgeons. This approach has major implications for surgical education and for the widespread implementation of immersive simulation at a time of increasing financial austerity.

AB - Objectives: To explore face, content and construct validity of Distributed Simulation (DS), an innovative approach to low-cost, high-fidelity surgical simulation and compare technical performance in the DS with that on a standard surgical box trainer.Background: Immersive simulation is widely accepted as an important modality for surgical education. However, access and cost limit the uptake of full-scale simulation training. DS is a portable, simulated clinical environment aiming at widening access to immersive simulation.Methods: Ten novice and 10 expert surgeons performed a laparoscopic cholecystectomy on a porcine model in the DS and on a box trainer. Face and content validity were measured using 6-point Likert-type questionnaires. Construct validity was rated using the Objective Structured Assessment of Technical Skills (OSATS). Comparison of technical performance between DS and box trainer was measured using the Wilcoxon test.Results: Face validity was rated as 5.1 (SD = 0.54) by novices and 4.8 (SD = 0.64) by experts.Content validity was rated as 5.2 (SD = 0.40) by novices and 5.1 (SD = 0.56) by experts. Experts performed significantly better than novices in the DS (16.3 vs. 27.3, P <0.001) demonstrating construct validity. Experts' technical performance did not differ between DS and box trainer (26.5 vs. 27.3, P > 0.84) whereas novices performed better on the box trainer (19.8 vs. 16.3, P <0.01). Qualitative data analysis demonstrated that surgeons felt able to behave as if in a real operating room (OR).Conclusion: DS offers a valid, low-cost, accessible environment for training and assessing surgeons. This approach has major implications for surgical education and for the widespread implementation of immersive simulation at a time of increasing financial austerity.

KW - Animals

KW - Attitude of Health Personnel

KW - Cholecystectomy, Laparoscopic/education

KW - Clinical Competence

KW - Computer Simulation

KW - Education, Medical, Graduate

KW - General Surgery/education

KW - Humans

KW - Models, Anatomic

KW - Models, Animal

KW - Surveys and Questionnaires

KW - Swine

KW - User-Computer Interface

U2 - 10.1097/SLA.0b013e318228944a

DO - 10.1097/SLA.0b013e318228944a

M3 - Article

C2 - 21738021

SN - 0003-4932

VL - 254

SP - 1059

EP - 1065

JO - Annals of Surgery

JF - Annals of Surgery

IS - 6

ER -