International Journal of Healthcare Simulation

Background:

The launch of the new Improving Surgical Training (IST) programme in 2020 introduced an exciting opportunity to develop a high-fidelity simulation course designed specifically with surgeons and their training in mind. Surgical simulation is often thought of as task-focussed training, with little emphasis on non-technical skills, especially in junior years of training. This created an opportunity for the formation of a bespoke high-fidelity course immersing IST trainees into surgical scenarios involving an extended surgical team and incorporating elements of technical and non-technical skills.

Methods:

Following a review of the curriculum [1], core training areas were identified. Index procedures and critical conditions appropriate for core-level training were selected to create the scenarios. Furthermore, a surgical simulation faculty was developed whereby consultant surgeons conducted faculty development training, enabling them to support the core simulation faculty. Three scenarios were piloted in a half-day course which was subsequently rolled out to all current IST trainees at the Trust. Key elements incorporated include:

1. Environment – immersion within environments where surgeons work such as theatres, surgical wards, and emergency departments.

2. Surgical issues – each scenario centres around a surgical complaint.

3. Non-technical components – often overlooked in traditional surgical simulation [2] but pertinent to the working life of a surgeon.

4. Multidisciplinary Team – scenarios must incorporate surgeons working within extended teams.

To ensure high-fidelity, a combination of simulation manikins and faculty were used as patients and other characters, with all tasks being carried out in real-time.

Results:

An initial pilot session ran with Deanery and non-Deanery trainees and a mixed simulation faculty including senior surgeons. Three sessions were delivered to a total of twelve trainees attending from a range of different surgical specialties. Feedback demonstrated satisfaction with the course given an average score of 4.67/5 and relevance of course content to current job role average of 4.5/5. 100% of trainees rated session content as either ‘Good’ or ‘Excellent’. Trainees enjoyed how ‘realistic’ the scenarios were and appreciated that they ‘gave a feel of real-life situations and a framework to resort to in difficult day-to-day situations’. Recommendations for improvement included wanting more scenarios and further opportunities to explore human factors.

Conclusion:

Overall feedback was overwhelmingly positive with appreciation of the role of human factors and non-technical skills in surgical training. The results provide a convincing argument for continuing the programme and developing a programme for second year IST trainees to aid transition to registrar training.

References

1. Royal College of Surgeons. Improving Surgical Training. London. October 2015. https://www.rcseng.ac.uk/careers-in-surgery/trainees/ist/ [Accessed on 26/06/2022]

2. Intercollegiate Surgical Curriculum Programme. Simulation training and core surgical training. 2017 https://www.iscp.ac.uk/ [Accessed on 26/06/2022]