Simulation In Surgery:A Proposal For Quality Control In The Use Of Simulators In Surgical Training

Abstract

Simulation is a concept that has been employed in numerous fields including that of defense, aviation and recently surgery. Simulation seems to hold the answer to several of the challenges faced within the field of surgery. In this study the author reviews the history of simulator use in surgery and then reviews the various applications of simulators in surgery. This will set the foundation to the objective of this study, which is the utility of simulation as a tool in the domain of surgical education (i.e. for training and assessing trainee surgeons). Much of the literature has tended to focus on the design, validity and reliability of simulators, the development of curricula incorporating simulators, and criteria for being regarded as a competent surgeon, in a mutually exclusive manner. [ii] [iv] This study will attempt to demonstrate that each of these aspects has an order of interrelationship to one another. This proposed model of inter-relationship will enable us to gain new insights into how the links between them affect one another. The observation of this order will firstly enable a more effective application of simulators as a tool for training future surgeons. Secondly, it will serve to avoid quality control debacles which may occur with the introduction of new technology, the prime example of this being the laparoscopic cholecystectomy fiasco that resulted in a dramatic rise in bile duct injuries in the 1990s.[v] Finally, the author will also demonstrate how continual feedback within this model enables continuous fine-tuning of the system. Satava RM. Historical review of surgical simulation – a personal perspective. World J Surg 2008; 32: 141-148.[ii] McClusky DA, Smith CD.Design and development of a surgical skills simulation curriculum. World J Surg 2008; 32: 171-181.[iii] Aucar JA, Nicholas RG, Troxel SA et al.A review of surgical simulation with attention to validation methodology. Surg Laparosc endosc percutan tech 2005; 15(2): 82-89.[iv] Sarker SK, Patel B. Simulation and surgical training. Int J Clin Pract 2007; 61(12): 2120-2125.[v] Wanzel KR, Ward M, Reznick RK. Teaching the surgical craft: from selection to certification. Curr Probl Surg 2002; 39: 573-660.