Simulation-based Training Research Articles

Implementing an obstetric sepsis bundle in a large academic hospital system

For the purposes of this review, obstetric sepsis refers to sepsis (from all causes, including non-obstetric such as pneumonia) in pregnant or postpartum patients, which was previously described as maternal sepsis. Obstetric sepsis poses a significant threat to pregnant, birthing, and postpartum individuals, contributing prominently to maternal mortality and morbidity despite being largely preventable1. In response to identified gaps in sepsis management, particularly the lack of specific protocols tailored to obstetric populations, New York-Presbyterian undertook a system-wide initiative to implement a comprehensive sepsis bundle. This initiative included the development of new criteria for identifying sepsis in obstetric patients, the creation of electronic medical record (EMR) alerts aligned with obstetric-specific indicators, and the establishment of a structured sepsis management algorithm.The project involved collaboration across eight hospital campuses within the New York-Presbyterian system, aiming to standardize and improve the early recognition and treatment of sepsis in maternal care. Key components included rigorous data analysis to select appropriate sepsis criteria, simulation-based training to familiarize clinical teams with the new algorithm, and continuous refinement of alert systems to mitigate alarm fatigue and enhance responsiveness.Post-implementation evaluation revealed a significant reduction in preventable morbidity related to sepsis, accompanied by the identification of additional gaps in fever and chorioamnionitis management. These findings prompted the development of new clinical guidelines to further enhance patient safety. Challenges encountered included adapting sepsis criteria to balance sensitivity and specificity, as well as integrating trauma-informed care principles into clinical practice.This project underscores the effectiveness of tailored quality improvement efforts in maternal health, emphasizing the critical role of proactive interventions in enhancing patient outcomes and safety within obstetric settings. Ongoing efforts focus on monitoring process metrics through a dedicated sepsis dashboard and advancing education on trauma-informed care principles, highlighting the continued commitment to sustained improvement in maternal health outcomes.

Formation des étudiants en pharmacie conduisant des entretiens ciblés sur les anticoagulants oraux : élaboration et évaluation d’une formation par la simulation en santé

Pharmaceutical care for patients receiving oral anticoagulants (OACs) should be performed by trained healthcare professionals to prevent adverse effects and improve patient adherence. Before meeting patients, all pharmacy students in our department (in a one-year hospital internship program) experienced a theoretical training for several years. It was decided to add a practical component based on simulation training. The study reports the simulation program conception and the assessment of the simulation-based training for pharmacy students involved in conducting interviews with patients receiving ACOs. Organization and content of the training course were defined by two hospital pharmacists and one pharmacy resident. Skills' assessment was measured in pharmacy students in 3 steps: (1) initial assessment by individual interview, (2) group training by simulation, (3) final assessment by individual interview. Student satisfaction was also assessed at the end of the training. Four scenarios and one assessment form were developed and 16 pharmacy students experienced the training. An improvement in skills after the simulations courses was observed in all parts of the process: the pre-interview (mean +15%), the interview itself (+16%) and the post-interview (+18%). All students felt more comfortable and motivated to conduct interviews and recommended that this training be continued. The study underlines the impact of the simulation training on students' skills and their satisfaction with the overall training program. The simulation training is now fully added to the program. Further studies should explore the skills improvement in real life during the first patient interview.

Effect of Simulation-Based Training on Nurses' Performance about Procedural Pain Management of Neonates' Heel-Sampling

Effect of Simulation-Based Training on Nurses' Performance about Procedural Pain Management of Neonates' Heel-Sampling

Focus on proficiency levels is necessary when virtual reality simulator software is updated–a randomized trial

BackgroundVirtual reality simulators are an integral part of modern surgical training and allow novice surgeons to acquire basic laparoscopic skills that are transferable to the operation room without compromising patient safety. The gold standard training method is proficiency-based training, where all trainees practice until a pre-defined proficiency level is reached. Simulator software versions are regularly updated to increase the quality of the simulator experience, but the impact of software updates used in conjunction with existing proficiency levels is unknown. MethodsTwenty surgical novices were randomized to simulator training on the LapSim® virtual reality simulator using either a 2019-version (new software group) or a 2016-version (old software group) of the simulator software. All participants practiced until reaching the proficiency level established for the old software. After 3-5 weeks, all participants returned and practiced to proficiency again using the old software. ResultsThe mean time to proficiency for the new software group was 183 minutes (SD: 43) versus 285 minutes (SD: 26) for the old software group (p<0.001). During the follow-up test, participants from the new software group spent 189 minutes (SD: 61) versus 91 minutes (SD: 50) (p=0.001) for the old software group to reach proficiency again. ConclusionUpdating simulator software without updating the proficiency levels creates the risk of changing the amount of training necessary to reach proficiency. Updates of simulator software for virtual reality simulators must lead to a critical re-evaluation of the previously established proficiency levels to ensure optimal outcomes of simulation-based training.

Surgical skill simulation training to proficiency reduces procedural errors among novice cardiac device implanters: a randomized study.

In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across institutions; suboptimal approaches may increase complications. We investigated how novel proficiency-based progression (PBP) simulation training impacts the surgical quality of implantations, compared to traditional simulation (SIM) training. In this international prospective study, novice implanters were randomized (blinded) 1:1 to participate in a simulation-based procedure training curriculum, with proficiency demonstration requirements for advancing (PBP approach) or without (SIM). Ultimately, trainees performed the surgical tasks of an implant on a porcine tissue that was video-recorded and then scored by two independent assessors (blinded to group), using previously validated performance metrics. Primary outcomes were the number of procedural Steps Completed, Critical Errors, Errors (non-critical), and All Errors Combined. Thirty novice implanters from 10 countries participated. Baseline experiences were similar between groups. Compared to SIM-trained, the PBP-trained group completed on average 11% more procedural Steps (P < 0.001) and made 61.2% fewer Critical Errors (P < 0.001), 57.1% fewer Errors (P = 0.140), and 60.7% fewer All Errors Combined (P = 0.001); 11/15 (73%) PBP trainees demonstrated the predefined target performance level vs. 3/15 SIM trainees (20%) in the video-recorded performance. Proficiency-based progression training produces superior objectively assessed novice operators' surgical performance in device implantation compared with traditional (simulation) training. Systematic PBP incorporation into formal academic surgical skills training is recommended before in vivo device practice. Future studies will quantify PBP training's effect on surgery-related device complications.

Enhancing Housekeeping Workforce Competency in the Hospitality Industry: A Comprehensive Training Approach

This study examines the influence of comprehensive training programs on the proficiency of housekeeping personnel in the hotel sector. Data were collected through semi-structured interviews, focus group discussions, and participant observations at different hotels using a qualitative study approach. The findings suggest that organized training programs have a substantial impact on improving technical skills, such as proficiency in advanced cleaning procedures and equipment handling, as well as enhancing soft skills, such as effective communication and customer service. The integration of several learning methods, including simulation-based training and virtual reality, was discovered to be extremely successful in involving workers and enhancing the acquisition of skills. Although faced with obstacles such as reluctance to change and limited resources, the use of proactive solutions, such as engaging staff in training development and providing ongoing professional development, effectively addressed these concerns. The results emphasize the need of a comprehensive training strategy that encompasses both technical and soft skills in order to enhance overall service quality and operational efficiency. Suggestions for future practice including consistently refreshing training material, involving personnel in the development process, and overcoming obstacles to implementation in order to maintain increases in housekeeping performance and visitor satisfaction

Sex-specific differences in surgical confidence: results of the Endo Workshop of the German Society of Residents in Urology 2022

Simulation-based training is gaining importance in urologic residents training. This prospective study evaluated the influence of the Endo Workshop of the German Society of Residents in Urology e. V. (GeSRU) on surgical confidence. GeSRU Endo Workshop 2022 included 1 h simulation-based training sessions on stone removal using ureteroscopy (URS) and transurethral resection of the bladder (TURB). Using an online questionnaire, surgical confidence was assessed before and after the workshop. Surgical assessment relied on the global rating scale (GRS). Overall, 40residents participated: 25(62.5%) men and 15(37.5%) women. In URS assessment, men vs. women achieved an average of 26.6 vs.26.1/35points on the GRS (p = 0.7) and completed the task in 8.1 ± 1.9 vs.9.9 ± 0.4 min (p < 0.001). In TURB assessment, men vs. women achieved an average of 26.0 vs.27.3/35points on the GRS (p = 0.3) and required 7.6 ± 1.9 vs.7.7 ± 2.2 min (p = 0.9), respectively. Among participants who answered the baseline survey and the evaluation (n = 33), 16(80%) men vs.3 (23%) women had surgical confidence to perform URS before (p = 0.01), and 19(95%) men vs.7 (54%) women after the workshop (p = 0.03). Regarding the performance of TURB, 10(50%) men vs.7 (54%) women reported surgical confidence before (p = 0.1), and 15(75%) men vs.10 (77%) women after the workshop (p = 1.0). An increase in surgical confidence to perform URS and TURB was reported by 9(45%) and 10(50%) men and 9(69%) and 8(62%) women, respectively. Endourologic simulation-based training increases surgical confidence of both female and male residents. Despite comparable surgical outcomes, women approach URS with lower surgical confidence compared to their male counterparts.

Competence over confidence: uncovering lower self-efficacy for women residents during central venous catheterization training

BackgroundWhile women make up over 50% of students enrolled in medical school, disparities in self-efficacy of medical skills between men and women have been observed throughout medical education. This difference is significant because low self-efficacy can impact learning, achievement, and performance, and thus create gender-confidence gaps. Simulation-based training (SBT) employs assessments of self-efficacy, however, the Dunning-Kruger effect in self-assessment posits that trainees often struggle to recognize their skill level. Additionally, the impact of gender on self-efficacy during SBT has not been as widely studied. The objective of this study was to identify if the gender-confidence gap and the Dunning-Kruger effect exist in SBT for central venous catheterization (CVC) on the dynamic haptic robotic trainer (DHRT) utilizing comparisons of self-efficacy and performance.Methods173 surgical residents (Nwomen=61, Nmen=112) underwent training on the DHRT system over two years. Before and after using the DHRT, residents completed a 14-item Central Line Self-Efficacy survey (CLSE). During training on the DHRT, CVC performance metrics of the number of insertion attempts, backwall puncture, and successful venipuncture were also collected. The pre- and post-CLSE, DHRT performance and their relationship were compared between men and women.ResultsGeneral estimating equation results indicated that women residents were significantly more likely to report lower self-efficacy for 9 of the 14 CLSE items (p < .0035). Mann-Whitney U and Fisher’s exact tests showed there were no performance differences between men and women for successfully accessing the vein on the DHRT. Regression models relating performance and self-efficacy found no correlation for either gender.ConclusionsThese results indicate that despite receiving the same SBT and performing at the same level, the gender-confidence gap exists in CVC SBT, and the Dunning-Kruger effect may also be evident.

Designing simulation-based curriculum content for emergency medicine residents in France: a Delphi method

BackgroundThe value of simulation in emergency medicine is indisputable because it allows training and acquisition of many technical and non-technical skills (TS and NTS). In France, there are no curriculum regarding the use of simulation as a teaching tool during emergency medicine residency. The aim of this study was to design the content of a national simulation-based curriculum for emergency medicine residency programs.MethodsThe Delphi method was conducted between March and June 2022. The questionnaire was divided into three sections: TS, NTS and clinical situations as starting points (SSPs). A panel of emergency physicians’ experts on simulation education was established. An online survey was conducted in which they were asked to score, on a four-point Likert scale, the suitability of skills and SSPs to be taught through simulation courses during the emergency medicine residency. The questionnaire was revised between each round following comments or suggestions for additional items from the experts.ResultsSixty-six experts completed the Delphi process. The initial questionnaire included 64 TS, 37 NTS and 103 SSPs. The experts’ comments led to the addition of 12 TS, 24 NTS and 6 SSPs. Consensus was obtained after three rounds. The experts selected 24 TS and 20 NTS to be taught as a priority through simulation during the emergency medicine residency, and 15 SSPs to be used in priority.ConclusionWith a Delphi method, French experts in simulation-based emergency medicine education have selected 24 technical and 20 non-technical skills to be taught as a priority with simulation-based training to emergency medicine residents.

Exploring seafarers' knowledge, understanding, and proficiency in SEEMP: A strategic training framework for enhancing seafarers' competence in energy-efficient ship operations

With 2.89 % of global carbon emissions caused by human activity, the maritime industry faces an imminent challenge in curbing its carbon footprint despite regulatory initiatives. As the shipping sector expands, the industry faces a projected increase in carbon emissions. Recognizing the key role of seafarers in emission reduction, this article introduces a comprehensive training framework designed to enhance awareness, knowledge, understanding, and skills for implementing energy-efficient ship operations. This study utilizes structural equation modeling to assess the effectiveness of seafarers' training on energy-efficient operation of ships (EEOS) by surveying 144 seafarers across 42 shipping companies worldwide and using structured questionnaires. This study found significant positive correlations between implementing the Ship Energy Efficiency Management Plan (SEEMP) and the training programs initiated by the International Maritime Organization (IMO) and shipping companies. The results of this study indicate that traditional institutional and specialized training programs on EEOS are relatively ineffective for seafarers in implementing SEEMP onboard ships. Furthermore, the study argues that computer and simulator-based training facilitates knowledge, understanding, and proficiency of SEEMP among seafarers more effectively than the onboard training provided by the ship's master and the chief engineer. The proposed training framework emphasizes the importance of initial training using the IMO E-Learning course and IMO “Train the Trainer” programs, followed by shipping companies' in-house training by classification societies, company project teams, and simulator-based training by service providers. The study proposes a strategic training framework that encompasses in-house training conducted by shipping companies in collaboration with partners, simulator-based training provided by specialized training providers, and ongoing onboard training facilitated by the vessel's master and chief engineer, with integration of computer-based training (CBT). This strategic approach intends to improve seafarers' competence in energy-efficient ship operations to meet predetermined carbon intensity targets, which aligns with the broader goal of leading the maritime industry toward a future of net-zero emissions.

A Systematic Review on Conditions Before and After Training of Teamwork Competencies and the Effect on Transfer of Skills to the Clinical Workplace.

We conducted a systematic review to assess if any condition before- or after simulation-based training of teamwork competencies for healthcare professionals affects learning or transfer of skills to the clinical environment.We searched CINAHL, Medline, and Embase for studies published between January 1, 2011, and July 10, 2023. We screened 13,149 abstracts and 335 full texts, of which 5 studies were included. We included primary studies with and without a comparator published in English. We assessed risk of bias using the ROBINS-I tool before narrative synthesis. All studies were observational and reported heterogeneous conditions such as posters, coaching, and leadership support initiatives. Very low certainty evidence suggested that implementing conditions in the clinical environment such as coaching, wider communication of learning objectives, or leadership initiatives could be considered to facilitate the transfer of skill to the clinical environment. Funding: Society for Simulation in Healthcare. Prospero registration: CRD42022320721.

Survey of Current Simulation Based Training in the US Military Health System.

Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system. A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue. Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%). The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.

Simulation-based training in robotic surgery education: bibliometric analysis and visualization.

Simulation-based robotic surgery training may help surgeons gain operative skills and experience in the simulation environment. This bibliometric analysis examined the development of simulation-based training for robotic surgical education. Articles pertaining to robotic surgical simulation training that were included in the Web of Science Core Collection up to April 25, 2024, were included. The temporal patterns in published paper numbers were evaluated using Microsoft Excel software, and the data regarding co-authorship and keyword co-occurrence were analyzed and visualized using the VOSviewer and SCImago Graphica tools. A total of 594 papers on simulation-based training for robotic surgical education were evaluated in this study. The United States and United Kingdom were the leading contributors in this field. The most published authors were Professor Ahmed Kamran (23 publications) and Prokar Dasgupta (22 publications). The highest number of papers was published in the journal titled "Surgical Endoscopy and Other Interventional Techniques." The most common keywords were "virtual reality," "curriculum," "robotic surgery simulator," "assessment," and "learning curve." Our study offers a detailed overview of international research on simulation-based training for robotic surgical education, including the publishing countries, institutions, authors, journals, and research hotspots. It also methodically summarizes the state of knowledge in the area, and provides definite directions and concepts for further in-depth analysis.

Health professions students' perspectives of a stigma-reducing simulation including simulated patients with lived experience of addiction and recovery

BackgroundStigma surrounding substance use disorders (SUDs) hinders treatment. This study explores perceptions of health professions students following simulation-based training involving individuals with lived experience of addiction and recovery. MethodsThematic analysis of self-reflection narratives was conducted to identify themes. ResultsThirty-three graduate students from various health disciplines participated. Four themes were identified: humanizing addiction, cultivation of hope, attitude of gratitude, and transformation and growth. Findings highlight contact-based simulations' potential to challenge stereotypes and foster empathy. ConclusionIntegrating stigma reduction interventions into health curricula is crucial. Contact-based simulation training shapes positive attitudes towards individuals with SUDs.

Enhancing aviation English competency: A simulation-based approach for aspiring pilots

Aviation English (AE) represents a noteworthy area of investigation within the realm of English for Specific Purposes (ESP), aimed at fostering English language competency among aspiring pilots. In this study, a simulation-based aviation English course was designed and implemented for improved learning gains. The present study took place at a tertiary educational institution, focusing on the analysis of AE vocabulary development, the readback performance of student pilots, and the examination of participants' perceptions of simulation-based training. Employing a mixed-methods sequential explanatory research design, data were gathered from 21 ab-initio pilots enrolled in the Pilotage Training program. The quantitative results showed that participants significantly improved their readback performance and AE vocabulary knowledge over the course of a semester. With regard to the qualitative results, student pilots overall perceived the simulation-based training as an innovative and effective method. The present study, therefore, constitutes a notable advancement in the AE research domain by documenting, for the first time, the application of simulation-based training in the aviation context. Moreover, the study offers insights into the implications for ESP practitioners and stakeholders in the aviation sector, along with recommendations for future research, which are delineated in the study's conclusion.

Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial

BackgroundTask-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether...

Virtual Reality Simulation-Based Training in Image-Guided Breast Intervention in Low- and Middle-Income Countries.

Online education has revolutionized global radiology education for low- and middle-income countries (LMICs). However, procedures requiring hands-on training, such as breast biopsies, are primarily taught through in-person sessions and patient interaction. Virtual reality (VR) offers an immersive way to simulate these sessions remotely. This Viewpoint presents an experience with an ultrasound-guided breast biopsy VR platform that may allow radiology residents in LMICs to practice breast interventions and provide all trainees with shared procedural experiences.

Enhancing the competencies of obstetrical nurses and midwives in high-risk pregnancy management through simulation-based training in Lao people's democratic republic: A pilot study

BackgroundSimulation-based training has been widely used as a valuable strategy for learning and evaluating clinical skills at different levels of nursing and midwifery education. The impact of simulation training on intensive management for high-risk pregnancy in a low-resource setting has been limited. AimTo examine the effect of simulation-based training with low-fidelity mannequins on obstetrical nurses and midwives’ knowledge, attitude, and skills for high-risk pregnancy management in a low-resource setting. MethodDuring September 2023, twenty-five obstetrical nurses or midwives who worked in five tertiary public hospitals in Vientiane Prefecture participated in the three-day training workshops for intensive management in high-risk pregnant women and newborns that used a simulation-based training approach integrating problem-based learning. The evaluated criteria of knowledge, attitudes, and skills pre- and post-test scores were statistically compared. FindingsWorkshop trainees demonstrated an increase significantly in knowledge for high-risk pregnancy management (p = 0.012), attitude toward high-risk pregnancy management (p = 0.000), and attitude toward simulation-based training design (p = 0.002). The clinical skills were used on the simulation performance checklist, and the pre-posttest gain in overall performance scores had a statistically significant difference (p = 0.000). The mean score of postpartum hemorrhage management skills was 11.48±2.23, which increased the highest score among all skills. ConclusionsThe simulation-based training in high-risk pregnancy management improves the knowledge, attitude, and skills of nurses and midwives in low-resource settings. Next steps include direct observation of trainees in the clinical setting to assess their competence in ensuring patient safety, achieving positive pregnancy outcomes, and enhancing satisfaction.

Impact of a simulator-based training program on the success rate of external cephalic version

ObjectiveTo compare the success and complication rates of external cephalic version before and after the implementation of a simulator-based training program at a tertiary care university centre with a dedicated external cephalic version team. Study designIn this single-center intervention study, the success rate and the complication rates of external cephalic version in the two years before the implementation of a simulation-based training program for all specialists and residents, were compared with the two years following the event. T- student, Mann-Whitney, and Chi-square tests were used. All data were extracted from the hospital’s electronic patient records. ResultsA total of 96 external cephalic versions were performed in the 2 years before the training program, and 74 after the training program. The overall success rates were similar between the two groups: 44.8 % before training and 43.2 % after training (p = 0.824). No major complications occurred, and no emergency cesarean deliveries were performed in either period. ConclusionIn a tertiary care university training center with a dedicated team in external cephalic version, a structured simulation-based training program did not impact the success rate or the complication rates of the procedure.

Assessing Surgeons' Attitude to Teaching Intra-Corporeal Anastomosis.

Introduction: There is a controversy in minimally invasive colorectal procedures regarding choosing optimal technique between intra-corporeal (ICA) and extra-corporeal anastomosis (ECA). Previous studies recognize the short-term benefits in right hemicolectomy with intra-corporeal approach; however, ICA can result in increased operative difficulty. The aim of this study is to understand attitudes towards teaching ICA in colorectal procedures and how this varies between subspeciality training. Methods: Active members of General Surgeons Australia were contacted through email to participate in a voluntary, unincentivized survey. Demographic details were collected and participants were asked to rate agreement for simulation-based training for increasing adoption of ICA through a Likert scale and when preferences for teaching ICA. Descriptive statistics were completed to describe frequencies and ordinal regression was completed to determine factors for Likert scale question. Results: There were 43 respondents and most participants recognized that ECA was easier to teach trainees and should be taught first. 53.5% of respondents recognized that simulation-based training would assist the adoption of ICA. Surgeons who routinely close bowel or enteric defects intra-corporeally are 354% more likely to show an interest in simulation-based training for adopting ICA, however, surgeons who are not involved in teaching trainees did not show an interest in simulation-based training. Conclusion: There is significant agreement that ECA forms the basis to learn ICA and simulation-based training would assist with the uptake of ICA. However, a multimodal approach, including expanding training avenues and providing financial incentives, would be necessary to enhance the adoption of ICA in colorectal surgery.