Surgical Skills Transfer After Simulation-Based Training
Surgical Skills Transfer After Simulation-Based Training
Objective: A systematic review to determine whether skills acquired through simulation-based training transfer to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy.
Background: Simulation-based training assumes that skills are directly transferable to the operation room, but only a few studies have investigated the effect of simulation-based training on surgical performance.
Methods: A systematic search strategy that was used in 2006 was updated to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision.
Results: Seventeen randomized controlled trials and 3 nonrandomized comparative studies were included in this review. In most cases, simulation-based training was in addition to patient-based training programs. Only 2 studies directly compared simulation-based training in isolation with patient-based training. For laparoscopic cholecystectomy (n = 10 studies) and endoscopy (n = 10 studies), participants who reached simulation-based skills proficiency before undergoing patient-based assessment performed with higher global assessment scores and fewer errors in the operating room than their counterparts who did not receive simulation training. Not all parameters measured were improved. Two of the endoscopic studies compared simulation-based training in isolation with patient-based training with different results: for sigmoidoscopy, patient-based training was more effective, whereas for colonoscopy, simulation-based training was equally effective.
Conclusions: Skills acquired by simulation-based training seem to be transferable to the operative setting for laparoscopic cholecystectomy and endoscopy. Future research will strengthen these conclusions by evaluating predetermined competency levels on the same simulators and using objective validated global rating scales to measure operative performance.
Surgical simulators have an increasing role in the instruction and training in surgical skills, and simulation-based training with lifelike experiences has the potential to make a significant contribution to evolution of the surgical curriculum. A surgical training program should combine training for technical and nontechnical skills, and for working as part of a team in the operating room, to make the most effective use of available resources and to maximize patient safety. Although simulation-based training programs were initially "add-ons" to traditional surgical training, simulation-based training is increasingly being incorporated into curricula or even mandated by registration bodies, such as the American Board of Surgery that has required Fundamentals of Laparoscopic Surgery (FLS) certification since 2009.
In 2007, our group published a systematic review which concluded that simulation-based training seemed to result in skills transfer to the operative setting. However, it was noted that the included studies were of variable quality and design that limited the strength of this conclusion. Since then, the number of studies addressing transferability of simulation-based skills to the operative setting has increased. There have been improvements in simulation-based training programs.
The methodology of recent studies has improved by acknowledging the importance of objective assessment when measuring competence in the operative setting to make valid comparisons between simulator-based and/or patient-based training. A number of procedure-specific objective global assessment scales that can be used in operative settings have been developed and validated. These include the Anaesthetist' Nontechnical Skills global rating scale, Global Objective Assessment of Laparoscopic Skills (GOALS), Objective Structured Assessment of Technical Skills, Orthopaedic Competence Assessment Project, and United Kingdom (UK) Joint Advisory Group on Gastrointestinal Endoscopy Direct Observation of Procedural Skills assessment form. Other studies modify global rating scales developed by others or developed their own.
The aim of this systematic review was to determine whether skills acquired through simulation-based training are transferable to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy.
Abstract and Introduction
Abstract
Objective: A systematic review to determine whether skills acquired through simulation-based training transfer to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy.
Background: Simulation-based training assumes that skills are directly transferable to the operation room, but only a few studies have investigated the effect of simulation-based training on surgical performance.
Methods: A systematic search strategy that was used in 2006 was updated to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision.
Results: Seventeen randomized controlled trials and 3 nonrandomized comparative studies were included in this review. In most cases, simulation-based training was in addition to patient-based training programs. Only 2 studies directly compared simulation-based training in isolation with patient-based training. For laparoscopic cholecystectomy (n = 10 studies) and endoscopy (n = 10 studies), participants who reached simulation-based skills proficiency before undergoing patient-based assessment performed with higher global assessment scores and fewer errors in the operating room than their counterparts who did not receive simulation training. Not all parameters measured were improved. Two of the endoscopic studies compared simulation-based training in isolation with patient-based training with different results: for sigmoidoscopy, patient-based training was more effective, whereas for colonoscopy, simulation-based training was equally effective.
Conclusions: Skills acquired by simulation-based training seem to be transferable to the operative setting for laparoscopic cholecystectomy and endoscopy. Future research will strengthen these conclusions by evaluating predetermined competency levels on the same simulators and using objective validated global rating scales to measure operative performance.
Introduction
Surgical simulators have an increasing role in the instruction and training in surgical skills, and simulation-based training with lifelike experiences has the potential to make a significant contribution to evolution of the surgical curriculum. A surgical training program should combine training for technical and nontechnical skills, and for working as part of a team in the operating room, to make the most effective use of available resources and to maximize patient safety. Although simulation-based training programs were initially "add-ons" to traditional surgical training, simulation-based training is increasingly being incorporated into curricula or even mandated by registration bodies, such as the American Board of Surgery that has required Fundamentals of Laparoscopic Surgery (FLS) certification since 2009.
In 2007, our group published a systematic review which concluded that simulation-based training seemed to result in skills transfer to the operative setting. However, it was noted that the included studies were of variable quality and design that limited the strength of this conclusion. Since then, the number of studies addressing transferability of simulation-based skills to the operative setting has increased. There have been improvements in simulation-based training programs.
The methodology of recent studies has improved by acknowledging the importance of objective assessment when measuring competence in the operative setting to make valid comparisons between simulator-based and/or patient-based training. A number of procedure-specific objective global assessment scales that can be used in operative settings have been developed and validated. These include the Anaesthetist' Nontechnical Skills global rating scale, Global Objective Assessment of Laparoscopic Skills (GOALS), Objective Structured Assessment of Technical Skills, Orthopaedic Competence Assessment Project, and United Kingdom (UK) Joint Advisory Group on Gastrointestinal Endoscopy Direct Observation of Procedural Skills assessment form. Other studies modify global rating scales developed by others or developed their own.
The aim of this systematic review was to determine whether skills acquired through simulation-based training are transferable to the operating room for the procedures of laparoscopic cholecystectomy and endoscopy.
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