Novel 3-D Simulation Technology Helps Surgical Residents

courtesy American college of Surgeons –

New Journal of the American College of Surgeons study reports that an online interactive simulation platform is an effective tool for assessing and training surgical residents in a variety of patient care scenarios –

Chicago, IL (August 1,  2013): A novel interactive 3-dimensional (3-D) simulation platform offers surgical  residents a unique opportunity to hone their diagnostic and patient management skills,  and then have those skills accurately evaluated according to a new study appearing  in the August issue of the Journal of the  American College of Surgeons. The  findings may help establish a new tool for assessing and training surgical  residents. surgery-hip-replacement[1]

Previous  research studies have shown that the management of patient complications  following operations is an extremely important skill set for surgeons to master. Therefore, in addition to performing  operations, surgeons must also be able to effectively manage surgical patients  in the emergency room, on the hospital floor unit, or in the intensive care  unit. Until now, the standard approach  for this instruction has been to learn to master this skill set on  patients.

“The  way we learn in residency currently has been called ‘training by chance,’  because you don’t know what is coming through the door next,” said study  coauthor Rajesh Aggarwal, MD, PhD, MA, FRCS, a National Institute for Health  Research (NIHR) clinician scientist in surgery at Imperial College, St. Mary’s  Hospital in London. “What we are doing  is taking the chance encounters out of the way residents learn and forming a  structured approach to training.”

Using  an online virtual world called Second Life™, a multidisciplinary team of  researchers from Imperial College, St. Mary’s Hospital developed three virtual reality  environments—a standard hospital ward, an intensive care unit, and an emergency  room.

For  the study, the researchers created modules for three common surgical scenarios:  gastrointestinal bleeding, acute inflammation of the pancreas, and bowel  obstruction. Each of these scenarios,  which could be accessed through a laptop or personal computer, was designed to  put the residents through their paces at three different levels of complexity.

“What  we want to do—using this simulation platform—is to bring all the junior  residents and senior residents up to the level of the attending surgeon, so  that the time is shortened in terms of their learning curve in learning how to  look after surgical patients,” Dr. Aggarwal said.

The  study involved 63 surgeons—including interns and junior and senior residents, as  well as attending surgeons whose performance was used as a benchmark. Each surgeon assessed and managed a series of  virtual patients via this 3D interactive surgical world. The process involved taking a patient  history, performing a physical, interpreting labs, diagnosing the disease,  using chest X rays and CT scans, and implementing an appropriate management  plan.

Using  a validated rating scale, researchers then evaluated and rated each surgeon’s  performance for each case he or she performed. The minimum score was eight and the maximum score was 56, which was  equivalent to achieving 100 percent or performing at the level of an attending.

The  study results showed significant gaps in performance between interns and  attendings, as well as between junior and senior residents and attendings. For example, analysis of the level-one  gastrointestinal bleeding module showed that interns scored 48, junior  residents scored 50, senior residents scored 54, and attendings scored 56. For other cases, study results showed similar  outcomes.

“What we have shown scientifically is that  these three simulated scenarios at the three different levels are appropriate  for the assessment of interns, junior residents, and senior residents and their  management of these cases,” Dr. Aggarwal explained.

Moving  forward, the research team plans to study how the implementation of this novel simulation  technology will improve clinical outcomes of surgical patients cared for by  residents. In future research, surgical residents and interns throughout London  will train on this program, which will enable them to achieve the skill level  of a senior resident or an attending. The idea is that this simulation training  will help residents become more effective at managing patients in a clinical  environment. Ultimately, the goal is to  maintain and improve patient safety.

“Going  through these different steps is not going to teach residents everything they  need to know for every patient with bowel obstruction, for example, but it is  going to teach them about the majority of patients that he or she is going to  look after and it’s going to do it in a much more education-efficient and  appropriate manner,” Dr. Aggarwal said. “This  platform can also be used as a refresher so it can be used for the maintenance  of their skills, not just the acquisition of their skills, and this goal can be  achieved in a more efficient manner as well.”

Thank you, TiA

Other  study participants include Vishal Patel, MRCS; Daniel Cohen, MRCS; Dave Taylor,  MSc, MBCS; Ara Darzi, KBE Hon FREng, FMedSci, MD, FACS, FRCS.

Grant support for this study was provided by  the London Deanery and the National Institute for Health Research, United Kingdom.

Citation: Journal of the American College of  Surgeons, August 2013: Vol. 217(2):270-79.

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About the American  College of Surgeons   The American College of Surgeons is a scientific and educational organization  of surgeons that was founded in 1913 to raise the standards of surgical  practice and improve the quality of care for all surgical patients. The College  is dedicated to the ethical and competent practice of surgery. Its achievements  have significantly influenced the course of scientific surgery in America and  have established it as an important advocate for all surgical patients. The  College has more than 79,000 members and is the largest organization of  surgeons in the world. For more information, visit



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