Current status of simulation training in plastic surgery residency programs: A review

Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors’ opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.

[1]  Ethan D Grober,et al.  Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. , 2004, The Journal of urology.

[2]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[3]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[4]  G. Maddern,et al.  A Systematic Review of Skills Transfer After Surgical Simulation Training , 2008, Annals of surgery.

[5]  C Fontaine,et al.  Reducing the number of animals used for microsurgery training programs by using a task-trainer simulator , 2014, Laboratory animals.

[6]  M. Sadeghi,et al.  Simulation-based training for burr hole surgery instrument recognition , 2016, BMC medical education.

[7]  P. Matteucci,et al.  Validation of microsurgical models in microsurgery training and competence: A review , 2007, Microsurgery.

[8]  Dana T Lin,et al.  Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study. , 2016, Surgery.

[9]  M. Urata,et al.  Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. , 2014, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[10]  Hiep T Nguyen,et al.  Does Warm-Up Training in a Virtual Reality Simulator Improve Surgical Performance? A Prospective Randomized Analysis. , 2016, Journal of surgical education.

[11]  Stephane Cotin,et al.  A hybrid elastic model for real-time cutting, deformations, and force feedback for surgery training and simulation , 1999, Proceedings Computer Animation 1999.

[12]  Eric G. Halvorson,et al.  Status of Microsurgical Simulation Training in Plastic Surgery: A Survey of United States Program Directors , 2016, Annals of plastic surgery.

[13]  Annabelle L. Fonseca,et al.  Open surgical simulation in residency training: a review of its status and a case for its incorporation. , 2013, Journal of surgical education.

[14]  C. Chang Medical simulation is needed in anesthesia training to achieve patient's safety , 2013, Korean journal of anesthesiology.

[15]  Aaron Oliker,et al.  A Real-Time Local Flaps Surgical Simulator Based on Advances in Computational Algorithms for Finite Element Models , 2016, Plastic and reconstructive surgery.

[16]  Sarah A. Long,et al.  Simulation in Plastic Surgery Training and Education: The Path Forward , 2009, Plastic and reconstructive surgery.

[17]  R. Linke,et al.  Assessment of skills using a virtual reality temporal bone surgery simulator , 2013, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[18]  R. Denadai,et al.  Teaching basic plastic surgical skills on an alternative synthetic bench model. , 2013, Aesthetic surgery journal.

[19]  B. Labow,et al.  Is There Bias against Simulation in Microsurgery Training? , 2016, Journal of Reconstructive Microsurgery.

[20]  Adam Dubrowski,et al.  Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. , 2007, Journal of vascular surgery.

[21]  A. Ghanem,et al.  A Systematic Review of Evidence for Education and Training Interventions in Microsurgery , 2013, Archives of plastic surgery.

[22]  T. Grantcharov,et al.  Randomized clinical trial of virtual reality simulation for laparoscopic skills training , 2004, The British journal of surgery.

[23]  Joe Rosen,et al.  Integration of Surgical Simulation in Plastic Surgery Residency Training , 2012, MMVR.

[24]  Moustafa Hassan,et al.  Novel simulation for training trauma surgeons. , 2011, The Journal of trauma.

[25]  A. Gosman,et al.  Implementing Assessment Methods in Plastic Surgery , 2016, Plastic and reconstructive surgery.

[26]  H. E. Garrett,et al.  A human cadaveric circulation model. , 2001, Journal of vascular surgery.

[27]  A. Ghanem,et al.  Development of a Five-Day Basic Microsurgery Simulation Training Course: A Cost Analysis , 2014, Archives of plastic surgery.

[28]  T. Hemmerling,et al.  A Novel Mammoplasty Part-Task Trainer for Simulation of Breast Augmentation: Description and Evaluation , 2016, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[29]  D F Nestel,et al.  Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre , 2010, The British journal of surgery.

[30]  Ethan D Grober,et al.  Validation of novel and objective measures of microsurgical skill: Hand‐motion analysis and stereoscopic visual acuity , 2003, Microsurgery.

[31]  Patricia Youngblood,et al.  Improvement in coronary anastomosis with cardiac surgery simulation. , 2008, The Journal of thoracic and cardiovascular surgery.

[32]  A. Ghanem,et al.  Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training , 2014, Journal of Reconstructive Microsurgery.

[33]  Marc Immenroth,et al.  Mental Training in Surgical Education: A Randomized Controlled Trial , 2007, Annals of surgery.

[34]  Kevin Montgomery,et al.  A surgical simulator for planning and performing repair of cleft lips. , 2005, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[35]  N. Lausada,et al.  Use of cryopreserved rat arteries for microsurgical training , 2005, Microsurgery.

[36]  Y. Zheng,et al.  CAD/CAM silicone simulator for teaching cheiloplasty: description of the technique. , 2015, The British journal of oral & maxillofacial surgery.

[37]  Daniel B. Jones,et al.  Laparoscopic training on bench models: better and more cost effective than operating room experience? , 2000, Journal of the American College of Surgeons.

[38]  A. Ponniah,et al.  The First Cleft Palate Simulator , 2007, Plastic and reconstructive surgery.

[39]  Daniel B. Jones,et al.  Improving operative performance using a laparoscopic hernia simulator. , 2001, American journal of surgery.

[40]  M. Sullivan,et al.  Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. , 2013, Journal of surgical education.

[41]  Joseph McCarthy,et al.  Step-Based Cognitive Virtual Surgery Simulation: An Innovative Approach to Surgical Education , 2012, MMVR.

[42]  Vishnu Mohan,et al.  Participation in EHR based simulation improves recognition of patient safety issues , 2014, BMC medical education.

[43]  Teodor P. Grantcharov,et al.  Development and Validation of a Comprehensive Curriculum to Teach an Advanced Minimally Invasive Procedure: A Randomized Controlled Trial , 2012, Annals of surgery.

[44]  J. Dungan,et al.  Effect of virtual reality training on laparoscopic surgery: randomised controlled trial , 2010 .

[45]  M. Yașargil,et al.  New laboratory model for neurosurgical training that simulates live surgery. , 2002, Journal of neurosurgery.

[46]  Stephane Cotin,et al.  A hybrid elastic model for real-time cutting, deformations, and force feedback for surgery training and simulation , 2000, The Visual Computer.

[47]  K. A. Ericsson,et al.  Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[48]  R. Agha,et al.  The role and validity of surgical simulation. , 2015, International surgery.

[49]  G. Dunnington,et al.  The New ACS/APDS Skills Curriculum: Moving the Learning Curve Out of the Operating Room , 2008, Journal of Gastrointestinal Surgery.