On the Road Again: Surgical Simulation is Rural Practice

D.R.Antonenko, MD.PhD.Professor of Surgery

Director of Surgical Simulation CenterUniversity of North Dakota School of Medicine and

Health Sciences

Simulation in Rural Surgery

Objectives• Describe the educational background for

simulation training in surgery• To describe the possible role of simulation in

rural/community surgical practice using a mobile simulation center

• To discuss how on site simulation training might help attract and retain surgeons in rural practice

Physician Learning

Patient focused learning

Resource accessibility

Clinical applicability

Familiarity with the resource

Return on investment in time

Physicians and Learning

Relevance to clinical practice needs

Scheduling conflict

Cost of attendance

Simulator Skills Training Curriculum

Sound educational principles

Goal oriented

Sensitive/objective performance metrics

Appropriate instruction/feedback

Simulator Skills Training Curriculum

Deliberate/distributed/variable practice

Allow overtraining

Provide maintenance training

Must have cognitive component

Simulator Skills Training Curriculum

Deliberate/distributed/variable practice

Allow overtraining

Provide maintenance training

Must have cognitive component

PROFICIENCY BASED

Simulation = Deliberate Practice

Move learning curve out of the OR

BUT performance still required

Reduce stress of learning

Focus is on learner, not the patient

Feedback improved

Simulators

Simulators

Procedural (task) trainers

Computer screen (micro-simulators)

VR trainers

Patient trainers

ACS/APDS Core skills Curriculum Phase I Curriculum Modules

Asepsis/instrumentsKnot tyingSuturingTissue handling wound

managementAdvanced tissue

handling/flaps/graftsCatheterizationAirway managementChest tubesCentral linesSurgical biopsy

Vascular anastomosisLaparotomyBone Fixation/castingInguinal AnatomyUpper endoscopyColonoscopyBasic laparoscopic skillsAdvanced laparoscopic skillsHand sewn anastomosisStapled anastomosis.

Simulation Center Equipment

Phase II Modules

Lap ventral hernia

Lap/open inguinal hernia

Lap/open colon resection

Lap/open CBD exploration

Abdominal wall stomas

Lap appendectomy

Lap Nissen fundoplication

Sentinel node biopsy/ALND

Lap/open splenectomy

Lap/open cholecystectomy

Thyroidectomy

parathyroidectomy

Gastrectomy

Simulation Center Equipment

Simulation Center Equipment

Simulation Center Equipment

`ACS/APDS Core Skills Curriculum

Phase III: Team Based Training

Simulation Center EquipmentTeam Based Training

Rationale For Simulator Training in Rural Surgery

Fiscal Restraints

Changing technology

Ethical Concerns

Patient Safety

Advantages of Simulation in Rural Surgery

Maintain skills

Enhance skills

Increase practice opportunities

Increase income

Reduce malpractice premiums (?)

Simulation for Rural Surgery

Surgeon specific

Site specific

High fidelity

Timely

Cost effective

Distributed vs. massed practice

Simulations for Rural Surgery

Minimally invasive

Ultrasound

ATLS procedures(?)

Airway management

Procedure specific

Endoscopy upgrades

The Future of Simulation for Rural Surgery

Tele-simulation

Tele-proctoring

Tele-mentoring 3 dimensional reconstruction

COST

Rural/Community Surgeons

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