The Royal College of Surgeons of EnglandRegional Representatives Meeting

Simulator Training – in practice

Implementation of a Surgical Skills Strategy within the Yorkshire and the Humber Deanery

David Wilkinson MD FRCS

Consultant Vascular Surgeon & Deputy Medical Director, Bradford Teaching Hospitals Foundation NHS Trust

Deputy Postgraduate Dean, Yorkshire and the Humber Deanery

Drivers for Change

•Public expectation•Evidence of efficacy•Changes in clinical practice•Changes in working practice•Technological developments and opportunities•Reduction in training time

2008

“A surgeon trained on a simulator is twice as fast and twice as accurate as one who has not been. It reduces errors, making surgery much safer.

Simulation works and the NHS must be able to provide it to make a difference to patients.”

Sir Liam Donaldson, Chief Medical Officer

One training simulator for every 300 pilots.One training simulator for every 7,300 doctors.

British Airways vs NHS in England

The Surgical Skills Strategy

• SHA / Yorkshire and the Humber Postgraduate Deanery / Trusts

• £2m investment

• Effective utilisation through Schools

• Immediate improvements to patient safety

• Enhanced training

A strategy to address 3 key elements:

1. Technical and operative skills• Practical procedures• Basic surgical skills• Operative ability

2. Non-technical skills• Leadership• Communication skills • Team working

3. Cognitive ability• Decision making• Data acquisition and risk assessment• Managing uncertainty• Professional judgement in challenging situations

Technical and Operative Skills: The Training Sequence

Knowledge

• Surgical literature

• e-learning platforms aimed at trainee surgeons – background information– animations and operative videos– assessment results to trainee and trainer

Basic Skills

• Every Trust engaged in the training of surgeons and specialists will possess a basic surgical skills laboratory that is appropriately equipped, staffed and is accessible both in working hours and out of hours.

• Schools will work with Trusts and Medical Education Centres to run the laboratories.

Common component of the early years syllabusModule 3 Basic surgical skills

• To prepare oneself for surgery

• To safely administer appropriate local anaesthetic agents

• To handle surgical instruments safely

• To handle tissues safely

• To incise and close superficial tissues accurately

• To tie secure knots

• To safely use surgical diathermy

• To achieve haemostasis of superficial vessels.

• To use a suitable surgical drain appropriately.

• To assist helpfully, even when the operation is not familiar.

• To understand the principles of anastomosis

• To understand the principles of endoscopy including laparoscopy

Complex Skills: Hi-fidelity Simulators

• Simbionix– Lap Mentor II– Angio Mentor Express– GI Bronch Mentor– URO & PERC Mentor– HystSim

• Owned and operated by Trusts

• Use or lose!

Technical and operative skills

Cognitive Ability

• Clinical Environment Simulators– Leeds– Sheffield– Hull– Bradford– York– Mexborough

Challenges

• Commissioning model – no money!• Simulator training mapped to curriculum• Assessments of competence and

introduction to supervised clinical practice

• Developing facilities and systems within Trusts

• Faculty engagement

Business model

• Delivered through School of Surgery business plan

• Local provision to avoid travel costs

• Development of local faculty

• Effective utilisation of study leave budget to deliver the curriculum

Faculty Engagement

• School of Surgery TPD to trainee ratio of 1 : 15

• Associate Postgraduate Deans

• Directors of PGME

• College Tutors

• Medical Education Centres and their staff

Launch – Regional meetings

• 15 April 2010 - York District HospitalHigh fidelity skills simulation

– Demonstration– Training and Planning– Workshops– Discussion of practical issues

• 29th June 2010 – Sheffield Northern GeneralMulti-professional training with manikins

– Demonstrations– School workshops

Conclusion

• Yorkshire and the Humber: attractive to surgical community and ‘competitive’ to potential trainees

• Better trained surgeons and well-supported training environment

• Improved patient safety

This strategy represents a major change to surgical training and will need the support of

Deanery, Schools and Trusts.