Introduction

Article Outline

• Copyright

Simulation-based training has grown exponentially in medical education over the last decade. Many factors have coalesced to increase the emphasis on training outside of the clinical environment. An increasing focus on errors in medicine, and methods to minimize errors, has been one of these factors. Many of the lessons learned from high reliability fields, such as aviation, have been adopted by medical educators. Decreased work hours for residents have also had a role in the increasing reliance on simulation-based training. The need to ensure all residents have exposure to a range of situations, and the need to make the most of sometimes limited clinical opportunities, means that many basic skills must be learned outside of the clinical arena. Cost and time constraints in the clinical environment also mandate a need for training of some skills elsewhere, enabling residents to be more active participants when they reach the operating room.

The articles in this issue of Seminars in Colon & Rectal Surgery outline some of the many potential applications of simulation technology in the education continuum for surgical training. Skills as diverse as performing a laparoscopic colon resection, resuscitating a patient in the trauma bay, or training a team in mass casualty triage can all be practiced in a simulated environment before they are taken to the clinical environment. Examples of how some programs are using the types of technology available are outlined in the following articles.

A recurring theme of these articles is the use of simulation within a curriculum. Simulation and simulators are only tools. They can be very powerful in the context of delivery of an effective curriculum, but must be used with the underlying educational goals and objectives in mind. Too often the cart is put before the horse, with the purchase of equipment, before the educational needs are framed and clarified. Unless simulation equipment is part of an overall curriculum process, it is doomed to be collecting dust in a corner somewhere.

The authors of the articles that follow are all well known for their programs in simulation in surgery. The articles will hopefully give readers a sampling of some of the many ways in which these environments are increasingly being used.

The program outlined by Aaron Jensen and Mika Sinanan, from the University of Washington, exemplifies how simulation can be integrated into a complete program, with clinical outcome measures to improve patient care and minimize errors. Their article nicely demonstrates how the cost of simulation can be justified to health care payers. Daniel Scott, in his article on proficiency-based training for surgical skills, underscores the importance of knowledge of motor skills development when designing a training curriculum. The use of proficiency-based training has the potential to revolutionize postgraduate programs and credentialing. Neal Seymour introduces the various types of virtual reality simulators available for training, and their strengths and weaknesses.

The needs of army personnel are often very different than those of civilians, with training needs that are difficult, if not impossible, to meet in standard medical encounters. We usually do not start an intravenous, or stabilize a patient while under fire. Mark Bowyer and his group, at the National Capital Area Medical Simulation Center, have been at the forefront of developing immersive virtual environments for medical training, and they demonstrate some of the many potential applications of these environments.

Often, simulation programs have focused primarily on undergraduate and postgraduate medical trainees. However, surgeons in practice who need to upgrade skills or develop a whole new set of skills can also benefit from simulation. The remainder of this issue focuses on a few of the issues in continuing professional education that can be addressed through simulation. John Paige and Sheila Chauvin, from Louisiana State University, outline some of the issues and dynamics of the operating room team. With a focus on error prevention, they have developed a mobile team training initiative that brings simulation to the point of care, enabling interdisciplinary team training. David Rogers addresses some of the unique challenges of continuing surgical education. His article will be helpful to those interested in developing effective continuing professional development programs using simulation, and some of the challenges involved.

Finally, Aggarwal and Grantcharov outline a curricular approach to laparoscopic colorectal surgical training, providing a framework of a theoretically effective training paradigm.

It is my hope that this issue of Seminars in Colon & Rectal Surgery will be of interest to all of its readers. As you will see from the articles that follow, the role of simulation in surgery is ever expanding, and will likely become an integral part of every component of the education continuum, impacting on all of us as we teach our residents or update our own skills.