Medical Modeling and Simulation Database

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White Paper on Surgical Simulation

Excerpts from the Literature

Medical Modeling and Simulation: The Potential

As computing power expands and the cost of simulation equipment falls, it is likely that most, if not all, surgical training programs will be devoting substantial curricular time to simulator-based training. Increasing evidence of the efficacy of ex vivo training, coupled with societal pressure, will probably mean that future residents will need to demonstrate proficiency in basic techniques before being allowed to operate on patients.

--Richard K. Reznick and Helen MacRae, Teaching Surgical Skills-Changes in the Wind, The New England Journal of Medicine, 2006:355(25):2664-2669.

For the first time in the history of medicine, they [simulators] offer the opportunity for the objective assessment of performance with standardized metrics in a safe and controlled manner.

--Mark W. Scerbo, The Future of Medical Training and the Need for Human Factors, Proceedings of the Human Factors and Ergonomics Society 49th Annual Meeting-2005.

The Committee believes that health care organizations should establish team training programs for personnel in critical care areas (e.g., the emergency department, intensive care unit, operating room) using proven methods such as the crew resource management techniques employed in aviation, including simulation.

--To Err is Human: Building a Safer Health System, Institute of Medicine, 1999.

While research in this field needs improvement in terms of rigor and quality, high-fidelity medical simulations are educationally effective and simulation-based education complements medical education in patient care settings.

--S. Barry Issenberg, et al, Features and Uses of High-Fidelity Medical Simulations That Lead to Effective Learning: A BEME Systemic Review, Medical Teacher, 2005:27(1):10-28.

Medical training must at some point use live patients to hone the skills of health professionals. At the same time there is an obligation to provide optimal treatment to insure patient safety and well-being...The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as a convenience of training.

--Amatai Ziv et al, Simulation-based Medical Education: An Ethical Imperative Academic Medicine, 2003 Aug;78(8):783-8.

The paradigm of medical education at each level of training and practice is shifting, causing the need to use alternative instructional methodologies. Simulation training is a viable alternative that allows the learner to obtain experience and skill prior to interacting with students in vivo. This training minimizes the risk to patients and limits the time and resources that are frequently expended through traditional training methodologies.

--Kathryn Mendoza and L.D. Britt, Minimally Invasive Surgical Simulation Training Center: Executive Summary, 2002.

Medical schools are redesigning their curricula and rethinking the nature of medical education. This transformation includes a greater emphasis on bioethics, patient-focused care, and the incorporation of the fruits of the medical-technological revolution. Although overreliance on technological medicine may sometimes be a threat to humanistic care, the proper use of simulation technology has the potential to enhance humanistic training in medicine. To optimize the use of SBME [simulation-based medical education] and overcome resistance by health professionals SBME trainers should be skillful in creating a receptive atmosphere, providing constructive feedback, and using video feedback and debriefing. Skillful use of SBME can use the intensity of simulated experience to nourish culture changes and support recognition of fallibility and areas of weakness.

--Amatai Ziv et al, Simulation-based Medical Education: An Ethical Imperative Academic Medicine, 2003 Aug;78(8):783-8.

High-fidelity simulation provides a promising opportunity for risk-free training in procedures and management of potential complications. While it does not replace clinical training, it does offer a means for mentored instruction in a realistic way, allows the interventionist to make procedural errors and then experience the consequences, and completely avoids the risks of patient injury and medico-legal liability associated with 'hands-on' training in a patient care setting. Our data support the contention that simulation is a valid tool for instructing surgical residents and fellows in basic endovascular techniques and should be incorporated into surgical training programs.

--Rabih A. Chaer, et al, Simulation Improves Resident Performance in Catheter-Based Intervention, Annals of Surgery, 2006:244(3):343-352.