Surgical Education Assessment of simulators for training and selection of trainees

Background
Approximately 15 % of surgical patients in hospital are affected of an adverse event, which is a medical error caused by the health care system. Laparoscopy is the preferred surgical technique in common procedures. Societal changes with shorter working hours, patient safety and ethics demand optimisation of resources to
achieve the goal of educating competent surgeons within a reasonable time frame. Errors related to procedures is more often due to communicational skills and lack of situational awareness than pure technical skills. Laparoscopic simulation creates a safe training environment to spare patients being operated on by surgeons at
the steepest part of their learning curve. Selection of surgical trainees by testing different areas of technical and non-technical competence and personality traits is uncommon in the surgical community.

Aim.
The aim of the research project is to investigate laparoscopic simulators used for training and potential unsuitable behaviour of surgical trainees as defined for the selection process.

Methods
Three studies were conducted with surgical novices, trainees and experienced surgeons by using laparoscopic simulators. Trainee and expert performance were investigated for simulator feasibility, effect of training of novices with sense of touch (haptics) and 3D vision, and opinion of experienced surgeons in using a virtual reality (VR) simulator.
A mixed methods design with questionnaires and interviews with experienced surgeons was used to identify unsuitable behaviour and traits in trainees.

Results
The Simball® Box is a new type of laparoscopic simulator which showed good feasibility and has the potential to mirror the technical progression with metrics. LapSim® Haptic Virtual Reality simulator with 3D and haptics shortens the acquisition of basic skills in novices with 32 %. Experienced surgeons considered that haptics in
LapSim® had limited fidelity, but in spite of this, produced less stretch damage to the simulated tissue with haptics enabled. Experienced surgeons have quite consistent views on what makes a person unsuitable as a surgeon. This knowledge have been systematized in 11 problem domains and a list of early “warning signs” in addition to a
structured interview guide.

Significance
The findings from the studies concerning laparoscopic simulators have increased the knowledge of their usefulness and effectiveness and could assist in the construction of training curricula. The findings from the study on unsuitable behaviour could increase awareness and suggest the possibility to identify these signs early during training and initiate actions to remediate. The interview guide could contribute to increased quality and transparency amongst candidates applying for a trainee position.