Dokument

Summary:
Introduction Simulation skill laboratories are being increasingly marketed from different institutions and are widely accepted in Europe and the United States of America (USA). Furthermore, residency training programs in the USA incorporate such laboratories into their residency curricula after having been mandated by the American College of Surgery (ACS) since 2008 and use them in the last few years to evaluate the competency of their surgical residents (Varban et al. 2013). Unlike to North America, the literature to date has shown a little or none about simulation skill laboratories and curricula in Europe, despite their existence in private institutes or few residency training programs. European training programs still rely mainly on traditional training methods and surgical simulators are still predominantly aimed at attracting attention at surgical equipment exhibitions. One of the well-known simulation skill laboratories in Germany is held yearly in the annual meetings of the German Society for Surgery (DGCH) since 2005. This skill laboratory is subdivided into different courses over four days with different modules in station-setting which include common trunk surgical skills, visceral laparoscopic techniques, and conventional visceral anastomoses techniques as well as courses in vascular and orthopedic surgery. A valid and reliable objective assessment tool was developed in Canada and is currently used widely by residency training programs in the USA and Canada to evaluate the efficacy of technical skill development outside the operating room in a bench setting. This tool is called, the Objective Structured Assessment of Technical Skills (OSATS) (Martin et al. 1997; Ault et al. 2001). The aim of our study is to demonstrate the improvement of surgical skills through the participation in a selected training module using this validated international assessment tool (OSATS). Materials und Methods The visceral anastomoses course which includes five training modules on animal models and takes place over two days was selected for evaluation. Performance of the participants in one module (end-to-end bowel anastomoses) was measured by qualified surgeons using a task specific checklist at the beginning and at the end of the course with instructor to participant ratio 1 to 10. The improvement in OSATS scores pre-post the course was assessed using paired T-Test. Participants were asked to perform a baseline bowel anastomoses independent of the course and their scores were analyzed as a possible correlation factor with final OSATS scores. Demographic data of the participants as well as subjective evaluation forms were collected. Results A total of 38 surgical residents completed the 2-day visceral anastomoses course. The mean age was 34 ± 6 years. 58 % were males. Most of the participants were in their 4th and 5th year of residency training. 66% reported having performed ≤ 10 bowel anastomoses since the beginning of their surgical training. 21% were able to perform an end-to-end bowel anastomoses independent of the course in terms of self-reporting and scored a mean of 15 ± 3 in OSATS. OSATS scores improved significantly after completing the course (p= 0.000018) with a mean of 15.7 ± 3.5 vs. 18.8 ± 2.4 at the beginning and end of the course, respectively. In the regression analysis, factors like the ability to perform the procedure before the course, number of in-training so far performed bowel anastomoses or current level of surgical training did not predict the improvement of OSATS scores of the participants pre-post the curriculum (p= 0.6, 0.5 and 0.07, respectively). Furthermore, 95 % of the participants reported subjective improvement in their skills and all participants gave a positive answer when asked whether to include simulation laboratories into their residency curricula. Conclusions Our results show a significant improvement of the surgical skills of residents regardless of their training level after participating in the simulation course as measured by OSATS. We highly recommend the integration of simulation laboratories in the curricula of our national residency training programs as a complementary part of traditional surgical training in the OR.

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