Surgical simulation in osteopathic medical schools
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Kevin D. Seely
,
Maxwell Hansen
To the Editor,
High-fidelity surgical simulation is uncommon in osteopathic medical schools despite evidence of improved procedural confidence in trainees [1, 2]. Considering that osteopathic physicians constituted 13.1% of matched surgical residents in 2022 [3], it is increasingly important to integrate low-risk, high-fidelity experiential procedural training early. The Rocky Vista University (RVU) Department of Simulation in Medicine and Surgery is accredited as a Comprehensive Accredited Education Institute by the American College of Surgeons. It is the first osteopathic medical school to receive this accreditation.
The purpose of this Letter to the Editor is twofold. First, we will discuss how osteopathic medical schools can implement surgical simulation to provide medical students with hands-on training experience to prepare for rotations and residency. We do so in the context of RVU’s experience, reporting components and challenges of our program. Second, we will review evidence in support of surgical simulation training at the medical school level.
RVU has employed surgical simulation in multiple forms. Located on Utah and Colorado campuses, simulated operating rooms are equipped with surgical manikins with cuttable and mendable skin. Numerous interactive electronic manikins are programmed for multiple surgical case simulations. Ultrasonography, laparoscopy, vascular access, sterile technique, instrumentation, suturing, and operating room etiquette are also taught (Figure 1).
Simulated operating rooms at the (left) Utah and (right) Colorado campuses. Students are able to participate in case-based scenarios to experience and learn the fundamentals of the operating room and basic surgical skills. Students and surgical residents practice techniques such as suturing, ultrasound, intubation, thoracotomies, cricothyrotomies, and other important procedures and skills. Simulated operating rooms are complete with wall murals, operating room lights, disposable medical kits, mayo stands, whiteboards, and personal protective equipment.
Surgical technique is also taught utilizing a surgical simulator known as Cut Suit™. Cut Suit™ is a lifelike, wearable bodysuit that contains battery-operated, blood-filled pumps to vessels and organs, producing the look and feel of intra-abdominal and intra-thoracic contents. The RVU College of Osteopathic Medicine (RVU-COM) was the first medical school in the country to employ this technology. 3D printers are also utilized for the production of anatomical body part facsimiles.
Challenges faced while implementing this program include fund allocation, curriculum integration, and operator training. Preliminary data from student feedback surveys are widely positive, and students report improved confidence on rotations and into surgical residency.
The proven benefits of simulation include improved skill acquisition, critical decision-making, spatial awareness, teamwork, and professionalism [4], [5], [6]. Knowledge retention has also been proven to improve with experiential training [7]. The American College of Graduate Medical Education (ACGME) has incorporated simulation training into residency curricula nationwide, reinforcing its utility as an integral teaching modality [8]. Recently, the value of simulation has been further substantiated with less surgical volume due to work-hour regulations [9].
Providing students with a controlled environment to encounter surgical scenarios and explore their technical curiosity aids in developing competency and reducing patient harm [10]. For the benefit of both students and patients, surgical simulation should be integrated into more osteopathic medical schools.
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Research funding: None reported.
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Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors contributed to the analysis and interpretation of data; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Conflicts of interests: None reported.
References
1. Meling, TR, Meling, TR. The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis. Neurosurg Rev 2021;44:843–54. https://doi.org/10.1007/s10143-020-01314-2.Search in Google Scholar PubMed PubMed Central
2. Ribeiro, IB, Ngu, JMC, Lam, BK, Edwards, RA. Simulation-based skill training for trainees in cardiac surgery: a systematic review. Ann Thorac Surg 2018;105:972–82. https://doi.org/10.1016/j.athoracsur.2017.11.036.Search in Google Scholar PubMed
3. National Resident Matching Program, Results and data: 2022 main residency Match®. Washington, DC: National Resident Matching Program; 2022.Search in Google Scholar
4. Ahlberg, G, Enochsson, L, Gallagher, AG, Hedman, L, Hogman, C, McClusky, DA, et al.. Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 2007;193:797–804. https://doi.org/10.1016/j.amjsurg.2006.06.050.Search in Google Scholar PubMed
5. Enter, DH, Lee, R, Fann, JI, Hicks, GL, Verrier, ED, Mark, R, et al.. “Top Gun” competition: motivation and practice narrows the technical skill gap among new cardiothoracic surgery residents. Ann Thorac Surg 2015;99:870–6. https://doi.org/10.1016/j.athoracsur.2014.09.051.Search in Google Scholar PubMed
6. Seymour, NE, Gallagher, AG, Roman, SA, O’Brien, MK, Bansal, VK, Andersen, DK, et al.. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002;236:458–63. discussion 463-4. https://doi.org/10.1097/00000658-200210000-00008.Search in Google Scholar PubMed PubMed Central
7. Langdorf, MI, Strom, SL, Yang, L, Canales, C, Anderson, CL, Amin, A, et al.. High-fidelity simulation enhances ACLS training. Teach Learn Med 2014;26:266–73. https://doi.org/10.1080/10401334.2014.910466.Search in Google Scholar PubMed
8. Accreditation Council for Graduate Medical Education (ACGME). Case requirements for residents beginning on or after july 1, 2017. Published online 2017. https://www.acgme.org/specialties/surgery/program-requirements-and-faqs-and-applications/ Search in Google Scholar
9. Munro, C, Burke, J, Allum, W, Mortensen, N. Covid-19 leaves surgical training in crisis. BMJ 2021;12:n659. Published online March. https://doi.org/10.1136/bmj.n659.Search in Google Scholar PubMed
10. Akhtar, K, Sugand, K, Wijendra, A, Standfield, NJ, Cobb, JP, Gupte, CM. Training safer surgeons: how do patients view the role of simulation in orthopaedic training? Patient Saf Surg 2015;9:11. https://doi.org/10.1186/s13037-015-0058-5.Search in Google Scholar PubMed PubMed Central
© 2023 the author(s), published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
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Articles in the same Issue
- Frontmatter
- Cardiopulmonary Medicine
- Original Article
- Systolic blood pressure in acute ischemic stroke and impact on clinical outcomes
- Medical Education
- Brief Report
- Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?
- Neuromusculoskeletal Medicine (OMT)
- Clinical Practice
- Potential therapeutic effects of adjunct osteopathic manipulative treatments in SARS-CoV-2 patients
- Public Health and Primary Care
- Brief Reports
- Physician stress in the era of COVID-19 vaccine disparity: a multi-institutional survey
- Trends and forecasted rates of adverse childhood experiences among adults in the United States: an analysis of the Behavioral Risk Factor Surveillance System
- Clinical Image
- Haglund deformity of the posterior heel
- Letters to the Editor
- Surgical simulation in osteopathic medical schools
- Comments on “Is cadaveric dissection essential in medical education? A qualitative survey comparing pre-and post-COVID-19 anatomy courses”
