This story is from the category World Specific Developments
Date posted: 02/08/2013
A novel interactive 3-dimensional (3-D) simulation platform offers surgical residents a unique opportunity to hone their diagnostic and patient management skills, and then have those skills accurately evaluated according to a new study appearing in the August issue of the Journal of the American College of Surgeons. The findings may help establish a new tool for assessing and training surgical residents.
Previous research studies have shown that the management of patient complications following operations is an extremely important skill set for surgeons to master. Therefore, in addition to performing operations, surgeons must also be able to effectively manage surgical patients in the emergency room, on the hospital floor unit, or in the intensive care unit. Until now, the standard approach for this instruction has been to learn to master this skill set on patients.
“The way we learn in residency currently has been called ‘training by chance,’ because you don’t know what is coming through the door next,” said study coauthor Rajesh Aggarwal, MD, PhD, MA, FRCS, a National Institute for Health Research (NIHR) clinician scientist in surgery at Imperial College, St. Mary’s Hospital in London. “What we are doing is taking the chance encounters out of the way residents learn and forming a structured approach to training.”
Using an online virtual world called Second Life™, a multidisciplinary team of researchers from Imperial College, St. Mary’s Hospital developed three virtual reality environments—a standard hospital ward, an intensive care unit, and an emergency room.
For the study, the researchers created modules for three common surgical scenarios: gastrointestinal bleeding, acute inflammation of the pancreas, and bowel obstruction. Each of these scenarios, which could be accessed through a laptop or personal computer, was designed to put the residents through their paces at three different levels of complexity.
“What we want to do—using this simulation platform—is to bring all the junior residents and senior residents up to the level of the attending surgeon, so that the time is shortened in terms of their learning curve in learning how to look after surgical patients,” Dr. Aggarwal said.
The study involved 63 surgeons—including interns and junior and senior residents, as well as attending surgeons whose performance was used as a benchmark. Each surgeon assessed and managed a series of virtual patients via this 3D interactive surgical world. The process involved taking a patient history, performing a physical, interpreting labs, diagnosing the disease, using chest X rays and CT scans, and implementing an appropriate management plan.
Using a validated rating scale, researchers then evaluated and rated each surgeon’s performance for each case he or she performed. The minimum score was eight and the maximum score was 56, which was equivalent to achieving 100 percent or performing at the level of an attending.
The study results showed significant gaps in performance between interns and attendings, as well as between junior and senior residents and attendings. For example, analysis of the level-one gastrointestinal bleeding module showed that interns scored 48, junior residents scored 50, senior residents scored 54, and attendings scored 56. For other cases, study results showed similar outcomes.
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