A Review of Surgical Simulation With Attention to Validation Methodology

Abstract

The use of simulation technology for teaching and evaluating surgical skills has gained considerable attention in recent years. This is driven by interest in quality of care, concerns over increasing operative complexity, constraints on the use of animal models, limited available patient material, medicolegal pressures, and fiscal mandates for cost-effective performance. Traditional mechanical models are yielding to techniques dependent on electronic technology, including virtual reality. Data to support the validity of simulation techniques for surgical training, assessment, and certification represent only a fraction of the literature available on the subject. Literature searches were conducted in MEDLINE and ERIC, covering the period from 1966 to the present. The electronic and bioengineering literature was not surveyed due to the extensive literature on technology development, distinct from assessment of context specific validity. The search results and the bibliographies of key review articles were examined to identify articles that contained original data, measured performance between cohorts, defined performance measures, and described a standard against which performance was compared. Most of the literature pertaining to simulation techniques for surgical training has been published within the past 5 years and consist of review, opinion, and feasibility articles. There is an emerging body of evidence to establish the validity of simulation techniques for assessing surgical skills. Further refinement of simulation techniques, identification of specific performance measures, longitudinal evaluations, and comparison to practice outcomes are still needed to establish the validity and the value of surgical simulation for teaching and assessing surgical skills prior to considering implementation for certification purposes.

Building an efficient surgical team using a bench model simulation: construct validity of the Legacy Inanimate System for Endoscopic Team Training (LISETT)

“…Despite considerable improvement in individual skills outside the operating room with simulation, competence performing surgery in the operating room still is under investigation [26][27][28]. One reason is that the low fidelity of most simulations restrains trainees from transferring their lab skills to the clinical setting [29].…”

Experience report on teaching surgical technique without animal use

“…Though there is no universal system to evaluate the surgical abilities precisely, there are three general categories identified for quality evaluation of the surgeon: (1) clinical cognitive abilities, (2) technical abilities, and (3) social interaction 4 . The graduation course must emphasize on methodologies that promote the active participation at the student educational process, early introducing him in practical activities indispensable for the medical career 5 .…”

Validation of a novel non-biological bench model for the training of percutaneous renal access

“…With the summary of questionnaire, face and content validity were demonstrated. For a training model to be effective, construct validity, which distinguishes the level of training (19,20), has to be proved. In the present study, this was clearly demonstrated by comparing the results of experts with those of novices.…”