How far will simulators be involved into training?

Abstract

The expansion of laparoscopy and endoscopic surgery has promoted a change in surgical skills acquisition. This review aims to identify problems that modulate surgical skills acquisition and the role of simulation in the current training programs. Social, medical, and working time constraints, together with patient safety issues, lead to a decreased availability of operating room (OR) training opportunities. Systematic reviews show that there is a positive "model to model" transfer of skills more evident for virtual reality (VR) simulation, although transfer from video tower exists for naïve trainees, both of which supplement standard laparoscopic training. VR to OR positive transfer is proven for laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, although not for all parameters analyzed. A mixed model integrating both types of trainers into surgical curricula may strengthen their respective possibilities. To what extent simulation will be included in the surgical training programs depends on development of objective and finer assessment tools and proficiency-based criteria.

A Systematic Review on Low-cost Box Models to Achieve Basic and Advanced Laparoscopic Skills During Modern Surgical Training

“…9 Therefore, VRS are still necessary to simulate and train endoscopy and a mixed model integrating both types of trainers into surgical curricula is probably the best approach to strengthen their respective possibilities and give trainees a more complete exposure to simulated procedures. 67 We wrote this article especially considering modern surgical trainees and their peculiar training difficulties with particular regard to the reduction in operating hours, increase pressure for hospitals to provide more service than teaching, and the higher chances of medicolegal litigations in cases of adverse outcomes. The direct consequences of these new issues consist in a decreased possibility for the modern trainee to learn his own laparoscopic skills directly in theater and an increased necessity to find alternative methods to fulfill this task (ie, courses and simulators).…”

A Simulator for Teaching Transrectal Ultrasound Procedures

“…Factors that need to be taken into account in determining the cost-effectiveness of simulators include the time of trainees and instructors for simulation-based training at the expense of clinical work and the benefits in terms of patient safety. 16 In conclusion, the TRUS simulator we investigated enables repeated use of ultrasound images of real patients for The range of probe movement is limited 4 8 No 3D images are provided to guide the student 2 4…”

Virtual Reality Simulation: A Valuable Adjunct to Surgical Training

“…The main disadvantages of the VR simulator are the lack of portability, high start-up costs and ongoing maintenance. Physical simulators are widely available and include bench simulation, live animal model and human cadavers (19). The video or 'box' trainer (VT) is a basic training simulator in which users perform tasks with 'real' laparoscopic instruments under videoscopic guidance.…”

“…Recently there have been a few structured reviews published which appraise the current value of simulation, their incorporation into the surgical curriculum and aim to address the question regarding positive transfer of skills (19,35,41,42,49,(51)(52)(53). A systemic review by Sturm et al (51) attempted to determine whether skills acquired by virtual-reality training are directly transferable to the operative setting.…”