Surgery simulation ‘catapults’ trainees' abilities

Nov 22 2012

By Sarah Guy, medwireNews Reporter

Study findings indicate that simulator training for otorhinolaryngology residents results in equal, if not superior, performance compared with traditional training that involves finite repetition of live procedures.

The simulator could therefore "catapult" novice surgeons beyond the initial learning curve, giving them skills that could improve patient safety in the operating room, say the researchers.

Furthermore, residents trained with the simulator achieved the required levels of proficiency "despite the existence of an inherent range of abilities," note Marvin Fried (Montefiore Medical Center, Bronx, New York, USA) and colleagues in the Archives of Otolaryngology-Head and Neck Surgery.

"To our knowledge, this is the first direct comparison of conventional and proficiency-based simulator training methodologies within the field of otorhinolaryngology, so this is a crucial finding in determining the future utility of surgical simulation," they remark.

A total of 14 junior residents (from postgraduate years 1-3) took part in the study. Eight were assigned to use the Endoscopic Sinus Surgery Simulator (ES3) until they reached proficiency at the intermediate level, and six of the residents acted as controls, completing ES3 training to novice level before receiving standard training by performing two surgery procedures. A further six attending surgeons served as subjects for comparison.

All residents (and attendings) were videotaped while performing endoscopic sinus surgery (including navigation, injection, and dissection) prior to "training" with the ES3 or standard method, and again afterward. Subsequently, an expert panel reviewed the videos, grading the difficulty of the surgery, tool manipulation, tissue respect, completion, and surgeon confidence.

Fried and team observed significant overall improvements in the residents' performance with regards to all injection and dissection tasks, and all navigation tasks except for tool manipulation.

In the final navigation task, the ES3-trained residents and attendings scored equally, with approximately 4.6 (out of 10) for difficulty, 7.1 for tool manipulation, 7.2 for tissue respect, 7.0 for completion, and 7.0 for confidence.

By contrast, traditionally trained residents scored significantly lower than ES3 trainees in all of these factors.

ES3 trainees also scored higher than traditionally trained residents in the final injection task, although the differences were not significant, while the traditionally trained residents scored significantly higher than their ES3 peers for completion and confidence in the final dissection task, at approximately 6.9 and 6.0 versus 5.5 and 5.0, respectively.

As virtual reality training means surgeons can bypass the learning curve, Fried and team write, "it contains the potential to protect patients from novice errors during this period."

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