Abstract
Surgical education by simulation is not new or bound to specific health systems. In this review 1 the earliest of the 21 publications from Asia, North America, and Europe stems from 2002. A third was published >10 years ago. The oldest one uses virtual reality techniques that prevail in 9/21. The effect seems to be limited.
The final goal of surgeons' education should be to improve or maintain the quality of patient care. The lower efficacy and higher complications rates of learning curves demonstrate that the introduction of surgical novices in the operating room principally fails to achieve this goal.
A recent systematic review on percutaneous nephrolithotomy learning curves showed some anecdotal kind of simulation being used in only 2 of 14 institutions. 2 European residents reported availability of simulation facilities for stone surgery in only 9% of the departments. 3
I see a few information and consequences: No publication found by the authors
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has made it into the operating room evaluating the educational technique by its effect on novices' performances and learning curves. “Increasing evidence of the efficacy of ex vivo training, coupled with societal pressure, will probably mean that future residents will need to demonstrate proficiency in basic techniques before being allowed to operate on patients” (Reference 1 in 1). This 14 years old vision has not materialized. Virtual reality training can be without any reasonable relation to reality “… for a 55 gram prostate, learning curve was stable after 4 procedures, for a 70 gram prostate, learning curve stable after 10 procedures.” (Reference 22 in 1) Virtual reality training is not principally embedded in regular surgical education: Type and number of operative procedures in the residents' logbooks qualifying them as urologist vary extensively, for example, in Germany,
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Great Britain,
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United States,
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and obviously follow differing objectives.
As long as virtual surgical education is not a compulsory part of a curriculum it will just be an article in the shop selling things nobody urgently needs.