Letter to the Editor: Simulation for Surgical Training

Dear Editor:

The training of surgery is undergoing a slow but radical transformation. Residents have a shorter workweek and are spending more time in front of a computer because of the electronic medical records. Minimally invasive procedures are becoming the rule rather than the exception, and technology is becoming more and more complex. In the academic world, there is today a lot of stress on productivity as compensation is often based on relative value units and litigation is becoming more common with increasing scrutiny on outcomes, limiting the willingness to teach or let the residents operate with minimal or no supervision. All these factors have had a detrimental effect on training and on the competence of residents who complete a general surgery program.

In a recent study, a survey was sent to program directors of fellowship programs in the United States to assess readiness of general surgery graduate trainees. Respondents covered the most important subspecialties such as minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic surgery. Among the new fellows, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. When the laparoscopic skills were specifically analyzed by the program directors, it was found that 30% of the fellows could not manipulate tissue properly, 26% could not recognize anatomical planes, and 56% could not suture. ¹

Simulation training offers a unique opportunity to improve this situation and has evolved as an important component of surgical education. Simulation is particularly attractive because it avoids practicing skills in patients, allowing trainees to learn such skills in a safe, controlled, and standardized environment. Today most surgical programs in the United States have simulation centers and residents often have protected time to practice. ²

This symposium will cover simulation for minimally invasive foregut and bariatric surgery, hepatobiliary surgery, abdominal wall hernias and colorectal surgery. In addition, simulation for robotic surgery will be discussed. A variety of different simulators are described, from very expensive to relatively cheap so that the readers will be able to choose what is best for their own center.