Meryl Altree

Multidisciplinary team simulation for the operating theatre: a review of the literature.

Analyses of adverse events inside the operating theatre has demonstrated that many errors are caused by failure in non‐technical skills and teamwork. While simulation has been used successfully for teaching and improving technical skills, more recently, multidisciplinary simulation has been used for training team skills. We hypothesized that this type of training is feasible and improves team skills in the operating theatre.

Laparoscopic skills maintenance: a randomized trial of virtual reality and box trainer simulators.

OBJECTIVE A number of simulators have been developed to teach surgical trainees the basic skills required to effectively perform laparoscopic surgery; however, consideration needs to be given to how well the skills taught by these simulators are maintained over time. This study compared the maintenance of laparoscopic skills learned using box trainer and virtual reality simulators. DESIGN Participants were randomly allocated to be trained and assessed using either the Society of American Gastrointestinal Endoscopic Surgeons Fundamentals of Laparoscopic Surgery (FLS) simulator or the Surgical Science virtual reality simulator. Once participants achieved a predetermined level of proficiency, they were assessed 1, 3, and 6 months later. At each assessment, participants were given 2 practice attempts and assessed on their third attempt. SETTING The study was conducted through the Simulated Surgical Skills Program that was held at the Royal Australasian College of Surgeons, Adelaide, Australia. RESULTS Overall, 26 participants (13 per group) completed the training and all follow-up assessments. There were no significant differences between simulation-trained cohorts for age, gender, training level, and the number of surgeries previously performed, observed, or assisted. Scores for the FLS-trained participants did not significantly change over the follow-up period. Scores for LapSim-trained participants significantly deteriorated at the first 2 follow-up points (1 and 3 months) (p < 0.050), but returned to be near initial levels by the final follow-up (6 months). CONCLUSIONS This research showed that basic laparoscopic skills learned using the FLS simulator were maintained more consistently than those learned on the LapSim simulator. However, by the final follow-up, both simulator-trained cohorts had skill levels that were not significantly different to those at proficiency after the initial training period.

What are the demographic predictors in laparoscopic simulator performance

Simulation is playing an increasingly important role in surgical education. There are a number of laparoscopic simulators of which the design and tasks vary considerably. It is unknown if any particular type may result in better outcomes for a specific population. This study assesses the predictors of acquisition of basic surgical skills on two different laparoscopic simulators.

Effect of fatigue on laparoscopic skills: a comparative historical cohort study

Fatigue has been shown to have a negative impact on surgical performance. However, there is a lack of research investigating its effect on laparoscopy, particularly in Australia. This study investigated whether fatigue associated with a surgeons usual workday led to a measurable drop off in laparoscopic surgical skills as assessed on a laparoscopic simulator.

Laparoscopic skills acquisition: a study of simulation and traditional training

Training in basic laparoscopic skills can be undertaken using traditional methods, where trainees are educated by experienced surgeons through a process of graduated responsibility or by simulation‐based training. This study aimed to assess whether simulation trained individuals reach the same level of proficiency in basic laparoscopic skills as traditional trained participants when assessed in a simulated environment.

Non-technical skills of surgical trainees and experienced surgeons

In addition to technical expertise, surgical competence requires effective non‐technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non‐technical skills considered essential for a competent surgeon. This study sought to compare the non‐technical skills of experienced surgeons who completed their training before the introduction of SET with the non‐technical skills of more recent trainees.

Mobile Simulation Unit: taking simulation to the surgical trainee

Simulation‐based training has become an increasingly accepted part of surgical training. However, simulators are still not widely available to surgical trainees. Some factors that hinder the widespread implementation of simulation‐based training are the lack of standardized methods and equipment, costs and time constraints. We have developed a Mobile Simulation Unit (MSU) that enables trainees to access modern simulation equipment tailored to the needs of the learner at the trainees workplace.

Demand for surgical simulated learning. Supervisors and trainees views: do they align?

The Royal Australasian College of Surgeons recently conducted the Simulated Surgical Skills Program in an attempt to better understand the role, function and outcomes of laparoscopic surgical simulation. Following this programme, access to simulation learning activities and the resources valued by surgical supervisors and/or Surgical Education Training (SET) trainees in Australia was investigated. An electronic survey concerning access to simulation activity and perception of simulation training was provided to 1478 surgical supervisors with an interest in academic surgery, education or research, and all 1091 SET trainees across Australia. The survey was administered online and was open to respondents for 18 days, from 14 May to 31 May 2012. The questionnaires were completed by 21% of the supervisors (315/1478) and 13% of SET trainees (140/1091). For ease of interpretation of the data collected, the simulation activities were grouped as follows: • Basic 1: Basic suturing and knot tying • Basic 2: A – Laparoscopic depth perception, camera navigation and tissue cutting B – Laparoscopic ligating loop, intraand extracorporeal knot tying • Advanced: A – Laparoscopic hernia repair, appendicectomy, cholecystectomy and colonoscopy B – Knee and shoulder arthroscopy