The APDSACS Surgical Skills

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The APDS/ACS Surgical Skills Curriculum
Committee
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Charge to the Simulation Committee

• Construct a curriculum that is
• Robust to meet RRC requirements
• Affordable
• Easily exportable
• Coordinated with the APDS Surgical
  Education Curriculum Committee
• A platform for future multi-institutional
  research studies

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Alignment of Stars in the Evolution of Surgical
Skills Laboratories

• RRC decision to require skills laboratories for
  accreditation by 2008
• ACS program for accreditation of skills
  laboratories
• APDS/ACS initiation of a national curriculum
  effort

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Surgical Skills Curriculum Task Force

• Mary Klingensmith
• Ajit Sachdeva
• Lisa Satterthwaite
• Neal Seymour
• Dan Smith
• James Valentine
• Richard Welling

• Gary Dunnington
• Helen MacRae
• Debra DaRosa
• Joe Cofer
• Gerald Fried
• Karen Horvath
• Dan Jones

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Skills Laboratory Questionnaire Results

• Debra DaRosa, PhD, Gary Dunnington, MD,
• and Muneera Kapadia, MD
• Departments of Surgery
• Northwestern University and Southern Illinois
  University

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Skills Lab Survey

• 33 of 40 PDs responded (70)
• University 25, Community 8
• 79 have 24 hour access
• 86 have MD surgeon director
• 59 of labs IN the hospital
• 39 have at least one FTE
• Only 16 use OSATS
• 48 have a documented curriculum

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Skills Lab Survey

• Would you welcome a national surgical skills
  curriculum for residents?
• 20 welcome
• 76 strongly welcome

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Devices Used in Skills Lab

• 28
• 28
• 45
• 17
• 35
• 24
• 14
• 90

• Promis
• MIST VR
• Lap Sim
• EGD trainer
• Colonoscopy trainer
• Bronchoscopy trainer
• Endovascular trainer
• Box trainer

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Focus of Surgical Skills Lab Activities

• Skills (suturing)
• Tasks (arterial anastomosis)
• Procedures (axillary dissection)

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Potential Project Phases

• Phase I Basic/core skills and tasks
• Phase II Advanced procedures
• Phase III Team based skills

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The Final Curriculum Package

• A web based package that includes
• Instructors Manual
• Vendors, products
• Implementation guidelines
• Verification of proficiency modules
• Evaluation packages
• The Surgical Skills Modules
• Skill/task/procedure demonstrations

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Skills Modules for Phase I

• Asepsis and instrument handling
• Knot tying
• Suturing
• Tissue handling, dissection, wound closure and
  wound management
• Advanced tissue handling, flaps and skin grafts
• Catheterization, urethral and suprapubic

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Skills Modules for Phase I

• Airway management
• Chest tube and thoracentesis
• Central venous access, arterial lines
• Surgical biopsy
• Basic vascular control
• Advanced vascular control
• Laparotomy, opening and closing

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Skills Modules for Phase I

• Principles of bone fixation and casting
• Inguinal anatomy
• Endoscopy, upper and lower
• Basic laparoscopy skills
• Advanced laparoscopy skills
• Hand sewn anastomosis
• Stapled anastomosis

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Template for Skills Module

• Objectives
• Assumptions
• Suggested readings (skills focus)
• Description of module (stations,options for
  training devices)
• Steps for skill/task/procedure
• Common errors, prevention strategies, rescue
  strategies
• Expert performance demonstration
• Recommendations for practice
• Supplies, teaching plans for module

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Dealing with Errors
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Using Errors in Skills Learning for Phases II and
III

• Expert procedure task analysis
• Expert definition of most common errors for each
  step of procedure
• For each error, description of error prevention
  strategies and error rescue strategies

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How do you teach performance of a bowel
anastomosis in a national curriculum?
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Proposed Verification of Proficiency Modules

• Knot tying
• Basic suturing
• Basic laparoscopic skills
• Laparoscopic cholecystectomy
• Central venous access
• Bowel anastomosis
• Arterial anastomosis
• EGD and Colonoscopy

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Template for Verification of Proficiency Modules

• Objectives

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Verification of Proficiency Objectives

• The resident will meet proficiency standards for
  the performance of
• A running fascial closure with O-prolene in a 30
  cm simulated fascial opening
• Interrupted simple sutures closing a 8 cm wound
  in a pig foot
• Vertical mattress sutures closing a 8 cm wound in
  a pig foot
• Subcuticular sutures closing a 8 cm wound in a
  pig foot

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Template for Verification of Proficiency Modules

• Objectives
• Learning materials
• Guidelines for practice
• Expert performance demonstration
• Performance checklist
• Instructions for testing

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Methodology for Development of Verification of
Proficiency Modules

• Expert development of performance checklist
• Expert/resident performance for time standard
• Production of expert performance
• Building validity

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Evaluation of Resident Performance

• Objective Structured Assessment of Technical
  Skills (OSATS)
• Verification of Proficiency Modules

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Project Timeline

• Drafts of Modules for Phase I due 9/01/06
• Editorial review and revisions 11/01/06
• Filming of expert performances with central
  editing
• Assembly of curriculum on web based platform by
  7/07
• Phase II completed by 1/08
• Phase III completed by 7/08

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Measures of Success of the Curriculum Project

• Utility
• Reaction of residents
• Reaction of faculty
• Outcome studies

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Research Opportunities with a National Surgical
Skills Curriculum

• Opportunity for multi-institutional studies with
  generalizable conclusions
• National performance standards
• Common curriculum for investigation of new
  training interventions
• Opportunity to design meaningful outcome studies

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An important scientific innovation rarely makes
its way rapidly winning over and converting its
opponents What does happen is that its
opponents gradually die out and the growing
generation is familiarized with the idea from the
beginning.
Max Planck The Philosophy of Physics, 1936