On the Road Again: Surgical Simulation is Rural Practice D.R.Antonenko, MD.PhD. Professor of Surgery Director of Surgical Simulation Center University.

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Presentation transcript:

On the Road Again: Surgical Simulation is Rural Practice D.R.Antonenko, MD.PhD. Professor of Surgery Director of Surgical Simulation Center University of North Dakota School of Medicine and Health Sciences

Simulation in Rural Surgery Objectives Describe the educational background for simulation training in surgery To describe the possible role of simulation in rural/community surgical practice using a mobile simulation center To discuss how on site simulation training might help attract and retain surgeons in rural practice

Physician Learning Patient focused learning Resource accessibility Clinical applicability Familiarity with the resource Return on investment in time

Physicians and Learning Relevance to clinical practice needs Scheduling conflict Cost of attendance

Simulator Skills Training Curriculum Sound educational principles Goal oriented Sensitive/objective performance metrics Appropriate instruction/feedback

Simulator Skills Training Curriculum Deliberate/distributed/variable practice Allow overtraining Provide maintenance training Must have cognitive component

Simulator Skills Training Curriculum Deliberate/distributed/variable practice Allow overtraining Provide maintenance training Must have cognitive component PROFICIENCY BASED

Simulation = Deliberate Practice Move learning curve out of the OR BUT performance still required Reduce stress of learning Focus is on learner, not the patient Feedback improved

Simulators

Procedural (task) trainers Computer screen (micro-simulators) VR trainers Patient trainers

ACS/APDS Core skills Curriculum Phase I Curriculum Modules Asepsis/instruments Knot tying Suturing Tissue handling wound management Advanced tissue handling/flaps/grafts Catheterization Airway management Chest tubes Central lines Surgical biopsy Vascular anastomosis Laparotomy Bone Fixation/casting Inguinal Anatomy Upper endoscopy Colonoscopy Basic laparoscopic skills Advanced laparoscopic skills Hand sewn anastomosis Stapled anastomosis.

Simulation Center Equipment

Phase II Modules Lap ventral hernia Lap/open inguinal hernia Lap/open colon resection Lap/open CBD exploration Abdominal wall stomas Lap appendectomy Lap Nissen fundoplication Sentinel node biopsy/ALND Lap/open splenectomy Lap/open cholecystectomy Thyroidectomy parathyroidectomy Gastrectomy

Simulation Center Equipment

`ACS/APDS Core Skills Curriculum Phase III: Team Based Training

Simulation Center Equipment Team Based Training

Rationale For Simulator Training in Rural Surgery Fiscal Restraints Changing technology Ethical Concerns Patient Safety

Advantages of Simulation in Rural Surgery Maintain skills Enhance skills Increase practice opportunities Increase income Reduce malpractice premiums (?)

Simulation for Rural Surgery Surgeon specific Site specific High fidelity Timely Cost effective Distributed vs. massed practice

Simulations for Rural Surgery Minimally invasive Ultrasound ATLS procedures(?) Airway management Procedure specific Endoscopy upgrades

The Future of Simulation for Rural Surgery Tele-simulation Tele-proctoring Tele-mentoring 3 dimensional reconstruction COST

Rural/Community Surgeons Your Thoughts/comments