1. Validation of Open Inguinal Hernia Repair Simulation Model A Randomised Controlled Educational Trial Khatib M, Hald N, Brenton H, Sarker S, Standfield N, Ziprin P, Kneebone R, Bello F Imperial College London Association for Surgical Education Surgical Education Week 24 th April 2013

2. Introduction Surgical simulation brought to the forefront of surgical training –Technological advances –Importance of surgical safety –Limitation in surgical trainee exposure EWTD Duty hour restrictions Abundance of laparoscopic/ endovascular simulators Development of Hernia Repair Open Surgical Simulation (HeROSS) model

3. Recruitment Clinical Years Medical students invited to participate Volunteers screened Exclusion criteria implemented Block Randomisation Pre-intervention MCQ Recruitment Clinical Years Medical students invited to participate Volunteers screened Exclusion criteria implemented Block Randomisation Pre-intervention MCQ Intervention Group Group 4: Control Group Group 4: Control Group Group 1: Interactive Simulation Group 1: Interactive Simulation Group 2: Non- interactive Simulation Group 2: Non- interactive Simulation Group 3: Video Tutorial Group 3: Video Tutorial Assessment 1. Post-intervention MCQ 2. Viva Assessment 1. Post-intervention MCQ 2. Viva Method Performing or assisting in an open inguinal hernia repair Previous bachelor degree in anatomy Anatomy demonstrator

4. Method Three separate one hour learning sessions Scenario given to candidates All in one week Assessment one day after final learning session

5. Method Interactive Simulation

6. Method Video Tutorial

7. Method Control Group –Internet access –Quick access to all surgical procedure textbooks and mini-textbooks available in Imperial College Library –Anatomy handouts from commonly used anatomy textbooks and atlases

8. Results 72 72 students showed interest 59 13 students excluded as per exclusion criteria 56 3 students did no complete study

9. Results 54 students completed study Group 1 n=15 Group 2 n=15 Group 3 n=12 Group 4 n=14

10. Results Group MeanStandard Deviation Pre Intervention MCQ (%) 143.3313.28 238.929.93 338.339.37 439.579.27 Total40.1410.58 Score Improvement in MCQ (%) 130.1513.68 236.0812.48 331.7412.87 47.419.56 Total26.416.41 Assessment Score(%) 176.929.9 265.382.72 359.678.86 442.939.54 Total61.6314.88

11. Results – Comparison Between Groups MCQ Improvement Score (MSI) Assessment Score (FAS) Group123123 2 -5.93 11.54 p=0.23 p<0.001 3 -1.594.3417.255.71 p=0.76p=0.34p<0.001p=0.001 4 22.7428.6724.3333.9922.4516.74 p<0.001

12. Conclusions Statistically significant Improvement in anatomical and procedural knowledge from using the interactive simulation model Vital role of simulation as an adjunct in modern surgical training Open surgical procedural knowledge a pre- requisite to laparoscopic surgery Envisage online virtual theatre with ability to do multiple core index procedures

13. Future Research Recruitment of surgical trainees ongoing Addition of recorded assessment on hernia model

14. Thank you