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Surgical Simulation Curriculum The University of Missouri Ob/Gyn residency program leads the way in integration of surgical simulation into early development of surgical skills.
The residency transition into the real-world OR environment can be challenging. Our goal is to prepare you for live procedures by concurrently orienting you to anatomy and technique using surgical simulation. The simulated environment gives you time to process through early development of technique and skill in a “cold action” practice environment (Eraut, 1985) before proceeding into the “hot action” of the operating room. Our program currently begins each July with a two-day, eight station Skills Camp experience where you learn and practice basic surgical component skills such as suturing, knot tying, incising skin without beveling, basic obstetrical exam for fetal vertex position, forcep and vacuum delivery, etc. During “surgical skill olympics” you will put your skill against other interns and residents using objective measures of these skills (don’t worry – only the top residents in each category are posted!). These objective scores allow you to quantify your surgical skill development as you progress through the program.
To allow an objective measure of progress, all of our residents are given a numeric competency score following each real-world operating room experience. This private score is compiled into a spreadsheet to allow progress to be tracked throughout residency. A “1” means that more one-on-one “cold-action” instruction is needed with simulation. A “2” means that a resident is capable of performing some but not all elements of a procedure with guidance. A “3” means that a resident is capable of performing a complete procedure with supervision and is usually achieved in the 2nd or 3rd year depending on the procedure. The coveted “4” is usually achieved by the 3rd or 4th year for most procedures (ie., mid-urethral sling, vacuum or forcep delivery, vaginal hysterectomy, laparoscopic hysterectomy) and means that the faculty member is confident that a resident is capable of performing a procedure independently in private practice without any supervision.
Gynecological Surgery Simulation Our gynecological surgery simulation begins with component skill simulation – suturing, knot tying, incising, and basic laparoscopic manipulation. We also use surgical videos and models (and in the near future cadavers) to review pelvic anatomy. Our residents are expected to practice these skills until they are proficient.
Models available in our Medical Education Suite at Columbia Regional Hospital are to be used for gynecological surgery practice, include laparoscopic video box trainers, suture sets, surgical videos, and laparotomy and vaginal hysterectomy models. At any time, our residents are encouraged to “test out” and beat their previous score obtained in “component skills olympics”. The highest scores in the residency are posted for each skill. Obstetrical Surgery Simulation
In addition to gynecological procedure simulation, our residents participate in our Obstetric Emergencies Course – an extremely popular course given for a fee to obstetricians in private practice – where they are given the opportunity to use our Noelle birth simulators to treat eclampsia, severe postpartum hemorrhage, precipitous vaginal breech delivery, etc. Communication and Professionalism Simulation
We are proud to partner with the Sheldon Simulation Center on main campus, 4.5 miles away. The Sheldon Simulation Center is a cutting-edge multimedia capable center with multiple videotaped exam rooms and simulated OR environment that can be used to evaluate a trainees response to common and uncommon clinical situations. Once a year, our curriculum includes an afternoon in the simulation center using gynecological teaching assistants to evaluate and teach skills such as informed consent, delivering bad news and dealing with the difficult patient or colleague. This experience is invaluable for developing a sense of constructive self-awareness in professional development. Summary We are committed to providing the very best educational experience for our residents. Simulation is an important tool in this process, especially early in training. Our vision is to maximize the use of this tool to give our residents a “jump start” into the surgical arena, allowing “real-world” OR experiences to be more meaningful and less stressful for all of our resident surgeons. References Eraut M. Knowledge creation and knowledge use in professional contexts. Studies in Higher Education 1985;10:117-133. |
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