Implementation of a surgical simulation care pathway approach to training in emergency abdominal surgery
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients’ management. A common disease was chosen: acute appendicitis.
Methods
All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured.
Results
All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2–20) vs. 4 (4–6); P = 0.004, and 17 h (4–48) vs. 6 (4–24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30–264) vs. 44 (21–145); P = 0.22].
Conclusions
CPA training is feasible in abdominal surgery. In the current study, it improved patients’ management in terms of earlier oral intake.
Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients’ management. A common disease was chosen: acute appendicitis.
Methods
All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured.
Results
All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2–20) vs. 4 (4–6); P = 0.004, and 17 h (4–48) vs. 6 (4–24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30–264) vs. 44 (21–145); P = 0.22].
Conclusions
CPA training is feasible in abdominal surgery. In the current study, it improved patients’ management in terms of earlier oral intake.
Date Issued
2019-10-28
Date Acceptance
2019-10-01
Citation
World Journal of Surgery, 2019, 44 (3), pp.696-703
ISSN
0364-2313
Publisher
Springer
Start Page
696
End Page
703
Journal / Book Title
World Journal of Surgery
Volume
44
Issue
3
Copyright Statement
© Socie´te´ Internationale de Chirurgie 2019. The final publication is available at Springer via https://doi.org/10.1007/s00268-019-05242-1
Sponsor
National Institute of Health Research
National Institute for Health Research
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000492916000002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
NF SI 061710038
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
3-D VIRTUAL WORLDS
OPERATING-ROOM
SKILLS
IMPACT
APPENDECTOMY
OUTCOMES
PERFORMANCE
DIAGNOSIS
EDUCATION
TRIAL
Publication Status
Published
Date Publish Online
2019-10-28