Integrating simulation into a busy residency program.

A mandatory program of computer-driven simulation training was instituted in a medium-sized surgical training program in order to achieve the goal of increased resident performance outside the setting of direct patient care. Postgraduate year (PGY) 1-5 residents received mentored instruction on a virtual reality (VR) laparoscopic surgical trainer in performance of specific tasks appropriate to training level. Training for PGY 1-2 residents consisted of basic manipulative VR tasks. Training for PGY 3-5 residents consisted of VR suturing and intracorporeal knot-tying tasks. Each resident received two to four mentored one-hour sessions, and was instructed to return for self-directed practice during blocked and unscheduled time. PGY 3-5 residents had laparoscopic suturing and knot-tying skills evaluated in an animal model prior to onset of VR training and two to four months after start of training. After seven months of availability of training, PGY 1-2 residents had undertaken significantly more training sessions than PGY 3-5 residents (18+/-3 vs. 9+/-2; p<0.01). All PGY 1-2 residents demonstrated improved task performance, and six achieved expert performance relative to experienced laparoscopic surgeons. The suturing task in the animal lab was accomplished faster post-training (91+/-9 seconds vs. 154+/-16 seconds; p<0.01). Early results suggest that broadly applied VR training is of significant benefit in increasing resident technical skills. Based on early success, a broader program of computer-based simulation has been implemented, using more advanced devices for technical skills training, and a human patient simulator for training critical decision-making skills.