Yvonne M Carter1, M Blair Marshall. 1. Division of Thoracic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA. ymc01@gunet.georgetown.edu
Abstract
BACKGROUND: Simulation has long been appreciated and used in professional industry training. The effectiveness of high-fidelity, low-cost simulators in such settings has led to its integration into surgical education for skill development. Simulation may possibly have a role in surgical specialty training. METHODS: Replicas of a human torso with a posterolateral thoracotomy incision were constructed from poultry netting and casting fiberglass, and used to house a previously prepared bovine lung. After reviewing computerized instructional material, student volunteers were asked to perform a lobectomy with the assistance of a thoracic surgeon, who also evaluated the subjects. Objective data were collected from knowledge-based examinations and technical skills evaluation scales. Statistical analysis was performed with the Student's t test. RESULTS: The initial success rate was 88.9% (16 of 18). Significant improvements were appreciated in both subjective and objective measures by the third week with weekly repetition. The average operative time was reduced to 34.8 +/- 5 minutes from 48.5 +/- 4.9 minutes (p = 0.01). The average task-specific score was 7.8 +/- 0.8 (versus 5.6 +/- 2.1; p = 0.05), and students achieved an average global performance score of 28.6 +/- 3.8 (p = 0.01). Scores on knowledge-based examinations also significantly improved. CONCLUSIONS: This open lobectomy simulation can be used to effectively teach thoracic surgery techniques. Our results prove the effectiveness of simulation training in thoracic surgery. Additional studies will determine whether simulation is effective for different training levels in thoracic surgery.
BACKGROUND: Simulation has long been appreciated and used in professional industry training. The effectiveness of high-fidelity, low-cost simulators in such settings has led to its integration into surgical education for skill development. Simulation may possibly have a role in surgical specialty training. METHODS: Replicas of a human torso with a posterolateral thoracotomy incision were constructed from poultry netting and casting fiberglass, and used to house a previously prepared bovine lung. After reviewing computerized instructional material, student volunteers were asked to perform a lobectomy with the assistance of a thoracic surgeon, who also evaluated the subjects. Objective data were collected from knowledge-based examinations and technical skills evaluation scales. Statistical analysis was performed with the Student's t test. RESULTS: The initial success rate was 88.9% (16 of 18). Significant improvements were appreciated in both subjective and objective measures by the third week with weekly repetition. The average operative time was reduced to 34.8 +/- 5 minutes from 48.5 +/- 4.9 minutes (p = 0.01). The average task-specific score was 7.8 +/- 0.8 (versus 5.6 +/- 2.1; p = 0.05), and students achieved an average global performance score of 28.6 +/- 3.8 (p = 0.01). Scores on knowledge-based examinations also significantly improved. CONCLUSIONS: This open lobectomy simulation can be used to effectively teach thoracic surgery techniques. Our results prove the effectiveness of simulation training in thoracic surgery. Additional studies will determine whether simulation is effective for different training levels in thoracic surgery.