Systematic Reviews
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2014; 6(9): 436-447
Published online Sep 16, 2014. doi: 10.4253/wjge.v6.i9.436
Evaluation of surgical training in the era of simulation
Shazrinizam Shaharan, Paul Neary
Shazrinizam Shaharan, National Surgical Training Centre, Department of Surgical Affairs, Royal College of Surgeons Ireland, Dublin 2, Ireland
Paul Neary, Division Of Colorectal Surgery, Adelaide and Meath incorporating the National Children’s Hospital, Trinity College Dublin, Tallaght, Dublin 24, Ireland
Author contributions: Shaharan S performed the literature search, analysis and wrote the manuscript; Neary P involved in analysis and editing the manuscript.
Correspondence to: Shazrinizam Shaharan, MB, BCh, BAO, BA, National Surgical Training Centre, Department of Surgical Affairs, Royal College of Surgeons Ireland, 121 St Stephen’s Green, Dublin 2, Ireland.
Telephone: +353-1-4022704 Fax: +353-1-4022459
Received: April 6, 2014
Revised: April 30, 2014
Accepted: August 27, 2014
Published online: September 16, 2014

AIM: To assess where we currently stand in relation to simulator-based training within modern surgical training curricula.

METHODS: A systematic literature search was performed in PubMed database using keywords “simulation”, “skills assessment” and “surgery”. The studies retrieved were examined according to the inclusion and exclusion criteria. Time period reviewed was 2000 to 2013. The methodology of skills assessment was examined.

RESULTS: Five hundred and fifteen articles focussed upon simulator based skills assessment. Fifty-two articles were identified that dealt with technical skills assessment in general surgery. Five articles assessed open skills, 37 assessed laparoscopic skills, 4 articles assessed both open and laparoscopic skills and 6 assessed endoscopic skills. Only 12 articles were found to be integrating simulators in the surgical training curricula. Observational assessment tools, in the form of Objective Structured Assessment of Technical Skills (OSATS) dominated the literature.

CONCLUSION: Observational tools such as OSATS remain the top assessment instrument in surgical training especially in open technical skills. Unlike the aviation industry, simulation based assessment has only now begun to cross the threshold of incorporation into mainstream skills training. Over the next decade we expect the promise of simulator-based training to finally take flight and begin an exciting voyage of discovery for surgical trainees.

Keywords: Simulation, Surgical training, Surgery, Training, Objective Structured Assessment of Technical Skills, Observational tool, Surgical skills, Assessment, Skill assessment

Core tip: The nature of surgical training has teetered on the brink of a seismic change in how we can deliver the level of expertise required of a modern surgeon for over a decade. It is evolving from Halstedian’s apprenticeship model towards simulation-based training similar to the aviation industry. Since 2000 there have been approximately 173 studies about validation of simulators as assessment tools. As the technology grows, its translation into real changes in curriculum is still unclear. This review is focused upon where we currently stand in relation to the effective integration of simulation-based skills assessment into modern surgical training curricula.