ASiT Yearbook 2011 - The Association of Surgeons in Training

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evaluation of the given simulator by experts, then an
evaluation of the simulator by trainees and if both of
these steps have a favourable outcome, carrying out
prospective studies on the simulator with the emphasis
on transferability of simulator acquired skills into the
clinical situation.
Only by going through this rigorous process can we be
certain that simulators will indeed make a significant
contribution to a training programme.
Figure 7 - Skills centre for simulation training (courtesy of the Cuschieri Skills
Centre, University of Dundee)
Conclusions
Currently many simulators covering a wide range of
procedures and levels of complexity are available to
surgical trainees and the recent report by the CMO in
England entitled ‘Safer Medical Practice, Machines,
Manikins and Polo Mints’ 23 has emphasised the
importance of integrating simulation into all medical
training programmes. Clearly some specialties will
benefit more from simulation than others but it is fair to
say that all surgical training programmes have the
potential to be enhanced by a considered introduction
of simulation. However, at present, trainees are faced
with a bewildering array of possibilities, many of them
expensive, with little guidance as to what is truly
beneficial. It should also be emphasised that, in surgery,
simulation has focussed on specific technical skills and
yet it has been recognised for many years that nontechnical
(human) factors have an effect on outcome
that outweighs that of purely technical ability 24 . Despite
this, simulation of decision making and the integration of
technical and non-technical skills has yet to find its place
in surgical training schemes.
In surgery, if the CMO’s vision is to be translated into
reality, it is essential that training programmes are
developed where simulation is incorporated appropriately.
Such simulation must be of the highest quality,
and given the expense of the more sophisticated
simulators, the only sensible approach is to concentrate
high-level simulation in state-of-the-art centres (figure 7).
Having a simulator in every hospital might seem to be a
laudable aim, but other than simple gadgets or boxes to
allow junior trainees to hone basic skills, this is neither
feasible nor useful. It must also be recognised that
introducing simulation in a co-ordinated and beneficial
manner will require a multi-disciplinary approach
involving expert surgeons, trainees, educationalists,
simulation designers and programme directors working
together to ensure that a rational, affordable syllabus of
simulation training is developed and integrated into
training programmes.
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