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Time Constraints in Surgical Skills Training

Time Constraints in Surgical Skills Training



By Dr. Niranjan Sathivel


Time constraints. We all have them and we all end up finding a way to deal with them. From my experience of having been an educator at a fully staffed medium sized simulation centre, I have first hand knowledge of the time constraints. Some sessions required elaborate set-ups which had to be started the day before.

An example of such a session was the Minimally Invasive Surgery (MIS) skills training session for senior general surgery residents and fellows. Each station comprised of a complete laparoscopy tower, setting up surgical grade instruments and disposables (such as sutures and staplers), porcine tissue (carefully selected and prepared based on the procedure steps), cautery equipment,  and protective equipment for the trainees, etc. 

And you guessed it! Taking down each station meant careful disposal of such materials as animal tissue (such as porcine bowel that were used for practicing procedure steps such as measuring, dividing, performing jejunojejunostomy, etc.), safely discarding the disposables, as well as cleaning the stations (lab tables and box trainers) and the equipment (laparoscopy towers and reusable surgical instrumentation). For the safety of the staff, the trainees and the patients with whom both the trainees and staff interacted, very strict protocols were developed by a collaboration of various departments which included the Infectious Diseases Dept., the Occupational Health Dept., the various residency training programs and the simulation centre. These policies had to be followed for setting-up and taking down surgical skills stations which involved animal tissue. This added a layer of complexity, which translated into more setup and takedown time. For instance, there were multiple cleaning and decontamination procedures (one type of procedure for each family of equipment used) and each procedure was further broken down into multiple steps, involving various chemicals and processing methods.

On any given day there would be several concurrent sessions that would be running. The simulation centre coordinators have to stay on top of all the available resources as some of the training sessions can push resources to the limit.

So what would be some of the best practices to reduce the load on the simulation centre resources? When it comes to staff time management, integrating validated VR simulators into training programs and using them in conjunction with the non-VR systems would be a good option.

By this, one system does not replaces the other, but when possible, using a validated VR simulator would significantly reduce the setup and takedown time, thereby freeing up time for staff. For instance once the VR systems are powered and the orientation has been provided, the trainees and their supervisors can then begin their sessions. Power off the VR systems once completed and sign-out. If allowed by the simulation centre those trainees and educators who have gone through the orientation and are familiar with the VR system(s) can sign-up and use the system(s) with minimal simulation centre staff time.

What are some of the ways you think could help with the setup and takedown times in the simulation theatres? We would like to hear from you. 



Niranjan Sathivel, Hon. BSc., M.D.
Consultant – Medical & Educational Content