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Debriefing is recognized as essential for successful simulation-based training. Unfortunately, its effective use is variable. We developed a train the trainer workshop to teach key evidence-based components of effective debriefing. A workshop focusing on best practices for debriefing in surgical simulation-based training was developed for the 2012 Annual Meeting of the Association for Surgical Education. Content emphasized key theoretical concepts related to and evidence-based components of an effective debriefing. Additionally, the workshop incorporated experiential learning via active debriefing following a simulated scenario. Content of the workshop emphasized effective debriefing as the key to learning in simulation-based education. Key elements of debriefing for educators to keep in mind include the following: approach, learning environment, engagement of learners, reaction, reflection, analysis, diagnosis, and application. Effective debriefing is an essential skill for educators involved in surgical simulation-based training. Without it, learning opportunities are missed. Training the trainer in effective debriefing is essential to ensure standardization of practice.

Key research priorities for surgical simulation have been identified in recent years. The aim of this study was to establish the progress that has been made within each research priority and what still remains to be achieved. Members of the Association for Surgical Education Simulation Committee conducted individualized literature reviews for each research priority that were brought together by an expert panel. Excellent progress has been made in the assessment of individual and teamwork skills in simulation. The best methods of feedback and debriefing have not yet been established. Progress in answering more complex questions related to competence and transfer of training is slower than other questions. A link between simulation training and patient outcomes remains elusive. Progress has been made in skills assessment, curricula development, debriefing and decision making in surgery. The impact of simulation training on patient outcomes represents the focus of simulation research in the years to come.

We evaluated the effectiveness of implementing a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their 3rd-year surgery clerkship. Medical students on the 3rd-year surgical clerkship completed a proficiency-driven, simulation-based knot tying and suturing curriculum consisting of 6 tasks. The effectiveness was evaluated by comparing the initial presession scores to the final postsession scores on an 8-item self-efficacy scale and evaluating pass rates on end of clerkship skills testing. A paired t test was used to analyze data. Sixty-five students had matched preintervention and postintervention questionnaires for analysis. Pass rates approached 100% by the 3rd attempt on all tasks. Significant gains on all 8 items of the self-efficacy questionnaire from pretraining to post-training were noted. Timing of the general surgery rotation did not impact results. Implementation of a simulation-based training, proficiency-driven knot tying and suturing curriculum for 3rd-year medical students during the surgery clerkship is feasible and effective in improving student self-efficacy and objective proficiency toward performance of the tasks taught.

A clear understanding of simulation-based curricula in use at American College of Surgeons Accredited Education Institutes (ACS-AEIs) is lacking. A 25-question online survey was sent to ACS-AEIs. The response rate approached 60%. The most frequent specialties to use the ACS-AEIs are general surgery and obstetrics/gynecology (94%). Residents are the main target population for programming/training (96%). Elements of the ACS/Association of Program Directors in Surgery Surgical Skills Curriculum are used by 77% of responding ACS-AEIs. Only 49% of ACS-AEIs implement the entire curriculum and 96% have independently developed their own surgical skills curricula. “Home-grown” simulators have been designed at 71% of ACS-AEIs. Feasibility (80%), evidence of effectiveness (67%), and cost (60%) were reasons for curriculum adoption. All programs use operative assessment tools for resident performance, and 53% use Messick's unitary framework of validity. Most programs (88%) have financial support from their academic institute. Majority of ACS-AEIs had trainees evaluate their faculty instructors (90%), and the main form of such faculty evaluation was postcourse surveys (97%). This study provides specific information regarding simulation-based curricula at ACS-AEIs.

Opportunities exist to revise the current residency selection process to capture desirable candidate competencies. We examined the extent to which components of the American College of Surgeons/Association for Surgical Education simulation-based medical student curriculum combined with a teamwork activity could be used as potential screening method. Students participated in a workshop consisting of training/evaluation of knot tying, suturing, airway management, gowning/gloving, and teamwork. Surveys were given to medical students (MS) and faculty/resident/staff (FRS) to examine their opinions about the residency screening process, the most critical competencies to assess, and the effectiveness of each station for candidate evaluation. Communication (FRS, 4.86 ± .35; MS, 4.93 ± .26), leadership (FRS, 4.41 ± .80; MS, 4.5 ± .76), judgment (FRS, 4.62 ± .74; MS, 4.67 ± .62), professionalism (FRS, 4.64 ± .73; MS, 5.00 ± .00), integrity (FRS, 4.71 ± .78; MS, 4.87 ± .35), and grit/resilience (FRS, 4.71 ± .78; MS, 4.53 ± .74) were considered most valuable for candidate screening. The simulation-based curriculum for evaluation of residency candidates was rated lowest by both groups. Open response comments indicated positive perceptions of this process. Employing simulation to assess candidates may be most beneficial for examining nontechnical attributes. Future work should continue to explore this area. •We examined the extent to which a simulation-based medical student curriculum combined with a teamwork activity could be used as potential screening method.•Communication, leadership, judgment, professionalism, integrity, and grit/resilience were considered most valuable for candidate screening.•Employing simulation-based activities to assess candidates may be most helpful to evaluate nontechnical skills in individuals applying for surgical training.

Renewal of surgical curricula is critical in maintaining relevance to contemporary healthcare needs. A curriculum document usually describes its purpose, intended outcomes, content, methods, and assessment and evaluation processes. The document may also consider cultural, professional, political, and social contexts. While there are published curriculum development approaches, guidance on renewal processes is limited. This scoping review aims to synthesise literature on surgical curriculum renewal, to understand the key elements of this process, and identify areas for improvement. A scoping review was conducted by the core author team, with co-creation involving a Knowledge User Group (KUG). Seven databases were searched for sources published since 2003. Sources relating to curriculum renewal were included, and data were extracted via iterative and consultative processes involving both core authors and the KUG. Themes were identified via qualitative content analysis and thematic mapping of reported features. Eighteen sources were included from an originally identified 2359 articles. Six models of curriculum development were characterised, yet no curriculum renewal model was delineated. Terminology was inconsistent. Primary participants (trainees and trainers) tended to be consulted but not included in curriculum renewal teams. Factors including participant engagement, educational support, and financial resources were identified as enablers in particular environments, and considered as barriers in other contexts. Drivers for renewal included changes in surgical education and training; in surgical practice; and, participant concerns. Addressing identified barriers can transform them into catalysts for change. Greater standardisation of terminology in surgical curriculum renewal is needed. The field would benefit from purpose-built frameworks, educational scholarship, co-design, and the implementation of strategies to ensure barriers to renewal become enablers of the surgical curriculum renewal process.

Our aim was to report the longitudinal assessment of technical performance of general surgery residents on select tasks from multiple programs over a 2-year period. An institutional review board-approved, multi-institutional collaborative study was undertaken with yearly resident performance assessments over a 3-year period. General surgery residents (postgraduate year [PGY] 1 to 5) were tested on 3 laparoscopic and 5 open simulated surgical tasks. Resident performance was compared individually over time and among interns and more senior residents. Forty-one residents from 4 residency programs were evaluated. Scores increased in all tasks with each assessment, plateauing at a lower PGY level for open tasks compared with laparoscopic tasks. Change in performance scores between assessments were higher for interns compared with more senior residents (P < .003). Resident performance on basic open and laparoscopic tasks assessed over time improved the most between the PGY 1 and 2 levels and was dependent on task difficulty. This documented skill evolution may allow tailoring of skills curricula to both meet existing needs and minimize performance variability.

BackgroundThe Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) uses the Laparoscopic colectomy Train the Trainer (Lapco TT) framework for standardization of instructor training for Hands-On surgical skills courses. The curriculum focuses on teaching structure, skills deconstruction, trainer intervention framework, and performance enhancing feedback. A halt in the in-person Lapco TT courses due to the Coronavirus Disease 2019 (COVID-19) pandemic necessitated creation of a virtual alternative. We investigated the effectiveness of this virtual course. MethodsAdaptation of the in-person Lapco TT course to the virtual format retained the majority of content as well as the 4:6 instructor-to-participant ratio. The virtual platform and simulators chosen allowed maximal interactivity and ease of use. After participating in the day and one half course, participants completed an 8-item post-course survey using a 5-point Likert scale related to the training experience. In addition, they had the opportunity to provide answers to several open-ended questions regarding the course. For the survey, frequency counts provided an assessment of each item. For the open questions, qualitative analysis included determination of themes for each question. Frequency counts of each theme provided quantitative analysis.ResultsThirty-six total participants completed a Lapco TT virtual course (six sessions of six participants). Of this number, 32 participants completed post-course surveys and questions. All the participants completing the survey would very likely or definitely (Likert scale 4, 5) recommend the course to a colleague and incorporate the teaching in their practice. The majority of participants completing open-ended questions felt the virtual course format was effective; half thought that post-course follow-up would be useful. Technical concerns were an issue using the virtual format.ConclusionA virtual Lapco TT course is feasible and well received by participants. It presents a potentially more cost effective option to faculty development.