GENERAL SURGERY RESIDENCY PROGRAM

Surgical Skills Lab

In 2007, the American College of Surgeons completed its Phase I Surgical Skills Curriculum for Residents. This curriculum is based on a system of didactic and psychomotor skills training offered in skills lab settings. Guthrie offers a resource for residents and surgeons pursuing technical expertise in line with the ACS curriculum: the Clinical Skills Laboratory and Simulation Center.

The skills lab is located on the fourth floor of Robert Packer Hospital, in the former operating room suite. Now in its second year, the lab is intended to be an avenue for residents and surgeons to gain proficiency with or brush up on techniques in an environment other than the operating room. For surgical residents, this represents a departure from traditional “see one, do one, teach one” methodology, instead offering hands-on training prior to a patient encounter. The skills lab offers lectures, laboratory sessions and scheduled training. A swipe-card entry allows surgeons and residents to hone techniques at any time. The lab is open to any Guthrie physician.

Thomas VanderMeer, MD, Director of General Surgery Residency Program, is the Medical Director of the lab. Burt Cagir, MD, Assistant Director of General Surgery Residency Program, serves as Attending Surgeon. Greg Coleman, RN, is the lab Coordinator. All general and vascular surgeons participate as instructors.

The skills lab consists of five rooms: three training rooms, equipped and staged appropriate to the skill being practiced; one lecture space; and an office. Much of the larger pieces of equipment, like the Stryker endoscopic video systems, anesthesia machine and Valley Lab cautery machine, have been decommissioned by the hospital and are now put to use in the lab. Expired items like central line kits and sterile supplies are also utilized during training.

The skills lab provides both high fidelity and low fidelity options. The first high fidelity offering is:

the Endoscopy AccuTouch Colonoscopy Simulator, which includes both upper and lower gastrointestinal flexible endoscopy. The endoscopy simulator uses virtual reality.
A bronchoscopy module is scheduled for purchase in the 2009 fiscal year.

Low fidelity options are many.

TraumaMan is a simulator for surgical skills training, including cricothyroidotomy, chest tube insertion, pericardiocentesis, diagnostic peritoneal lavage, and IV cutdown.
CentraLineMan is a venous simulator to train surgeons on subclavian, supraclavicular and internal jugular central line access. CentraLineMan also allows the user to practice real-time ultrasound guidance during central line catheter placement.
Pig bowel and vessels are provided for surgeons to practice enteric or vascular anastomotic techniques on organic tissue.
Box trainers are available to practice laparoscopic skills such as: tissue manipulation and dissection, application of Endo-Loops, and intra/extra-corporeal knot tying.
The laparoscopic box trainers are utilized to practice the skills that comprise the Fundamentals of Laparoscopic Surgery (FLS) program, developed by SAGES and jointly supported by the ACS. FLS is a comprehensive educational module designed to teach the physiology, fundamental knowledge and technical skills required in basic laparoscopy.

While low fidelity tools are not intended to closely approximate a living subject, their components are anatomically true. By using these low fidelity tools repetitively, the objective is for residents to gain an understanding of procedure and appropriate situational response.

Since January 2007, the skills and simulation lab has hosted almost 700 residents and staff from various departments and specialties such as: surgery, cardiology, OR, neurosurgery, respiratory, anesthesiology, ER and orthopedics. Training topics have included: stapled bowel anastomosis, endoscopic vein harvest, skin suturing, laparoscopic surgery, catheter placement, Endo-Stitch laparoscopic suturing device training, chest tube insertion and vascular anastomosis. Basics like gowning, gloving, draping and sterility are also offered. In addition, the lab provides space for training on non-surgical equipment like the Vocera VOIP communication device.

Surgical skills training using low fidelity simulation began in 2005. The move into the current facility, plus Coleman’s efforts, greatly increased the frequency of skills training sessions and the quality and variety of the programs. Additionally, the Robert Packer Hospital Auxiliary has been very generous with its support.

Coleman’s immediate goal for the skills lab is gaining ACS accreditation. He also wants to expand the curriculum and training offered, eventually providing a venue for team training in trauma and surgery. The skills lab team is also available to create a training session tailored to individual physician or departmental needs.

For more information about the Clinical Skills Laboratory and Simulation Center, contact Greg Coleman, RN, at 570-882-6523.