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Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery

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Abstract

Background

Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients’ management. A common disease was chosen: acute appendicitis.

Methods

All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured.

Results

All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2–20) vs. 4 (4–6); P = 0.004, and 17 h (4–48) vs. 6 (4–24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30–264) vs. 44 (21–145); P = 0.22].

Conclusions

CPA training is feasible in abdominal surgery. In the current study, it improved patients’ management in terms of earlier oral intake.

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Author information

Authors and Affiliations

  1. Department of Surgery and Cancer, St. Mary’s Campus, Imperial College Healthcare NHS Trust, London, UK

    Laura Beyer-Berjot, Vishal Patel, Pramudith Sirimanna, Ara Darzi & Rajesh Aggarwal

  2. Centre for Surgical Teaching and Research (CERC), Faculté de Médecine Secteur Nord, Aix-Marseille University, 51 Boulevard Pierre Dramard, 13015, Marseille, France

    Laura Beyer-Berjot & Stéphane Berdah

  3. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Daniel A. Hashimoto

  4. Division of Minimally Invasive, Metabolic, and Bariatric Surgery, Department of Surgery, Thomas Jefferson University and Jefferson Health, Philadelphia, USA

    Rajesh Aggarwal

Authors
  1. Laura Beyer-Berjot
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  2. Vishal Patel
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  3. Pramudith Sirimanna
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  4. Daniel A. Hashimoto
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  5. Stéphane Berdah
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  6. Ara Darzi
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  7. Rajesh Aggarwal
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Corresponding author

Correspondence to Laura Beyer-Berjot.

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Conflict of interest

Rajesh Aggarwal is funded by a Clinical Scientist Award from the National Institute of Health Research, U.K. (Award Grant Number NIHR/CS/009/001), and a consultant for Applied Medical. This study was approved by the NRES Committee, London.

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Beyer-Berjot, L., Patel, V., Sirimanna, P. et al. Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery. World J Surg 44, 696–703 (2020). https://doi.org/10.1007/s00268-019-05242-1

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