Simulation in the early management of gastroschisis
Joseph Bacarese-Hamilton1, Victor Pena, Munther Haddad
1From the Imperial College London (J.B.H.); and Department of Paediatric Surgery (V.P., M.H., S.C.), Chelsea and Westminster Hospital, London, UK.
Aim:
Our aim was to design, create, and validate a simulator model and simulation scenario for the early management of gastroschisis.
Methods:
Candidates of varying surgical experience had 1 attempt on an abdominal wall defect simulator and were scored for 4 different aspects: resuscitation of the neonate, application of a silo by both a global rating scale and a procedure-specific checklist, and nontechnical skills (scored by Non-Technical Skills scale). Surgical trainees subsequently received a focused teaching module on the resuscitative management and the surgical decision-making process, including bowel protection methods. Trainees then had a second attempt, which was objectively analyzed for improvement.
Results:
Candidates attempted the simulation and were assessed, looking for construct validity. There was a statistically significant difference between candidate experience levels for all aspects of the simulation (resuscitation, global rating scale, procedure-specific checklist, and nontechnical skills) calculated using analysis of variance. Feedback forms gave us face validity, with a mean adjusted score of 8.3/10 for realism. After teaching the module, there was a statistically significant improvement (P < 0.05) of 20% for technical skills and 10% for nontechnical skills, which is comparable with similar controlled studies.
Conclusions:
We showed that creating and running a simulation scenario for the early management of gastroschisis is a feasible and useful tool for training and assessment. The simulation may also be able to discriminate between experience levels and could be used as a teaching aid to improve a surgeon's technical and nontechnical skills.
