Development and implementation of a clinical pathway approach to simulation-based training for foregut surgery

Area of Science:

• Medical Education
• Surgical Simulation
• Surgical Training

Background:

• Contemporary medical education increasingly requires simulation integration for resident training.
• A novel simulation-based curriculum was developed for Post Graduate Year 1 (PGY-1) surgery residents.
• The curriculum focuses on technical and nontechnical skills using a clinical pathway approach for foregut surgery patients.

Purpose of the Study:

• To design and implement a simulation-based curriculum for PGY-1 surgery residents.
• To teach technical and nontechnical skills within a clinical pathway for managing a foregut surgery patient.
• To evaluate the effectiveness of the simulation curriculum on resident performance and confidence.

Main Methods:

• A 3-day curriculum for groups of 6 residents.
• Incorporated standardized patient encounters, didactic sessions, and hands-on training.
• Utilized a summative simulation "pathway" (preoperative, intraoperative, postoperative encounters) repeated on days 1 and 3, including a gastrojejunostomy on a porcine model.

Main Results:

• Faculty ratings of overall operative performance significantly improved post-curriculum.
• Resident self-ratings significantly improved for all assessed encounters.
• Resident confidence in meeting learning objectives significantly increased.

Conclusions:

• The novel "pathway" curriculum effectively integrates technical and nontechnical skills in a clinical context, addressing a gap in traditional simulation training.
• The curriculum demonstrated consistent improvements in performance assessments, confidence, and learning objective achievement.
• The study supports the continued use of this simulation approach for foregut surgery resident education.