Leveraging Simulation to Support Competency-Based Surgical Training

Area of Science:

• Medical Education
• Surgical Training
• Patient Safety

Background:

• Simulation-enhanced education (SEE) is an evidence-supported cornerstone of medical training.
• Currently, SEE is mainly used formatively, with limited impact on high-stakes progression decisions in surgical programs.
• This disconnect hinders SEE's potential to improve patient safety during critical transitions to greater resident autonomy.

Purpose of the Study:

• To examine how national policies, funding, and leadership can integrate SEE and simulation-based assessment into surgical training governance.
• To demonstrate how simulation-based assessment can be used summatively for high-stakes decisions in surgical training.
• To propose a model for using simulation-based assessment to ensure resident readiness for clinical autonomy.

Main Methods:

• Case study of surgical training in the Republic of Ireland.
• Analysis of national policy levers, funding arrangements, and institutional leadership.
• Examination of the integration of summative simulation-based assessment into an 8-year surgical training scheme.

Main Results:

• Ireland has integrated summative simulation-based assessment into its surgical training scheme.
• Scores from simulation-based assessments contribute directly to resident progression.
• This integration illustrates transferable design principles for other specialties and jurisdictions.

Conclusions:

• The next step is implementing specialty-specific autonomy thresholds using entrustable professional activities (EPAs).
• Simulation-based assessment should substantiate these EPAs at defined progression points.
• Mandatory, simulation-anchored checkpoints will align assessment with patient safety and competency-based progression.