Simulation-enhanced interprofessional education in surgery - a scoping review

Simulation-enhanced interprofessional education (Sim-IPE) has been successfully used in various health professions and shown to improve communication and teamwork. Surgery, where preventable serious adverse outcomes are often attributed to issues with communication and teamwork, represents a compelling context for Sim-IPE. However, implementing Sim-IPE in surgery requires investment in faculty development, equipment and facilities while incurring the cost of reduced staff availability and theatre productivity during simulation activity. We conducted a scoping review to characterise how Sim-IPE in surgery is practised and researched.

This scoping review followed the methodological framework described by Arksey and O'Malley. Reporting followed the PRISMA-ScR checklist. Electronic databases (Medline, EMBASE, Web of Science, PsycINFO and ERIC) were searched for records pertaining to Sim-IPE in surgery published after 1st January 2000 and in English.

The final analysis included 81 articles. Simulation scenarios showed a rich variety of combinations of professions, disciplines, training levels and settings. While most scenarios used manikins (N = 54, 75%), other modalities included simulated participants, cadavers, task trainers, computers, laparoscopic simulators, role play and animal models with many scenarios using multiple modalities (N = 20, 27.8%). Of studies reporting on evaluation outcome, almost half (N = 32, 47.1%) were limited to participants' views of their learning experience and satisfaction with the program. Few studies reported using educational theory to inform Sim-IPE design and even fewer used theoretical frameworks in the research design. Facilitators for implementing Sim-IPE in surgery included a skilled faculty, institutional support and evidence of benefit. Barriers included lack of protected training time, restricted access to facilities and unreliable ongoing funding.

Studies described a rich variety of Sim-IPE scenarios, including multiple professions, disciplines, training levels, simulation modalities and settings, facilitating training in a broad range of skills reflective of the complexity of modern surgical care. While barriers such as time, funding, and cultural resistance to simulation are commonly reported in the simulation-based education literature, these issues may be amplified in surgery due to surgical service pressures and traditional hierarchies (e.g. surgeon as "captain of the ship"). Overcoming these barriers will likely require structural (policy, funding, scheduling) and cultural (leadership, team identity) change.