Best Practices for Designing Effective Procedural Skills Training in Resource-Constrained Settings: SELF Series...

The shortage of practitioners trained to provide essential surgical care remains among the most stubborn contributors to the global burden of disease. Independent procedural skills training must supplement the traditional apprenticeship model, particularly where trainers are scarce. The Surgical Education Learners Forum (SELF) is a global community of practice dedicated to addressing this need through cost-effective, scalable training modules that clinicians use to learn, practice, and evaluate procedural skills independently. For these self-assessed simulation modules to be effective, developers need guidance and tools. This third article in the SELF series presents the expert recommendations of 2023 SELF Symposium participants on designing procedural skills training in resource-constrained settings, focusing on simulator fidelity and an open-access database of simulators and associated materials.

The SELF community of practice members from diverse professional and regional backgrounds convened at the SELF Symposium for two working sessions addressing simulator fidelity and a proposed simulation materials database. Participants generated and voted to prioritize best-practice recommendations for simulator developers, actions the SELF community should take to support them, and a reference set of procedural tasks, tissues, and structures. Following the symposium, the authors deconstructed the prioritized tasks into fundamental tissue interactions ("rudiments") and mapped these to the material characteristics and fidelity types required to simulate them.

Participants produced 26 prioritized best-practice recommendations for developers across five categories, with aligning fidelity to the learning objective the single most strongly supported recommendation. A further set of recommended community actions prioritized creating an open-access simulator material repository, investing in research on appropriate fidelity, and establishing quality-assurance and sustainable-funding mechanisms. The prioritization of tasks, structures, and tissues, together with the subsequent cross-mapping, produced a framework and proposed architecture for a surgical simulation material database.

Emphasizing appropriate rather than maximal fidelity-simulations tailored as narrowly as the learning objectives allow-offers a cost-effective route to scalable procedural skills training in resource-constrained settings. Realizing this will require the SELF community to build and maintain a shared material database and to generate the research evidence needed to support appropriate-fidelity simulation.