Association for Surgical Education
Surgical Education Week
24th April 2013
Validation of Open Inguinal Hernia Repair Simulation Model
A Randomised Controlled Educational Trial
Khatib M, Hald N, Brenton H, Sarker S, Standfield N, Ziprin P, Kneebone R, Bello F
Imperial College London
Introduction
• Surgical simulation brought to the forefront
of surgical training
– Technological advances
– Importance of surgical safety
– Limitation in surgical trainee exposure
• EWTD
• Duty hour restrictions
• Abundance of laparoscopic/ endovascular
simulators
• Development of Hernia Repair Open
Surgical Simulation (HeROSS) model
Method
Recruitment
Clinical Years
Medical students
invited to participate
Volunteers screened
Exclusion criteria
implemented
Group 1:
Assessment
Interactivein an open
Performing or assisting
Simulation
inguinal hernia repair
Group 2:
Previous
bachelor degree in
Intervention
Group
Anatomy
1. Post-intervention
MCQ
anatomy
Noninteractive
demonstrator
Simulation
2. Viva
Block
Randomisation
Group 3:
Pre-intervention
MCQ
Video Tutorial
Group 4:
Control
Group
Method
• Three separate one hour learning sessions
• Scenario given to candidates
• All in one week
• Assessment one day after final learning
session
Method
• Interactive Simulation
Method
• Video Tutorial
Method
• Control Group
– Internet access
– Quick access to all surgical procedure
textbooks and mini-textbooks available in
Imperial College Library
– Anatomy handouts from commonly used
anatomy textbooks and atlases
Results
72
• 72 students showed
interest
59
• 13 students excluded as
per exclusion criteria
56
• 3 students did no complete
study
Results
• 54 students completed study
•
•
•
•
Group 1 n=15
Group 2 n=15
Group 3 n=12
Group 4 n=14
Results
Pre Intervention MCQ
(%)
Score Improvement in
MCQ
(%)
Assessment Score(%)
Group
Mean
Standard Deviation
1
2
3
4
Total
1
2
3
4
Total
1
2
3
4
Total
43.33
38.92
38.33
39.57
40.14
30.15
36.08
31.74
7.41
26.4
76.92
65.38
59.67
42.93
61.63
13.28
9.93
9.37
9.27
10.58
13.68
12.48
12.87
9.56
16.41
9.9
2.72
8.86
9.54
14.88
Results – Comparison Between Groups
Group
2
3
4
MCQ Improvement Score
Assessment Score
(MSI)
(FAS)
1
2
3
1
-5.93
11.54
p=0.23
p<0.001
2
3
-1.59
4.34
17.25
5.71
p=0.76
p=0.34
p<0.001
p=0.001
22.74
28.67
33.99
22.45
16.74
p<0.001
p<0.001
p<0.001
24.33
p<0.001 p<0.001 p<0.001
Conclusions
• Statistically significant Improvement in
anatomical and procedural knowledge from
using the interactive simulation model
• Vital role of simulation as an adjunct in
modern surgical training
• Open surgical procedural knowledge a prerequisite to laparoscopic surgery
• Envisage online virtual theatre with ability to
do multiple core index procedures
Future Research
• Recruitment of surgical trainees
ongoing
• Addition of recorded assessment on
hernia model
Thank you