The evolution of simulation-based surgical education is changing the way we prepare students for surgery. Traditionally, students used box trainers to learn basic surgical skills. But universities like Yale have responded to evolving simulation technology by adding virtual reality (VR) simulation training to their surgical curriculum. We talk with Hulda Einarsdottir, the director of Yale Center for Medical Simulation.

Hi, give us a quick introduction to you and your simulation center in Yale
Hi, I am the director of Yale Center for Medical Simulation and I train approximately 75 students in our general surgery training program. I introduced simulation training into our curriculum in 2015 and teach with two haptic LapSim VR simulators for laparoscopy training.

What do you think are the main benefits of VR simulation training?
Simulation training helps students to acquire manual dexterity and hone their visuospatial perception knowledge required to perform laparoscopic procedures. The most rewarding aspect of my work is seeing my residents progress and appreciate the value of their simulation training.

In what way do residents value the simulation training?
Once students go through our LapSim training and earn certification, they appreciate their increased competence and confidence in their skill level. I see how much more confident they are in the OR (operating room) doing actual surgeries. When I ‘scrub in’ with a LapSim-trained resident, their confidence in the OR is obvious. They feel capable of doing more.

The most rewarding aspect of my work is seeing my residents progress and appreciate the value of their simulation training.

How does this differ to the skills acquired from traditional box training?
You can gain surgical skills by doing traditional box training, certainly. But there are important aspects of surgical training that a box trainer cannot provide. I think there are  many benefits of VR simulation training over box training.

1. Corrective feedback in real time.
For example, when training, LapSim alerts you when your left hand is drifting out, or if your movements are not efficient. It’s so important to have feedback as you train. . A box trainer cannot give you this objective corrective feedback.

2. 24/7 teaching tools.
The LapSim curriculum tells students what they need to do and corrects them when they are doing something wrong. It is a built-in teacher. Our lab is open 24/7, so residents can train at their convenience. Later, I can review the LapSim data and see how well the students scored on assigned tasks.

3. Objective data to assess skill competence.
With simulation training, I can track how many times each student has practiced basic knot tying skills. The simulator gives me precise data on each student’s training trajectory which provides a better basis for evaluation.

4. Reduced demands on supervision time.
Residents training on the box trainer need hands-on guidance. The LapSim simulator guides residents with real time feedback, so it requires less of my time to guide students, yet I still have data to evaluate their progress.

5. Ability to practice an entire surgical procedure.
This is an incredibly useful simulation training benefit. Learning a procedure, such as appendectomy, step by step, is something that the training box definitely cannot provide. The procedural modules gives residents a sense of what an actual surgery is going to be like from beginning to end.

6. A more realistic experience of surgery.
Simulation training gives residents the feeling of what it’s like to be in the OR. I think of it like an appetizer. It is the best approximation of what it’s like when you treat a patient, it helps to bridge the gap between skills practice and patient interaction, keeping residents motivated and engaged.


Thanks that’s great. So you think there is a strong future for VR simulation training?
Yes! I would love to see our LapSim training and certification become a requirement for entry into the OR. It would be great to see residents get a badge or a little sticker on their identification card that clearly shows that they’ve passed the simulation program.

You recently received a Faculty Award for contribution to education.
I was surprised and honored with this recognition from my residents. They didn’t share the specifics of their decision-making, but I think it may have had something to do with the nights I spent in the simulation lab helping them with their mock exams!

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