With the combination of rapidly advancing surgical technologies as well as pressures from work hours regulations, mastering new surgical skills outside the OR, prior to working with a patient, is imperative for surgeons at all levels of training. The centerpiece for this shift in surgical education is simulation. As such, the Columbia Department of surgery has implemented a robust series of cognitive, decision-making, and technical skills training programs for third-year surgical clerkship students, surgical residents and fellows, as well as practicing surgeons. The residents' program utilizes two sample curricula: a surgical skills curriculum based on the ACS-APDS (American College of Surgeons/ Association of Program Directors in Surgery) surgical learning program, and the skills training program of the Fundamentals of Laparoscopic Surgery (FLS) and Fundamentals of Endoscopic Surgery (FES). Residents also have access to the DaVinci Robotic Virtual Trainer utilizing the actual operative console in off hours. Additional didactics are also coordinated with the Department's COACH online educational platform, which contains self-directed study and evaluation resources.
Overall the program includes:
- Manual laparoscopic skills training on inanimate laparoscopic simulators
- Laparoscopic skills coaching by NYPH/Columbia attendings
- A custom-created laparoscopic "challenge" station to assess resident ability and improvement
- Proctored basic skills modules, with topics such as asepsis, patient positioning, safe handling of surgical instruments, arterial anastomosis, urinary catherization, etc.
- Videos of Surgical Skills Lab lectures and presentations as well as supplementary material
- Coordination with the self-directed study resources of Columbia's COACH online cognitive pre-training system
- Animate lab sessions for residents at all levels
Please see a brief description below of the different aspects of the simulation program.
Surgical Skills Lab
The Surgical Skills lab is available to residents 24 hours a day. It houses seven state of the art, high definition laparoscopic stations as well as virtual mannequin simulators for colonoscopy, endoscopy, and bronchoscopy. The surgical skills curriculum is designed to enable residents to be familiar with proper surgical technique prior to application in the operating room. The simulation training begins with a new intern "boot camp" at orientation and continues longitudinally throughout the residency. Sessions are divided into specific modules each led by a faculty advisor with cognitive pre-training modules available on COACH. Each skills training module lasts approximately 60-120 minutes, and consist of brief didactics followed by practical sessions with immediate feedback and verification of proficiency.
The laparoscopic skills and basic skills training are supplemented by monthly animate lab sessions for residents in all years of training. These sessions are intended to reinforce skills gained during inanimate labs. Based upon the evaluations from the participants, these are a highlight of the educational initiatives offered by the Department of Surgery. During these labs, anesthetized porcine models and human cadavers are used to hone various techniques in both open and laparoscopic surgery. In addition to these general animate lab sessions, 4th year residents attend the Advanced Trauma Operative Management (ATOM) course, where they learn and perform the techniques for operative management of various traumatic injuries not commonly seen in practice such as penetrating injuries to the heart or inferior vena cava.