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On the Road Again: Surgical Simulation is Rural Practice

On the Road Again: Surgical Simulation is Rural Practice. D.R.Antonenko, MD.PhD. Professor of Surgery Director of Surgical Simulation Center University of North Dakota School of Medicine and Health Sciences. Simulation in Rural Surgery. Objectives

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On the Road Again: Surgical Simulation is Rural Practice

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  1. On the Road Again: Surgical Simulation is Rural Practice D.R.Antonenko, MD.PhD. Professor of Surgery Director of Surgical Simulation Center University of North Dakota School of Medicine and Health Sciences

  2. Simulation in Rural Surgery Objectives • Describe the educational background for simulation training in surgery • To describe the possible role of simulation in rural/community surgical practice using a mobile simulation center • To discuss how on site simulation training might help attract and retain surgeons in rural practice

  3. Physician Learning Patient focused learning Resource accessibility Clinical applicability Familiarity with the resource Return on investment in time

  4. Physicians and Learning Relevance to clinical practice needs Scheduling conflict Cost of attendance

  5. Simulator Skills Training Curriculum Sound educational principles Goal oriented Sensitive/objective performance metrics Appropriate instruction/feedback

  6. Simulator Skills Training Curriculum Deliberate/distributed/variable practice Allow overtraining Provide maintenance training Must have cognitive component

  7. Simulator Skills Training Curriculum Deliberate/distributed/variable practice Allow overtraining Provide maintenance training Must have cognitive component PROFICIENCY BASED

  8. Simulation = Deliberate Practice Move learning curve out of the OR BUT performance still required Reduce stress of learning Focus is on learner, not the patient Feedback improved

  9. Simulators

  10. Simulators Procedural (task) trainers Computer screen (micro-simulators) VR trainers Patient trainers

  11. Asepsis/instruments Knot tying Suturing Tissue handling wound management Advanced tissue handling/flaps/grafts Catheterization Airway management Chest tubes Central lines Surgical biopsy Vascular anastomosis Laparotomy Bone Fixation/casting Inguinal Anatomy Upper endoscopy Colonoscopy Basic laparoscopic skills Advanced laparoscopic skills Hand sewn anastomosis Stapled anastomosis. ACS/APDS Core skills Curriculum Phase I Curriculum Modules

  12. Simulation Center Equipment

  13. Lap ventral hernia Lap/open inguinal hernia Lap/open colon resection Lap/open CBD exploration Abdominal wall stomas Lap appendectomy Lap Nissen fundoplication Sentinel node biopsy/ALND Lap/open splenectomy Lap/open cholecystectomy Thyroidectomy parathyroidectomy Gastrectomy Phase II Modules

  14. Simulation Center Equipment

  15. Simulation Center Equipment

  16. Simulation Center Equipment

  17. `ACS/APDS Core Skills Curriculum Phase III: Team Based Training

  18. Simulation Center EquipmentTeam Based Training

  19. Rationale For Simulator Training in Rural Surgery Fiscal Restraints Changing technology Ethical Concerns Patient Safety

  20. Advantages of Simulation in Rural Surgery Maintain skills Enhance skills Increase practice opportunities Increase income Reduce malpractice premiums (?)

  21. Simulation for Rural Surgery Surgeon specific Site specific High fidelity Timely Cost effective Distributed vs. massed practice

  22. Simulations for Rural Surgery Minimally invasive Ultrasound ATLS procedures(?) Airway management Procedure specific Endoscopy upgrades

  23. The Future of Simulation for Rural Surgery Tele-simulation Tele-proctoring Tele-mentoring 3 dimensional reconstruction COST

  24. Rural/Community Surgeons Your Thoughts/comments

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