Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Courses

Simulation in the National Surgical Training Centre

Surgical training, contained within the Department of Surgical Affairs, delivers instructional courses to trainees in surgery, emergency medicine, ophthalmology and radiology as well as NCHDs across multiple specialties and disciplines. In the 2015/2016 academic year for our recurring curriculum, we delivered 183 full days of teaching to trainees, NCHDS and consultants, amounting to 1,281 hours of face to face time instruction.

In addition to this, we deliver several stand-alone courses which run from a one-day to five-day duration. These include:

  • ATLS – Three times in 15/16
  • CCrISP – once in 15/16
  • BSS – Four times in 15/16
  • MRCS prep – twice in 15/16
  • Train the trainer - twice in 15/16
  • Plastic Surgery Microsurgical Teaching course – five days
  • All Ireland Teaching Programme in Plastic Surgery – five days
  • ENT:FESS – Three days
  • ENT: Temporal bone course – Two days
  • ENT: Tracheostomy course – Three days
  • CT artery workshop – One day
  • T&O core curriculum - One days
  • Joint RCSI-RCPI endoscopic training – Two days

The vast majority of the courses we deliver employ simulation as the main instructional method or as a significant component. The use of this instructional method includes;

  • Task and part-task training in technical skills
  • Hybrid human or mannequin technical skills models
  • Combined technical and non-technical skills scenarios
  • High fidelity mannequin simulated patient care scenarios.
  • Simulated patient encounters

Procedure, task and part-task training in technical skills

Our Operative Surgical Skills (OSS) programme delivers case-based discussion and technical skills instruction to Core Surgical Trainees (CST), Emergency medicine trainees (CSTEM) and NCHDs attending CPD training days. In 2015/16 these classes accounted for 118 one-day classes (total 826 hours). These classes all occur in the skills lab. As a rule, greater than 60% of these days are technical skills practice or assessment. Skills range from basic to complex operative procedures on bench models, task and part task trainers, non-living animal material, VR and other electronic simulators. Portions of some of these classes and of the stand-alone technical skills classes are carried out on cadaveric material in the Anatomy department. General surgery and surgical specialties as well as emergency medicine and radiology are covered. (see attached calendar for full range of topics covered).

Hybrid human or mannequin technical skills models

Technical skills models combined with simulated patients or mannequins are used in training and assessment in our Human Factors (NTS) programme. For example, laceration and cyst excision models have been used attached to a simulated patient to examine performance of procedures while simultaneously dealing with a difficult patient scenario. Laparoscopic simulators and limb amputation models are use with high fidelity mannequins in our interdisciplinary NTS training in conjunction with the College of Anaesthetists.

Combined technical and non-technical skills scenarios

Selected courses in the core curriculum for CST and CSTEM teach TS and NTS on the same day. For example, we combine clinical skills in trauma management with Crisis Resource Management teaching on high fidelity mannequins.

High fidelity mannequin simulated patient care scenarios

Trauma and ED scenarios have been delivered in the skills lab and the RCSI Beaumont simulation facility. Intraoperative and ED scenarios are delivered in collaboration with the College of Anaesthetists, using their simulation facility. A total of 85 hours of high fidelity simulation was delivered in 15/16 and our curriculum is currently being revised to greatly increase the level of high fidelity mannequin simulation. In the 16/17 academic year this is increasing to 172 hours, with further significant increases planned for the following year.

Simulated patient encounters

As part of our Human Factors in Patient Safety programme, actors and trained volunteers are frequently employed to represent patients, relatives and healthcare colleagues. Trainees engage in roleplay, individual and group simulated consultations and scenarios.

Assessment

Multiple mini formative assessments occur within the structure of the technical skills (TS) and non-technical skills (NTS) courses. Formal summative assessment in TS and NTS occurs in February and March of years 1-3 CST, CSTEM (NTS) and Ophthalmology (NTS). The assessments carried out in the National Surgical Training Centre are in the form of multiple station OSCEs and technical skills stations. The trainees are assessed using combined modalities of checklists and global score instruments, some of which have been developed and validated locally and others which are internationally published and validated. Trainees also undergo multiple workplace based assessments in their clinical rotations which we administer, collate, quality check and analyse. These are combined with the structured assessments in the skills lab and form the basis for a competency-based progression through surgical training. The assessments are both criterion and norm referenced and undergo rigorous analysis for validity and reliability.

Faculty development

We run ‘Train the Trainer’ courses multiple times per academic year for clinical faculty who are involved in delivering our programmes, focussing on feedback and debriefing skills. We are introducing simulation scenarios to the faculty development courses as we move to more high fidelity simulation in our programme. We also train our cohort of simulated patients in communication and feedback techniques. All faculty involved in assessment attend examiner training sessions before each exam to ensure examiner calibration and increased reliability of our assessments.

Summary

We have an extensive programme of instruction in simulated technical and non-technical skills which has been running since 2002. We are attaching our 2016/2017 academic year calendar to demonstrate the content and frequency of courses currently being delivered in the National Surgical Training Centre and other locations in RCSI. We are currently undertaking an extensive review and revision of our curriculum which commenced in early 2016 in order to obtain maximum benefit from the NAEB from the start of the academic year 2017/2018. We would be happy to provide additional detail on individual courses as required and are looking forward to collaborating on the future use of the NAEB.

Our Simulation Team

 

  • Professor Oscar Traynor, Dean of Postgraduate Education and Director of the National Surgical Training Centre
  • Ms Dara O'Keeffe, Senior Lecturer and Simulation Lead in Postgraduate Surgical Education
  • Dr Eva Doherty, Senior Lecturer and Director of Human Factors in Patient Safety
  • Ms Leonie Heskin, Lecturer in Postgraduate Surgery and Education (Technical Skills and Human Factors)
  • Mr Brian Lane, Postgraduate Vice Dean (Anatomy and Surgical Training, Technical Skills)
  • Mr Peter Gillen, Associate Professor RCSI (Department of Surgery and Surgical Training) (Technical Skills and Human Factors)
  • Dr Angela O’Dea, Senior Lecturer in Surgical Education (Human Factors)
  • Mr Adam Roche, Human Factors Coordinator and Mannequin/AV Assistant