Improving Surgeon Skills With Simulator Training to Automaticity

Studies have shown that using surgical simulators to improve skills in the operating room (OR) can be effective for surgeons in training. To maximize the effectiveness of simulation training, a proficiency-based training paradigm in which trainees are required to achieve expert-derived performance goals has been suggested. This type of training is tailored to individual needs and ensures the acquisition of uniform skills. However, while proficiency-based curricula have been effective in improving operative performance, studies show that simulator-trained learners do not always reach expert performance in the OR. “Simulators cannot always reliably predict when skill acquisition is complete because the currently used metrics of performance may have limited sensitivity,” explains Dimitrios Stefanidis, MD, PhD, FACS. “This can be problematic should problems emerge in the demanding environment of the OR.” According to Dr. Stefanidis, most simulation curricula traditionally use time and errors as metrics of performance. “The problem with these metrics is they don’t provide a complete picture of trainee performance. They give no information about the attention demands required by the task, the effort the trainee had to invest to achieve a level of performance, and the quality of the learning that occurred. While two different surgeons may get equal results on time and accuracy measurements, they may have substantial differences in workload, attention demands, and physiologic parameters that reflect differences in learning, true skill level, and experience.” Defining Automaticity in Surgery One of the key characteristics that distinguishes experts from novices is their ability to engage in certain activities without requiring significant attention. “Psychologists have called this ‘automaticity,’ ” says Dr. Stefanidis. “Many habitual or highly practiced motor acts...