AUSTIN, Texas – (August 29, 2012) – Obstetrics/gynecological residents from the University of Texas Southwestern Medical School Residency Program in Austin participated in its first gynecology surgical simulation developed by the Ascension Seton as a component of their curriculum. The new simulation training for OB/GYN residents in the Clinical Education Center (CEC) at University Medical Center Brackenridge-aims to improve teamwork, communication and technical skills by placing residents in a complex and lifelike patient scenario. Ascension Seton program is one of just a handful in the country offering this type of hands-on gynecology surgical simulation.
“While we have used simulation training in residency education, this is the first time we have incorporated teamwork training in surgical simulation,” said Jim Lindsey, MD, Ascension Seton’s senior vice president of medical affairs and chief medical officer. “Providing a realistic surgical environment, these doctors-in-training will be better equipped to address circumstances successfully in the dynamic hospital setting.”
Traditionally, residents conduct surgical skills practice with modules or animal tissues to replicate steps of a procedure. Although sometimes referred to as “surgical simulation,” the practicum is performed in isolation, outside of a patient care situation and using simulated surgical equipment or materials. Missing from most learning environments is the clinical context associated with a patient scenario that may influence human performance.
“A complex case might include a mother screaming, anxious family in the background, blood pressure machines beeping and several nurses at bedside,” said Diana Wang, MD, faculty member of the UT Southwestern OB/GYN residency program in Austin. “A physician must be able to address the team and especially the needs of the patient in the midst of these environmental factors.”
For the program’s first gynecological surgical simulation, Dr. Wang selected an ectopic* pregnancy, a common yet complex scenario that combined both surgical and teamwork competencies. Taking advantage of the CEC’s innovative simulation technology-a hybrid simulation was created using a birthing simulator Noelle® with a human voice, on-demand files of ultrasound images and lab reports, as well as a custom designed ectopic pregnancy model inside her abdomen-the residents’ simulation was ready to begin.
Simulation from Start to Finish
Noelle was admitted to the emergency department with vaginal bleeding and lower abdominal pain. After a confirmed diagnosis of ectopic pregnancy, she was transferred to the operating room (OR) for a minimally invasive surgery called laparoscopic salpingectomy (removal of part of fallopian tube where ectopic pregnancy resides).
The resident surgeons proceeded to scrub and gown while OR technicians turned on the laparoscopic tower and prepared surgical instruments. Dr. Zachary Chipman, faculty member of the UT Southwestern OB/GYN residency program in Austin and the attending physician, reviewed the plan aloud before the surgery started.
Hearts were racing. The energy of the room mounted as each minute went by. The residents worked closely together calling out patient status and steps of the procedure including positioning a camera near the uterus to navigate the surgeon. Each attempt brought the instrument closer to the target. With the camera perfectly angled, the resident made careful and precise incisions. Finally, the ectopic pregnancy was removed. The laparoscopic surgery was a success.
The simulation was videotaped and discussed in a debriefing session.
The animated residents reported that they felt real pressure during the training, helped by a technology that allowed for operating on a uterus inside the mannequin. “This is my first ectopic case,” said Dr. Joe Diaz, one of two participating UT Southwestern residents. “It’s very cool to practice with a team using real surgical instruments. It gives me chills.”
According to Judy Kitchens, MHA, Simulation Manager at the CEC, the simulation “uterus” echnology was invented at Seton and made the gynecological surgical simulation possible.
Said Dr. Lindsey, “Creating a technologically advanced and realistic setting for our future physicians is an extension of our commitment to quality patient care at the bedside.”