The role of simulation in the development of technical competence during surgical training: a literature review

Objectives: To establish the current state of knowledge on the effect of surgical simulation on the development of technical competence during surgical training. Methods: Using a defined search strategy, the medical and educational literature was searched to identify empirical research that uses simulation as an educational intervention with surgical trainees. Included studies were analysed according to guidelines adapted from a Best Evidence in Medical Education review. Results: A total of 32 studies were analysed, across 5 main categories of surgical simulation technique - use of bench models and box trainers (9 studies); Virtual Reality (14 studies); human cadavers (4 studies); animal models (2 studies) and robotics (3 studies). An improvement in technical skill was seen within the simulated environment across all five categories. This improvement was seen to transfer to the real patient in the operating room in all categories except the use of animals. Conclusions: Based on current evidence, surgical trainees should be confident in the effects of using simulation, and should have access to formal, structured simulation as part of their training. Surgical simulation should incorporate the use of bench models and box trainers, with the use of Virtual Reality where resources allow. Alternatives to cadaveric and animal models should be considered due to the ethical and moral issues surrounding their use, and due to their equivalency with other simulation techniques. However, any use of surgical simulation must be tailored to the individual needs of trainees, and should be accompanied by feedback from expert tutors.