Teaching core surgical skills using a low cost model

I taught core laparoscopic surgical skills in low resource settings overseas, and found that there was a lack of validated, low cost, easily reproducible simulators. This is a key barrier for many programmes across the world. We aimed to develop - and validate - our simulator using a scoring system. We did this with a large cohort of junior surgeons with diverse experience levels. We wanted to ensure that it could be used in any setting, and purposefully designed it to be low cost, so this simulator could be used anywhere - even in resource poor countries.

I initially created it with colleagues and mentors at Great Ormond Street Hospital in London more than 20 years ago. Surgical simulation and the bench trainers used to model laparoscopic skills have evolved so much, it was great to definitively validate the simulator with a much larger and more diverse cohort of learners than was previously possible.

It also means that when we utilise it in our overseas training programmes, it has now been validated for effective learning, and we can use it with confidence. This also means that educators unfamiliar with surgical simulation have an objective assessment of its validity to increase their confidence.

We use it in our national and international surgical training programmes in Chile and Myanmar. Feedback from students is always very positive even if they don’t perform well initially. They can repeat it as many times as they need to until they gain confidence and competency.  They commonly really get immersed in the task.

I have also received feedback from our international colleagues that they love using it and that they can really see the benefits in skill acquisition for their students.

We use the simulator as part of our training programme via the principles of Mastery Learning where the learners’ progress is scaffolded. Once they have completed the core entry level task, they are guided to the next level task, then the next. It's an excellent incentive for the learners to progress.

The task takes around 7-10 minutes to complete, depending on the participant’s existing skill base and experience.

Series of steps

	The double-glove model is simply made from two non-sterile latex gloves, and parts of an intravenous giving set.
	Once this simulator is in the eoSim bench trainer, the participant dissects the oval of the outer glove without perforating the inner one.
	As the gloves are extremely economical and non-sterile, they can be used repeatedly by participants until competency is gained through repeated practice.

As for any surgical skills acquisition activity, it is always essential to partner with experts within the field. The provision of their constructive feedback is essential for true progression of learning.

Innovation is key to forming new educational interventions like this, and also being open to trying new things. I also find that talking and discussing issues and challenges with colleagues from other disciples is vital to changing your viewpoint and outlook.

At Monash University we have so many excellent academics from different disciplines and they are always very happy to help and give advice!