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General Orthopaedics

‘No surgeon should do an operation for the first time on a living patient’: a stimulus for cadaveric simulation in specialist training in trauma and orthopaedic surgery

British Orthopaedic Association/Irish Orthopaedic Association Annual Congress (BOA/IOA)



Abstract

Introduction

Simulation is increasingly perceived as an important component of surgical training. Cadaveric simulation offers an experience that can closely simulate operating on a living patient. We have explored the feasibility of providing cadaveric training for the whole curriculum for trauma and orthopaedic surgery speciality trainees, before they perform those operations on living patients.

Methods

An eight station surgical training centre was designed and built adjacent to the mortuary of a University Hospital. Seven two-day courses for foot and ankle, knee, hip, spine, shoulder and elbow, hand and wrist, and trauma surgery were designed and delivered. These courses, designed for 16 trainees, were delivered by eight consultant trainers and a course director. Each was structured to allow every trainee to perform each standard operation in the curriculum for that respective subspecialty. We designed the courses to maximise simulated operating time for the trainees and to minimise cost. We surveyed trainers and trainees after the courses to qualitatively assess their value.

Results

We found that it was possible to create a state-of-the-art surgical training centre in a University Hospital with a business model that could be replicated. It was possible to deliver cadaveric surgical training to trainees, early in their experience in that subspecialty, such that they learn the principles of each operation in the curriculum in the course of two days. This required some very intense work: for example the foot and ankle course included 30 surgical procedures. Trainees and trainers rated this experience as very high quality training and judge that it will substantially affect the safety and value of future training with living patients.

Conclusion

We suggest that our findings support the idea of cadaveric training for all trainees before operating on living patients. We are implementing this in our training programme.