According to Larson, most surgeons who participate in simulation training note improvement. They are evaluated through technology called M-Score, which measures performance and provides an actual score on areas that represent their strengths and weaknesses. This type of assessment is meant to improve training efficiency, since the surgeon can then focus on his or her own specific deficiencies.
Once surgeons complete their training, they must meet the credentialing standards of the hospital where they are practicing. Currently, there are no universal standards or benchmarks for robotic surgery. Each individual hospital has its own standards for credentialing and privileging. There is an effort through the American College of Surgeons to develop the Fundamentals of Robotic Surgery; however, these standards are still in development. Since the Joint Commission requires ongoing professional practice evaluation to ensure surgeon competency, simulation can serve not only as an objective performance measure but also as a tool to maintain competency utilizing advanced technology, such as robotics. Surgeons claim that individual high surgical case volumes lend themselves to maintaining one’s skills. This is why objective-based simulation can serve as a great tool for skills maintenance and overall competency. As Orady and Larson point out, surgical skill is individualistic and skills decay will vary with each individual practitioner. However, by continuing to use simulation, a surgeon can continue to evaluate and maintain his or her skills.
“There is a lot of equipment in the hospital that has the potential to cause harm. Robotics is certainly no different," says Larson. “What is unique about robotics is the means to safely acquire and maintain a surgeon’s skills through simulation and advanced training."
Since gynecology is becoming more specialized, the need for advanced training is even more necessary. Mimic is also working on an augmented reality product that will simulate hysterectomy, coming out this fall. Augmented reality combines three-dimensional (3D) computer-generated objects and text and superimposes them onto real images and 3D surgical video footage, all in real time. The surgeon then has the feeling of being in an actual surgery. This accompanying video provides a brief example of how this augmented reality training software will work.
Larson says this is needed because the current controlled basic training environment is incomplete: “The current animal model used in training does not adequately emulate actual practice. What would be ideal is to perform the procedure in a simulated environment and be objectively evaluated on your performance.” Hospitals are constantly looking for the safest way to acquire skills, learn the specifics of the surgical procedure, and learn how to manage potential complications.
“We believe this is the future of GYN training,” says Mimic CEO Jeff Berkley, PhD. “Practicing surgery on animals will only take us so far. Through augmented reality, we hope to expose surgeons to a wide variety of surgical scenarios that they would not normally encounter as a part of the typical case load. This approach may help limit the amount of learning that must not take place on real patients.”
Berkley explains that it was gynecologists who were the first to make the aggressive push toward simulation testing to gain surgical privileges. This is due, in part, to the access issues of training in the OR. “Gynecology training is special—it is tougher to get to the volume of surgeries you need,” he says. “It can be tough to keep up those needed skills. That is why we have made women’s health a priority, because skills maintenance through simulation should play a larger role in gynecology.”
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