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Identifying and reducing errors with surgical simulation

¹ Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
² Department of Surgery University of Washington, Seattle, Washington, USA
³ Human Interface Technology Laboratory, University of Washington
⁴ Emory Endosurgery Unit, Emory University School of Medicine, Atlanta, Georgia, USA
⁵ Department of Surgery Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
⁶ Department of Surgery, Division of Otolaryngology, Yale University School of Medicine
⁷ Department of Surgery, University of Washington
⁸ Otolaryngology Surgery Simulator Center, Montefiore Medical Center, Bronx, New York
⁹ Otolaryngology Surgery Simulator Center, Montefiore Medical Center
¹⁰ Albert Einstein College of Medicine, Bronx, New York
¹¹ Otolaryngology Surgery Simulator Center, Montefiore Medical Center

Correspondence to:
Dr Marvin P Fried
Montefiore Medical Center, Department of Otolaryngology, 3400 Bainbridge Ave 3rd Floor, Bronx, NY 10467; mfried{at}montefiore.org The major determinant of a patient’s safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills—which are at the core of the profession—are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety.

Abbreviations: AHRQ, Agency for Healthcare Research and Quality; ES3, endoscopic sinus surgery simulator; ESS, endoscopic sinus surgery; MIST-VR, minimally invasive surgical trainer virtual reality; PicSOr, pictorial surface orientation; VR, virtual reality

Keywords: error reduction; patient safety; surgical simulation; endoscopic sinus surgery

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