- Email: [email protected]
Costs and Effectiveness of Surgical Simulation Training
LETTER TO THE EDITOR
Costs and Effectiveness of Surgical Simulation Training Dear Editor, Tavlasoglu et al.1 are to be lauded for their innovative study into the effectiveness of a simulation-based training program on skills acquisition in mitral valve repair. Their study demonstrated clear findings that are likely to be applicable to other simulation innovations in other fields; however, it is still worth looking at the study in more detail to see what else could be learned. Firstly, the authors state that the simulation design was “simple and cheap.” In this they are probably correct; however, it is impossible to know this for certain as there are no costings cited in the paper. A paper that described a drug or therapeutic innovation as low cost would not be acceptable unless the authors described exactly what those costs were and so it should be with medical and surgical education. We must now move beyond the position where we state that an educational intervention appears to be highly cost effective to one where we define costs and effectiveness exactly and state what both these constructs actually are for the intervention in question.2 Secondly, the educational intervention was complex and multistream and it is difficult to tell which element within the intervention caused the results. It is likely that the simulated surgical practice was most effective but equally possible that watching the videos of best practice had a significant effect on improved technique. Only by means of further research whereby different groups of surgical trainees receive different interventions will we be able to know for sure which intervention led to which outcome.
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Thirdly, and lastly, the authors rightly point out potential limitations of the study—namely that the lack of exact correlation between the human heart and the bovine heart, and the fact that the bovine heart was in steady state. A further study might be possible using an alternative heart or model that is closer in anatomy to the human heart or where the model or animal heart was beating. The downside of this approach, however, is that it is likely it would be more expensive. Yours sincerely, Kieran Walsh, FRCPI, FHEA BMJ Learning, BMJ Publishing Group, BMA House, Tavistock Square, London, United Kingdom E-mail address: [email protected]
REFERENCES 1. Tavlasoglu M, Durukan AB, Arslan Z, Kurkluoglu M,
Amrahov A, Jahollari A. Evaluation of skill-acquisition process in mitral valve repair techniques: a simulationbased study. J Surg Educ. 2013;70(3):318-325. 2. Walsh K, ed. Cost Effectiveness in Medical Education.
Abingdon: Radcliffe, 2010.
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2013.06.006
Costs and Effectiveness of Surgical Simulation Training Dear Editor, Tavlasoglu et al.1 are to be lauded for their innovative study into the effectiveness of a simulation-based training program on skills acquisition in mitral valve repair. Their study demonstrated clear findings that are likely to be applicable to other simulation innovations in other fields; however, it is still worth looking at the study in more detail to see what else could be learned. Firstly, the authors state that the simulation design was “simple and cheap.” In this they are probably correct; however, it is impossible to know this for certain as there are no costings cited in the paper. A paper that described a drug or therapeutic innovation as low cost would not be acceptable unless the authors described exactly what those costs were and so it should be with medical and surgical education. We must now move beyond the position where we state that an educational intervention appears to be highly cost effective to one where we define costs and effectiveness exactly and state what both these constructs actually are for the intervention in question.2 Secondly, the educational intervention was complex and multistream and it is difficult to tell which element within the intervention caused the results. It is likely that the simulated surgical practice was most effective but equally possible that watching the videos of best practice had a significant effect on improved technique. Only by means of further research whereby different groups of surgical trainees receive different interventions will we be able to know for sure which intervention led to which outcome.
6
Thirdly, and lastly, the authors rightly point out potential limitations of the study—namely that the lack of exact correlation between the human heart and the bovine heart, and the fact that the bovine heart was in steady state. A further study might be possible using an alternative heart or model that is closer in anatomy to the human heart or where the model or animal heart was beating. The downside of this approach, however, is that it is likely it would be more expensive. Yours sincerely, Kieran Walsh, FRCPI, FHEA BMJ Learning, BMJ Publishing Group, BMA House, Tavistock Square, London, United Kingdom E-mail address: [email protected]
REFERENCES 1. Tavlasoglu M, Durukan AB, Arslan Z, Kurkluoglu M,
Amrahov A, Jahollari A. Evaluation of skill-acquisition process in mitral valve repair techniques: a simulationbased study. J Surg Educ. 2013;70(3):318-325. 2. Walsh K, ed. Cost Effectiveness in Medical Education.
Abingdon: Radcliffe, 2010.
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2013.06.006