title: A cost-effective approach to establishing a surgical skills laboratory.
abstract: BACKGROUND
  Recent studies comparing inexpensive low-fidelity box trainers to expensive computer-based virtual reality systems demonstrate similar acquisition of surgical skills and transferability to the clinical setting. With new mandates emerging that all surgical residency programs have access to a surgical skills laboratory, we describe our cost-effective approach to teaching basic and advanced open and laparoscopic skills utilizing inexpensive bench models, box trainers, and animate models.
  
  
  METHODS
  Open models (basic skills, bowel anastomosis, vascular anastomosis, trauma skills) and laparoscopic models (basic skills, cholecystectomy, Nissen fundoplication, suturing and knot tying, advanced in vivo skills) are constructed using a combination of materials found in our surgical research laboratories, retail stores, or donated by industry. Expired surgical materials are obtained from our hospital operating room and animal organs from food-processing plants. In vivo models are performed in an approved research facility. Operation, maintenance, and administration of the surgical skills laboratory are coordinated by a salaried manager, and instruction is the responsibility of all surgical faculty from our institution.
  
  
  RESULTS
  Overall, the cost analyses of our initial startup costs and operational expenditures over a 3-year period revealed a progressive decrease in yearly cost per resident (2002-2003, $1,151; 2003-2004, $1,049; and 2004-2005, $982).
  
  
  CONCLUSIONS
  Our approach to surgical skills education can serve as a template for any surgery program with limited financial resources.
authors.affiliation: Department of Surgery, and Institute for Clinical Simulation and Patient Safety, Temple University School of Medicine, Philadelphia, PA 19140, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Berg
authors.forename: Richard E
authors.initials: RE
authors.lastname: Milner
authors.forename: Carol A
authors.initials: CA
authors.lastname: Fisher
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Dempsey
authors.forename: Harsh
authors.initials: H
authors.lastname: Grewal
mesh_terms: D000818:Animals; D003162:Competency-Based Education / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000191:economics* / Q000379:methods*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000191:economics* / Q000379:methods*; D010535:Laparoscopy