title: Distributed Simulation in surgical training: an off-site feasibility study.
abstract: BACKGROUND
  Simulation offers recognised training benefits, but the cost of high-fidelity contextualised simulation is prohibitive and its accessibility limited to specialised Distributed Simulation centres. Distributed simulation (DS) is an innovative concept of low-cost, portable and high-fidelity contextualised simulation. However, it has previously only been trialled at a central London teaching hospital.
  
  
  OBJECTIVE
  (1) To explore the off-site feasibility of DS. (2) To determine the response of end-users to DS.
  
  
  METHODS
  A DS naive researcher recreated a standardised porcine laparoscopic cholecystectomy scenario at a District General Hospital using DS. A research diary detailed the logistical feasibility of the project, whilst mixed methods were used to determine the response of the 10 surgeons who completed the full-team simulation.
  
  
  RESULTS
  DS is feasible off-site with end-users comparing it favourably to their previous simulation experiences. Surgeons perceived DS as being most useful for building the operative confidence of juniors between learning the basics on a bench top model and before entering the operating theatre.
  
  
  CONCLUSIONS
  DS has the potential to provide high-fidelity contextualised simulation as an adjunct to, and not a replacement for, surgical training. Unlike other modalities, it is low cost and portable, thereby addressing concerns over affordability and accessibility.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, UK. alexander.harris00@imperial.ac.uk
authors.forename: Alexander
authors.initials: A
authors.lastname: Harris
authors.forename: Eva
authors.initials: E
authors.lastname: Kassab
authors.forename: Jimmy Kyaw
authors.initials: JK
authors.lastname: Tun
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D008131:London; D018709:Statistics, Nonparametric; D013552:Swine