title: Unanticipated teaching demands rise with simulation training: strategies for managing faculty workload.
abstract: BACKGROUND
  Using simulation to teach and assess learners represents a powerful approach to training, but one that comes with hidden costs in terms of faculty time, even if programs adopt existing curricula. Some simulators are built to be used independently by learners, but much of the surgical simulation curricula developed for cognitive and psychomotor tasks requires active faculty involvement and low learner-to-faculty teaching ratios to ensure sufficient practice with feedback. The authors hypothesize that the added teaching demands related to simulation have resulted in a significant financial burden to surgery training programs. To date, the effect of simulation-based training on faculty workload has not been estimated objectively and reported in the literature.
  
  
  METHODS
  To test their hypothesis, the authors analyzed data from 2 sources: (1) changes over time (2006-2014) in formal teaching hours and estimated faculty costs at the University of Minnesota, General Surgery Department and (2) a 2014 online survey of general surgery program directors on their use of simulation for teaching and assessment and their perceptions of workload effects.
  
  
  RESULTS
  At the University of Minnesota, the total number of hours spent by department faculty in resident and student simulation events increased from 81 in annual year 2006 to 365 in annual year 2013. Estimated full-time equivalent faculty costs rose by 350% during the same period. Program directors (n = 48) of Association of Program Directors in Surgery reported either a slight (60%) or a significant (33%) increase in faculty workload with the advent of simulation, and moderate difficulty in finding enough instructors to meet this increase. Calling upon leadership for support, using diverse instructor types, and relying on "the dedicated few" represent the most common strategies.
  
  
  CONCLUSIONS
  To avoid faculty burnout and successfully sustain faculty investment in simulation-based training over time, programs need to be creative in building, sustaining, and managing the instructor workforce.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: acton002@umn.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Acton
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Chipman
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lunden
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Connie C
authors.initials: CC
authors.lastname: Schmitz
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008910:Minnesota; D000066908:Simulation Training; D016526:Workload
keywords: Cost; Faculty; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Resident Education; Simulation; Surgery