title: Development and implementation of a clinical pathway approach to simulation-based training for foregut surgery.
abstract: BACKGROUND
  Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up.
  
  
  METHODS
  The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation "pathway" repeated on days 1 and 3. The "pathway" is a series of simulated preoperative, intraoperative, and postoperative encounters in following up a single patient through a disease process. The resident sees a standardized patient in the clinic presenting with distal gastric cancer and then enters an operating room to perform a gastrojejunostomy on a porcine tissue model. Finally, the resident engages in a simulated postoperative visit. All encounters are rated by faculty members and the residents themselves, using standardized assessment forms endorsed by the American Board of Surgery.
  
  
  RESULTS
  A total of 18 first-year residents underwent this curriculum. Faculty ratings of overall operative performance significantly improved following the 3-day module. Ratings of preoperative and postoperative performance were not significantly changed in 3 days. Resident self-ratings significantly improved for all encounters assessed, as did reported confidence in meeting the defined learning objectives.
  
  
  CONCLUSIONS
  Conventional surgical simulation training focuses on technical skills in isolation. Our novel "pathway" curriculum targets an important gap in training methodologies by placing both technical and nontechnical skills in their clinical context as part of managing a surgical patient. Results indicate consistent improvements in assessments of performance as well as confidence and support its continued usage to educate surgery residents in foregut surgery.
authors: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: kiyoyuki.miyasaka@uphs.upenn.edu.
authors: Kiyoyuki W
authors: KW
authors: Miyasaka
authors: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Joseph
authors: J
authors: Buchholz
authors: Standardized Patient Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Denise
authors: D
authors: LaMarra
authors: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Giorgos C
authors: GC
authors: Karakousis
authors: Arnold and Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Canada.
authors: Rajesh
authors: R
authors: Aggarwal
mesh_terms: D000818:Animals; D002983:Clinical Competence; D019091:Critical Pathways; D003479:Curriculum; D013505:Digestive System Surgical Procedures / Q000193:education*; D004503:Education, Medical, Graduate / Q000379:methods; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D000066908:Simulation Training; D013552:Swine
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; education; residency; simulation; standardized patient; surgery