title: Development and evaluation of a simulation-based continuing medical education course: beyond lectures and credit hours.
abstract: BACKGROUND
  The aim of our study was to modify our previously developed laparoscopic ventral hernia (LVH) simulator to increase difficulty and then reassess validity and feasibility for using the simulator in a newly developed simulation-based continuing medical education course.
  
  
  METHODS
  Participants (N = 30) were practicing surgeons who signed up for a hands-on postgraduate laparoscopic hernia course. An LVH simulator, with prior validity evidence, was modified for the course to increase difficulty. Participants completed 1 of the 3 variations in hernia anatomy: incarcerated omentum, incarcerated bowel, and diffuse adhesions. During the procedure, course faculty and peer observers rated surgeon performance using Global Operative Assessment of Laparoscopic Skills-Incisional Hernia and Global Operative Assessment of Laparoscopic Skills rating scales with prior validity evidence. Rating scale reliability was reassessed for internal consistency. Peer and faculty raters' scores were compared. In addition, quality and completeness of the hernia repairs were rated.
  
  
  RESULTS
  Internal consistency on the general skills performance (peer α = .96, faculty α = .94) and procedure-specific performance (peer α = .91, faculty α = .88) scores were high. Peers were more lenient than faculty raters on all LVH items in both the procedure-specific skills and general skills ratings. Overall, participants scored poorly on the quality and completeness of their hernia repairs (mean = 3.90/16, standard deviation = 2.72), suggesting a mismatch between course attendees and hernia difficulty and identifying a learning need.
  
  
  CONCLUSIONS
  Simulation-based continuing medical education courses provide hands-on experiences that can positively affect clinical practice. Although our data appear to show a significant mismatch between clinical skill and simulator difficulty, these findings also underscore significant learning needs in the surgical community.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA. Electronic address: pugh@surgery.wisc.edu.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Pugh
authors.affiliation: Department of Surgery, Northwestern University, Chicago, IL, USA.
authors.forename: Fahd O
authors.initials: FO
authors.lastname: Arafat
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: Calvin
authors.initials: C
authors.lastname: Kwan
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.affiliation: The Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, McGill University, Montréal, Quebec, Canada; The Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montréal, Quebec, Canada.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.affiliation: The Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, McGill University, Montréal, Quebec, Canada; The Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montréal, Quebec, Canada.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.affiliation: The Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery & Innovation, McGill University, Montréal, Quebec, Canada; The Arnold and Blema Steinberg Medical Simulation Centre, McGill University, Montréal, Quebec, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008953:Models, Anatomic; D015203:Reproducibility of Results; D000066908:Simulation Training
keywords: CME; Evaluation; Laparoscopy; Simulation; Training; Validity