Integrating simulation into a surgical residency program - Is voluntary participation effective?

Objective: Surgical training programs nationwide are struggling with the integration of simulation training into their curriculum given the constraints of the 80-h work week. We examine the effectiveness of voluntary training in a simulation lab as part of the surgical curriculum. Methods: The ProMIS (TM) simulator was introduced into the general surgery residency at Boston University Medical Center. All categorical residents (28) and noncategorical residents (23) were offered a 2-h training session and curriculum review. After the introductory session, time spent in the lab was encouraged, but voluntary. Use of the simulator was tracked for all residents. Participation in the simulation curriculum was defined as three or more uses of the simulator. After 3 months, all residents completed a survey regarding the simulation lab and their simulator usage. Results: Twenty-six (93%) categorical residents and three (6%) non-categorical residents completed the introductory simulator training session. Over a 3 month period, use of the simulator at least once was 31% among all eligible residents; 80% of postgraduate year (PGY) 1, 40% of PGY2, 60% of PGY3, and 0% of PGY4 and PGY5. Four residents (14%) participated in the simulation curriculum. Overall, 70% of simulator usage was during working hours, and 30% was completed post-call or when the resident was off duty. Most residents agreed that the simulator was easy to use and that its use improved their operative skills, but they did not think it was a good substitute for actual operative experience. Reported reasons for not using the simulator included off-site rotation (44%), no time (30%), and no interest (11%). Conclusions: Voluntary use of a surgical simulation lab leads to minimal participation in a training curriculum. Participation should be mandatory if it is to be an effective part of a residency curriculum.