Skills Training

 Skills training skills training

The General Surgery Residency Program at the University of Nebraska Medical Center has an extensive surgical skills training program in place. This comprehensive skills training program consists of open surgical skills training, minimally invasive skills training, and simulation skills acquisition.

Open Surgical Skills
The open surgical skills training is undertaken in the Advanced Anatomy laboratory that simulates the real operating room and uses lightly embalmed cadavers. The laboratory has the same instruments and equipment (ligasure, electocautery, staples, etc.) that are used in the operating room. The lightly embalmed cadavers are different from the regular cadavers and closely resemble live tissue. Residents practice open surgical procedures appropriate for their level on these cadavers under Faculty guidance. The procedures are chosen from the list of Residency Review Committee (RRC) mandated operations that need to be undertaken during the residency. The skills training curriculum is being expanded on an annual basis.  Approximately 40 sessions are scheduled each academic year.

Simulation
The 8000 square feet state-of-the-art Sorrell Simulation Center is an integral part of our residency training. Since its opening in 2008 we have gradually increased the number of simulation-based training sessions. Residents get the opportunity to become proficient in many procedures that are currently available. Simulation also plays a key role in the intern orientation curriculum.

We are continuously seeking to improve our simulation-based trained facilities. The recent opening of the state-of-the-art Ryan Surgical Simulation Suite has allowed us to develop our robust simulation curriculum.

We are acutely aware of the enormous influence that simulation can play in the training of the current generation of residents. Our proactive efforts will ensure that we stay abreast and provide our residents with the best training opportunities in simulation. 

Minimally Invasive Surgical Techniques
Minimally invasive surgical techniques are taught in wet laboratory sessions using cadavers. This includes teaching both laparoscopic, endoscopic and thoracoscopic procedures. Several sessions are available for residents to practice prior to taking the Fundamentals of Laparoscopic (FLS) Surgery exam. These training sessions ensure that the residents are kept abreast with the current and evolving new minimally invasive surgical techniques. The Sorrell Clinical Simulation Center also provides the opportunity to acquire skills training. Through this comprehensive skills training curriculum we aim to train residents to be technically proficient in all aspects and approaches to surgery.

Fundamentals of Laparoscopic Surgery
The Fundamentals of Laparoscopic Surgery (FLS) program is a SAGES/ACS jointly supported educational module and assessment tool designed to teach the fundamental knowledge, judgment and technical skills required in basic laparoscopic surgery. Learning and applying these fundamentals will help ensure a minimal standard of care for patients undergoing laparoscopic surgery. FLS also offers a proctored exam that gives surgical residents and fellows the opportunity to assess and document those skills.

Fundamentals of Endoscopic Surgery
The Fundamentals of Endoscopic SurgeryTM (FES) program is a comprehensive educational and assessment tool designed to teach and evaluate the fundamental knowledge, clinical judgment and technical skills required in the performance of basic gastrointestinal (GI) endoscopic surgery (endoscopy). Our goal is to provide participants with an opportunity to learn the fundamentals of endoscopic surgery in a consistent, scientifically accepted format, and to test cognitive and technical skills – all with the goal of improving the quality of patient care.

UNMC was recently designated as one of three testing centers for FES in the nation. Obtaining this designation is another milestone on our path to becoming a regional and national leader in education.

Virtual OR
The Ryan Virtual operating room provides a unique setting for residents to learn about how to handle real-life intra-operative adverse events in a simulated environment. The state-of-the-art Ryan Virtual Operating room was constructed to closely simulate the real operating room with specific details to patient set up, patient monitoring, mannequins with adjustable hemodynamic capabilities and other equipment. This provides the ability for the educators to create real-life like intra-operative adverse events such as bleeding, difficult airway, difficult access etc.  Each module focuses on one of these adverse events and residents are expected to handle these adverse events with a debriefing afterwards to assess their performance. In addition, simulated scenarios are also developed in conjunction with the Department of Anesthesia to have combined educational days with residents from Surgery and Anesthesia. It is expected that after these simulated training exercises residents will be better prepared to handle adverse events in the real operating room.

Ultrasound
The first lecture during the year-long schedule on Ultrasound and Echo Lab skills is a two-hour lecture where residents are taught basic physics, knobology, and instruction of basic image acquisition for Transthoracic Echo and the FAST and e-FAST exam.  After this first introduction, the remaining lectures occur in the Clinical Simulation Lab accompanied by hands-on skills.

The Ultrasound equipment that is housed in the Michael F. Sorrell Clinical Simulation Lab consists of an electronic Transthoracic and Transesophageal Simulator, which allows residents to practice with tremendous precision and with the intent of acquiring basic skills for imaging the heart.  In our curriculum, we focus on the Transthoracic version.  After residents have had the opportunity to practice those skills we proceed to using a real ultrasound machine, practicing among themselves the basic skills of acquiring echo images on the four transthoracic approach.  This builds residents’ confidence using an ultrasound machine and trains them to make acutely hemodynamic assessments in the ICU.

An important portion of their training is to teach them skills tested on the FAST and e-FAST exam.  During this testing, residents acquire skills to find fluid in the abdomen and diagnose pleural fluid and pneumothorax, situations commonly seen in their clinical trauma experience.

Sample schedule during an academic year:

Skills Labs
August - May:

HO I

Open
Endoscopy
Ultrasound
Open
Lap Sim
Lap Sim
Virtual OR
Endoscopy

HO II Lap Sim
Open
Endoscopy
Robotics
IR
Virtual OR
Robotics
Lap Sim

HO III

Lap Sim
Lap - Cadaver
Virtual OR
Endoscopy
Robotics
Ultrasound
Lap Sim
Open
IR
Thoracic

HO IV Endoscopy
IR
Thoracic
Open
Robotics
Ultrasound
Lap - Cadaver
Open
Lap - Cadaver
HO V Endoscopy
Lap - Cadaver