Simulation-Based Medical Education Simulation-based medical education (SBME) aims to transfer the technical aspects of training out of the operating theatre. SBME proves suitable to a steeper learning curve, and thus reduces the number of operative procedures needed to master a procedure. Second, continuous simulation training can prevent a decay of skills over time, which may already occur after 90 days.8 Many forms of SBME exists, including simple box-trainers, cadaveric, animal, and synthetic models, and virtual and augmented reality (AR) trainers. Virtual reality (VR) is one of the most common types of SBME, especially in laparoscopic surgery. VR training differs from AR training by constructing an entirely digital environment, whereas augmented reality usually uses an overlay of digital content onto the real world. Both offer promising additions to ex-vivo training. In a study from Ahlberg et al. video recordings of 13 laparoscopic novices who performed their first laparoscopic cholecystectomies with or without upfront VR training, demonstrated a reduction in errors in the group with VR training, who also performed the procedure faster.9 In 2012 Lewis et al. presented their use of a VR model in training advanced laparoscopic skills and used this model to train a laparoscopic jejunojejunostomy.10 For assessments, they proposed to use a cadaveric porcine model and showed that a combination of VR training and this porcine model account for a training and assessment tool with face-, construct-, and concurrent validity. This means the tool is a realistic representation of the task, differentiates between ability levels, and correlates to in-vivo performance.11 The validity of assessments is discussed in more detail in the following paragraph ‘Assessments’. In Chapter 6 a study is described that uses a simple Plexiglas box to train the skill of running the small bowel and determining its length, an important step in the execution of the LRYGB. Even the use of a simple box without a 2D or 3D camera and without the fulcrum effect of the abdominal wall proved feasible as a training instrument. Combining these training options together, a simulation-based training curriculum for MBS was proposed by Zevin (Figure 1).12 The next phase in development of an MBS curriculum is to transfer the obtained skills to operative procedures and integrate the SBME curriculum. 150 8
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