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Training to proficiency in surgery using simulation: is there a moral obligation?
  1. Conor Toale,
  2. Marie Morris,
  3. Dara O Kavanagh
  1. Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Conor Toale, Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland; conortoale{at}rcsi.com

Abstract

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.

New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.

This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

  • surgery
  • medical errors
  • education

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • Twitter @ToaleConor, @MarieMorrisRCSI

  • Contributors All authors contributed substantially to the manuscript: CT: First draft authorship, concept, literature search, final approval. MM: concept, critical draft review, final approval. DOK: concept, critical draft review, final approval. DOK accepts full responsibility for the work and controlled the decision to publish.

  • Funding This study was funded by Hermitage Medical Clinic/ Royal College of Surgeons in Ireland Strategic Academic Recruitment (NA).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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