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• W2753105514 abstract "Commentary Simulation-based surgical training is now mandated for all American orthopaedic surgery training programs. The traditional, mentorship-based, “see one, do one” approach is being augmented by, and may gradually be supplanted by, simulation-based proficiency-progression training1. As Angelo et al. demonstrated2, proficiency-progression training is extremely effective, but the transition requires dedicated effort, careful assessment, and a new way of thinking. Change is hard. Beyond the anticipated cultural resistance to modification of time-honored educational traditions, there are also important concerns about expenses associated with simulation-based training. New costs must be managed by orthopaedic leaders and by hospital administrators in the setting of already-scarce resources. Karam et al.3 found that 87% of orthopaedic program directors identified a lack of available funding as the most substantial perceived barrier to development of a formal surgical skills program. Nousiainen et al.4 measured the marginal costs associated with implementation of a novel and highly effective competency-based orthopaedic residency curriculum at their institution. They focused on direct costs of training, but had little information about changes in patient safety and potential cost-savings associated with fewer clinical complications. In their article, Bae et al. address these important clinical and financial issues. The study compares the incidence of cast-saw burns before and after implementation of a simulation-based curriculum focused on cast application and removal for pediatric distal radial fractures and then calculates the clinical and medicolegal costs associated with cast-saw injuries during the study period. Bae et al. conclude that the return on investment (incremental clinical and indemnity savings divided by the additional cost of simulation training) was 11 to 1, which provides a very compelling argument for continued implementation of this program at their organization. It is important to note that the analysis by Bae et al. was performed from a relatively global organizational perspective. The approach may not be easily translated to other institutions, where educational costs are highly siloed from clinical and medicolegal accounting. Nonetheless, this study is important because it demonstrates that simulation-based training can save money in the big picture. What parent would argue against an educational approach that decreases risk for children, especially when training is done in a simulation laboratory that puts no one at risk? There is a strong ethical argument for advancement along the surgical learning curve prior to patient exposure, whenever possible. And it is possible. As with all research, there were some limitations to the current study, which Bae et al. acknowledge. Because this was not a randomized prospective study, it is possible that the observed changes in complication rates were associated with a new educational curriculum, increased awareness of cast-saw injuries, greater practice by the residents with use of cast saws, or other variables not associated with the simulation exercise specifically. Furthermore, observation and measurement sometimes change performance. In other words, as residents became more aware of cast-saw problems, they might have become more careful with use of the tool. Although I agree with Bae et al. that this study provides a compelling argument for a strong return on investment at their program, I do not agree that there is a lack of equipoise for prospective research on the topic. Some might argue that improvement of the educational curriculum is all that it takes, with or without the marginal costs of surgical simulation. These are important considerations that warrant additional research. This study is particularly valuable because very little information is available regarding clinical return on investment for simulation training in orthopaedic surgery. The financial methodology implemented in the current study adds another dimension to an already complex analysis. Although it may be challenging for the educational system to move from “see one, do one,” I believe that the change will ultimately benefit those who matter most: our patients." @default.
• W2753105514 created "2017-09-15" @default.
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• W2753105514 date "2017-09-06" @default.
• W2753105514 modified "2023-09-23" @default.
• W2753105514 title "Moving from “See One, Do One”: Simulation Training Can Save Money" @default.
• W2753105514 cites W1760893596 @default.
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• W2753105514 doi "https://doi.org/10.2106/jbjs.17.00611" @default.
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