Nousiainen Markku T, McQueen Sydney A, Ferguson Peter, Alman Benjamin, Kraemer William, Safir Oleg, Reznick Richard, Sonnadara Ranil
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 621-43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.
Clin Orthop Relat Res. 2016 Apr;474(4):935-44. doi: 10.1007/s11999-015-4512-6.
Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time.
QUESTIONS/PURPOSES: This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program.
All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment.
The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase.
Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes.
The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.
尽管基于模拟的培训在外科教育中日益普及，且研究也支持其应用，但一个主要限制因素是成本。到目前为止，关于住院医师培训中模拟培训成本的报道很少。在多伦多大学，已实施了一种新颖的基于能力的骨科手术课程，用于培训选定的住院医师，该课程大量使用了模拟技术。尽管这种强化模拟方法有诸多益处，但仍需考虑其财务影响以及对教员时间的需求。
问题/目的：本研究对在多伦多大学基于能力的新课程项目中实施模拟作为教学和评估工具的成本及教员工作时间进行了分析，并与住院医师培训项目中使用模拟的历史成本进行了比较。
审查了所有模拟培训发票，以确定基于能力的课程实施前后的财务成本。发票项目包括尸体、人工模型、技能实验室人工、相关材料和标准化病人的成本。由于与技能实验室和植入物供应商的特殊安排，免除了与手术技能实验室租金和骨科植入物相关的成本。尽管教员时间未获报销，但仍对用于模拟的教员时间进行了评估。选择2008至2009学年代表引入基于能力的课程之前的学年。在这一年，12名住院医师使用模拟进行教学。选择2010至2011学年代表基于能力的课程培训项目与常规培训并行但独立运行的学年。在这一年，6名住院医师使用模拟进行教学和评估。选择2012至2013学年代表在基于能力的课程住院医师和常规住院医师中均同等使用模拟进行教学（60名住院医师）以及在14名基于能力的课程住院医师和21名常规住院医师中进行评估的学年。
在基于能力的课程和常规项目中对所有住院医师进行教学和评估时使用模拟的总成本（2012 - 2013学年）（155,750加元，158,050美元）比在基于能力的课程实施之前（2008 - 2009学年）使用模拟对住院医师进行教学的成本（10,090加元，11,140美元）高出约15倍。在此期间，用于教学和评估学员的时间从96小时增加到317小时，增长了两倍。
尽管在多伦多大学新的基于能力的课程中运行模拟项目的财务成本和对教员时间的需求很高，但学员和教员满意度的提高伴随着学习成果得到改善和更高效的直接证据。
在使用模拟来加强外科培训时必须考虑与实施教学和评估相关的更高成本以及对教员时间的需求。
