Abstract P2-18-18: Improving training in breast surgical oncology: The development and preliminary validation of a simulator for wide local excision
Authors: Leff DR , Petrou G , Mavroveli S , Berishand M , Cocker D , Al-Mufti R , Darzi A , Hanna G , Hadjiminas D 
Published: August 2014

Background

Simulation training has the potential to increase resident confidence in basic procedural tasks prior to operating room (OR) refinements, offsets a reduction in mentoring opportunities, avoids the use of patients for skills practice, and facilitates objective assessment of technical skills. Despite a multitude of benefits, adoption of simulation training and assessment in breast surgical oncology has not been forthcoming.

Aims

To develop and validate a high-fidelity surgical simulator for the practice, training and assessment of technical skills in wide local excision (WLE) of a palpable breast tumour.

Methods

Subjects (attendings and residents with an interest in breast surgery, and novice trainees) were invited to perform a WLE of 25mm palpable breast lesion located 30mm from the nipple areolar complex in the 3o clock position, on a synthetic breast simulator developed at Imperial College London as part of the London Deanery Skills Programme. Procedures were videotaped (blind) and were retrospectively reviewed and independently rated against procedure-specific ratings of performance (VAS 0-100) by two expert breast surgeons (&gt;10 years experience). Specimen radiographs were performed (BioVision, Faxitron, USA) and margin of clearance (mm) were calculated from the edge of the “tumour” to the limits of surrounding breast tissue excised in 4 cardinal directions (i.e. N, S, E W). Specimen weights were recorded (g). Subjects completed a comprehensive questionnaire to determine simulator content and face validity.

Results

21 subjects participated (5 attendings, 13 registrars, and 3 junior trainees). Data was analysed according to experience (high = &gt;100 independent wide local procedures; low = no independent wide local procedures). Statistically significant (p ≤ 0.05) differences in performance were observed between high and low experience surgeons [for each category data are VAS score medians±IQR; ‘exposure’: low = 70.0±50.0, high = 80.0±20.0; ‘skin flap development’: low = 70.0±50.0, high = 80.0±40.0; ‘resection skills’: low = 60.0±55.0, high = 80.0±45.0; ‘glandular remodelling’: low = 70.0±25.0; high = 80.0±50.0, ‘skin closure’: low = 70.0±25.0, high = 90.0±20.0]. Resection margin width and specimen weight (MWU = 52.5, p = 1.0) did not discriminate high-low experience surgeons. The majority of participants believed that training on the model simulated the same steps as a real WLE (94.7%) and was useful for real practice (84.2%).

Discussion

Preliminary data on a WLE simulator suggests that the model is face and construct valid, and may be useful to supplement early stage practice prior to skills development in the OR. Video performance ratings whilst time consuming appear to distinguish high-low experience surgeons better than do specimen weight or radiographic margin width.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-18.