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Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 135-138

Simulation-based surgical skill training in internship program

1 Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
2 Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Submission25-Jun-2019
Date of Acceptance14-Jul-2019
Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Surekha Rathod
Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur - 440 017, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_45_19

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Background: Objective structured assessment of technical skills (OSATS) are crucial in assessing operative skills. The education of basic surgical skill (BSS) depends on precise assessment of their surgical skill levels and competency level. Hence, this study aimed to determine the effectiveness of BSS module on intern's competency and confidence. Materials and Methods: Fifty-four interns were included in the module. Three faculty members were included in the module. The module has been prepared on: (1) Asepsis – surgical hand scrubbing, gloving, gowning. (2) Simple interrupted suturing. Intervention: Small group teaching was given to each batch, and hands-on training in dry skill laboratory on simulation was given. Interns were assessed by OSATS, and feedbacks were taken at the end of the assessment. Results: The score of global rating scale for each trainee increased within the 15 days of posting. The knowledge domain of posttest score also improved. Conclusion: BSS module was found to be effective, aiding for the interns to improve their knowledge and skills.

Keywords: Basic surgical skill, objective structured assessment of technical, simulation

How to cite this article:
Rathod S, Ghoderao D, Kolte V, Budhraja N. Simulation-based surgical skill training in internship program. SRM J Res Dent Sci 2019;10:135-8

How to cite this URL:
Rathod S, Ghoderao D, Kolte V, Budhraja N. Simulation-based surgical skill training in internship program. SRM J Res Dent Sci [serial online] 2019 [cited 2022 Nov 29];10:135-8. Available from:

  Introduction Top

Blending of knowledge, technical skills, decision-making, communication skills, and management skills are required for the surgical competency. Supreme importance among surgical trainees to improve surgical competency is handiness and technical skills.[1] Before dental students proceed their clinical works on actual patients, one of the vital steps is including suturing and knot-tying skills in the preclinical basic surgical skill (BSS) training.[2]

There are challenging situations for the practitioners that need implementation of ambulatory surgical procedures. During the academic training, the majority of practitioners are not provided with adequate surgical training; hence, it is essential to set up a training program planned at educating undergraduates and newly graduate about surgical technical skills.[3]

Simulation to substitute or intensify real-patient experiences with guided experiences, artificially contrived that evokes or replicates substantial aspects of the real world in a fully interactive manner.[4]

Various types of simulations such as simulated and virtual patients, static and interactive manikin simulators, task trainers, and screen-based (computer) simulations are used by healthcare professionals to improve education and ultimately enhance patient's safety. The main role of simulation is to reconstruct situations that are infrequently practiced and test professionals in difficult circumstances and to cautiously replay or inspect their actions. Simulation helps the modern healthcare professional to accomplish higher levels of capability and safer care and thus is considered as an influential learning tool. The main principle of using simulation is to improve technical capability and to deliver beginners with a chance for careful training. It provides safe environment so that they can make mistakes, learn from those mistakes, and achieve skills.[5]

Usually, the supervisor assesses the surgical skills of trainees, with feedback. In contrast to these subjective assessments, the validity and reliability of several objective methods of assessing surgical skills have been reported previously. Objective structured assessment of technical skills (OSATS) is one of the objective skill assessment tools, used by the University of Toronto since 1990s. The OSATS comprise of two components: an operation-specific checklist and a global rating scale. Both of these methods were testified to be relative to the maturity of surgical skills. Common method of evaluation is the global rating scale which is not restricted to any definite procedure, which consists of seven evaluation items scored on a 5-point scale. The global rating scale can be applied to any other skill assessment.[6]

There is no planned structured training during BDS internship to teach BSS to interns; but, at the same time, the interns are expected to perform BSS during their posting. Hence, our aim was to develop BSS module and assess its effectiveness for interns.

  Materials and Methods Top

After ethical clearance from institutional ethics committee, students and faculty members were sensitized about the module and OSATS. 54 interns and 3 faculty members were participated in the study. Inform consent was taken from each participant before study was started. At the beginning of the module, a pretest was conducted. The questions in test were based on basic knowledge about asepsis, suturing, and knot-tying techniques. Small group teaching was carried out on asepsis, gloving, gowning, and suturing techniques.

After the lecture, faculty members shown the videos on hand scrubbing, gloving, and gowning; at the same time, suturing techniques demonstrated on simulations. Interns practiced suturing and knot-tying techniques on simulations which included soft cardboard templates and plaster models. At the end of the module, a posttest was taken to assess the knowledge as well as the improvement of the interns. Surgical skills were assessed using OSATS. Skills of the interns were assessed using OSATS illustrated in [Table 1]. Simulations used are shown in [Figure 1] and [Figure 2].
Table 1: Structured assessment of technical skills' global rating scale

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Figure 1: Simulations: Plaster models

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Figure 2: Simulations: Soft cardboard template

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  Results Top

Knowledge assessment

A total of 54 interns were participated in the module. A pre- and post-training test was conducted; each consisted of 12 questions to assess the knowledge of the trainees. The data in the pre- and post-training questionnaire were given in [Table 2] and [Table 3]. Posttraining scores were improved compared to pretraining scores, which was statistically significant.
Table 2: Pretest results

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Table 3: Posttest results

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Skill assessment

Skill assessment was done using OSAT global rating scale. Global rating scale has scoring range of 1-7 for each domain. Scores were given in [Table 4]. Most common score found during this module was between 3 and 4 for domain 1, 3-5 for domain 2, whereas for domain 3, it was 4.
Table 4: Structured assessment of technical skills scores Category

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  Discussion Top

Marked improvement was seen among the interns regarding the knowledge and skills. OSATS was used successfully to evaluate surgical skills. Including small group teaching in the module, which was based on asepsis, sterilization, suture material, suturing techniques was found to be helpful in improving the knowledge of interns. The knowledge was evaluated by pre- and post-test, and marked results were seen.

Operative time, difficult procedures, and medicolegal concern are some of the factors that affect the proper teaching of operative skills to trainees. Teaching basic skills on a patient arises ethical concerns. Budding dentists struggle with the process of a surgical exercise on patients which also causes inconvenience to patient who are under prolonged anesthesia. Another factor is trying to learn in an extremely tense situation in which the purpose is the achievement of a beneficial procedure is a provocation to the growth of error patterns in motor performance. Thus, students have a lesser amount of chance to get acquaint with BSS and procedures on living human patients. Furthermore, simulator models offer a precise situation to carry out technical skills, and obtainable simultaneous response delivers a more planned and comprehensive method to the acquire BSS.[7]

Moulton et al. found that the application of academically sound concepts to improve learning skills is one of the advantages of training surgical skills in dry skill laboratory.[8]

Acquisition of technical skills is the key principle of having simulators in the surgical training arena. From both the trainees and patient's perspective, it provides safe training environment. Use of simulation in surgical training is imperative in educating the surgical trainees and to monitor their improvement along the training programs until they possess the essential technical skills without risking patients' lives.[9]

Shabbir et al. found that use of workshop setting to teaching BSS is both viable and beneficial using simulation and stated that all medical student's should undergo training BSS, regardless of their career aims.[7] Because of the greater degree of cognitive involvement, surgical skill may be more complicated than other motor skills. Therefore, assumptions about how well existing motor learning principles apply to surgery cannot be confidently made without testing them in the surgical skills arena.[8]

The OSATS guarantees a dependable and valid method for testing specific operative skills in surgical trainees.[10]

Shaharan and Neary noted that OSATS persists the top assessment tool in surgical training particularly in open technical skills and stated that simulation-based evaluation has now started to cross the threshold of incorporation into conventional skills' training.[9]

Martin et al. proposed that assessment of surgical skills by OSATS is reliable and valid. They also found that the bench model simulation gives corresponding results when live animals were used for training.[10] Alam et al. in their study evaluated the usefulness of OSATS as a tool for measuring surgery skills during dermatology residency training. They observed that the OSATS seems useful and reliable for the evaluation of dermatologic surgery skills.[11]

Considering our results, marked improvement was seen regarding the knowledge of BSS among the interns. Such workshops including use of simulation encourage the budding dentist to learn the surgical skills in safe environment without any stress so that if mistakes are made, they can learn from their mistakes and can practice again under the supervision of trained faculties.

  Conclusion Top

Development of BSS module found to be effective and helpful for the interns to improve their knowledge and skills. Such module can be included in the educational curriculum. The OSATS remains the top priority tools to assess the technical skills of trainee.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327:1032-7.  Back to cited text no. 1
Shen Z, Yang F, Gao P, Zeng L, Jiang G, Wang S, et al. A novel clinical-simulated suture education for basic surgical skill: Suture on the biological tissue fixed on standardized patient evaluated with objective structured assessment of technical skill (OSATS) tools. J Invest Surg 2018;31:333-9.  Back to cited text no. 2
Denadai R, Souto LR. Organic bench model to complement the teaching and learning on basic surgical skills. Acta Cir Bras 2012;27:88-94.  Back to cited text no. 3
Krishnan DG, Keloth AV, Ubedulla S. Pros and cons of simulation in medical education: A review. Int. J. Med. Health Res 2017;3:84-7.  Back to cited text no. 4
Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, et al. Training and simulation for patient safety. Qual Saf Health Care 2010;19 Suppl 2:i34-43.  Back to cited text no. 5
Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, et al. Using the objective structured assessment of technical skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 2013;43:271-5.  Back to cited text no. 6
Shabbir MN, Memon ZA, Nizami M, Khanzada R. Assessment and teaching of surgical skills through simulation in surgical training. Pak J Surg 2008;24:168-72.  Back to cited text no. 7
Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R, et al. Teaching surgical skills: What kind of practice makes perfect?: A randomized, controlled trial. Ann Surg 2006;244:400-9.  Back to cited text no. 8
Shaharan S, Neary P. Evaluation of surgical training in the era of simulation. World J Gastrointest Endosc 2014;6:436-47.  Back to cited text no. 9
Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84:273-8.  Back to cited text no. 10
Alam M, Nodzenski M, Yoo S, Poon E, Bolotin D. Objective structured assessment of technical skills in elliptical excision repair of senior dermatology residents: A multirater, blinded study of operating room video recordings. JAMA Dermatol 2014;150:608-12.  Back to cited text no. 11


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


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