Various materials and models support our simulation teaching concepts for a wide range of basic surgical skills, intermediate skill tasks, and more advanced surgical procedures. This includes basic knot tying and suturing, forcep handling and needle driver manipulation, surgical instrumentation recognition and categorization, incision creation, basic and advanced wound closure techniques, diagnostic and therapeutic ultrasound techniques, performance of intestinal anastomosis and vascular surgical arterial and venous repairs and anastomoses.

Specific surgical skills and simulation teaching and training modules have been developed for all open skills modules. The curricula for each module a didactic syllabus covering the appropriate knowledge domains necessary for developing expertise in the skill task being taught, procedural checklist of skill task steps, hands-on expert demonstration, practice guideline recommendations, and assessment of competency utilizing procedural checklists, task completion times, and global rating scores.

The Fundamentals of Endoscopic Surgery™ (FES) program is comprised of two components: education and assessment. The educational piece is a web-based, didactic presentation consisting of 13 interactive, cognitive, content chapters covering basic diagnostic and therapeutic endoscopy, using rich text, images, and illustrations. The assessment portion contains both a multiple-choice exam and a performance-based manual skills assessment to evaluate technical and psychomotor skills. The skills exam is performed on a virtual reality simulator, the GI Bronch or GI Express, both proprietary pieces of hardware developed by 3D Systems|Simbionix.

SurgicalSim VR (METI) is a learning system displaying a virtual reality fixed camera view. The simulation training exercises within this educational platform cover basic, intermediate, and advanced laparoscopic skill tasks including laparoscopic camera navigation (visualize target and scope, visualize and acquire target and scope, tissue and instrumentation manipulation (retract tissue, retract and dissect tissue, traverse tube, arrow placement, retraction and clip application, gallbladder dissect), basic suturing (needle adjust, one-handed and two-handed stitch-traction or no traction), advanced suturing (abstract and realistic square, surgeon and free knot, abstract and realistic continuous and interrupted suture). There is no haptic feedback to the instruments but rather virtual visual feedback is provided from sophisticated anatomic simulations. This program can objectively measure performance, identify problem areas, assess an individual learner’s progress, and ensure competency standards are met and mastered.

SurgicalSim LTS (METI) is a training and testing program for basic skill in laparoscopic surgery. The training exercises include 10 skill and coordination skill tasks that are performed with real laparoscopic instruments. These tasks focus on coordination (peg manipulation [#1], ring manipulation [#2/3], rod cannulation [#4/5]), knot tying (extracorporeal and intracorporeal knots [#6/7/8]), knot integrity (suturing flaps and foam [#9]) and cutting (disc cutting [#10]). Live video review of task performance can be viewed on the incorporated computer monitor. Scores for each task, based on speed and accuracy, are calculated and recorded within the program data system. Data can be printed or exported for later evaluation and comparison.

Laparoscopic Box Trainer (Medical Applied Research Corporation [MARC], Olympus Medical) is a modular lap trainer developed by MARC in conjunction with Olympus Visera and cameras and video display unit allows for integration of more advanced laparoscopic skills training. The MARC trainer box accurately simulates the abdominal cavity and allows for actual camera views utilized in clinical laparoscopic surgical procedures (and different from the FLS trainer box). Resident performance can be recorded for immediate debriefing and/or later review and feedback.

Accutouch Endoscopy Simulator (Immersion Medical): A simulation endoscopic training program which utilizes mock, gastroscopes, colonoscopes, and bronchoscopes with active controls but no view channel or active tip motion. Following insertion of the different scopes into the simulator an intraluminal view is initiated where the view can be altered simulating a realistic clinical exam with manipulation of the scope controls. Haptic feedback resistance is provided to the user as the simulator will grip the scope during the exam. Diagnostic and therapeutic training exercises provided include the opportunity to negotiate the entire upper GI tract (EGD, cytology sampling, ERCP, papillotomies, cholangiopancreatograms), lower GI tract (flexible sigmoidoscopy, colonscopy, biopsy, basic polypectomy), and bronchial tree (flexible bronchoscopy, bronchoalveolar lavage, endobronchial sampling and biopsy, transbronchial needle aspiration, bronchoscopy-assisted endotracheal tube placement). Various performance metrics are obtained and recored including percentage of mucosa viewed, task completion time, and pressure exerted. In addition, cheat views showing the true position of the scope and its orientation can be toggled on as insets overlaying the intraluminal view.