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Validation of the Simulated Ward Environment for Assessment of Ward-Based Surgical Care

Pucher, Philip H. BSc, MRCS*; Aggarwal, Rajesh PhD, MA, FRCS*; Srisatkunam, Tharanny BSc; Darzi, Ara MD, KBE, FRCS, FACS*

Annals of Surgery:
doi: 10.1097/SLA.0b013e318288e1d4
Features
Abstract

Objective: To assess the feasibility of developing a simulated ward environment in which to assess the ward-based care of surgical patients by clinicians of varying levels of experience (construct validation).

Background: Increasing evidence points to the importance of the postoperative or ward-based phase of surgical care in determining patient outcomes. Ward-based care is determined by the clinician ward round, with the simulated ward environment potentially providing a safe environment for training and assessment.

Methods: A high-fidelity surgical ward environment was developed. Junior and senior trainees conducted ward rounds of 3 standardized surgical patients and were assessed using a checklist of assessment and management care processes, modified NOTECHS score, and fidelity questionnaire.

Results: Nine senior and 9 junior trainees were observed. There was no significant difference in time taken to conduct the round (37.6 ± 2.7 vs 32.6 ± 1.9 minutes, P = 0.16). Senior trainees performed significantly more assessment processes (73% ± 2.8% vs 63% ± 2.5%, P = 0.016) and completed more management tasks (73% ± 4.5% vs 59.4% ± 5%, P = 0.058). Fifteen adverse events were committed by junior trainees versus 8 by seniors (P < 0.001). Seniors scored higher on nontechnical ability (NOTECHS score 21.8 ± 0.61 vs 18.1 ± 1.12, P = 0.017). All of subjects felt the ward, patients, and scenarios were realistic.

Conclusions: A high-fidelity, immersive, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.

In Brief

Increasing evidence points to the importance of the postoperative phase of surgical care in determining outcomes. A simulated ward was developed; junior and senior trainees conducted ward rounds of standardized patients. Significant differences in performance were observed. A high-fidelity, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.

Author Information

*Division of Surgery, Department of Surgery and Cancer; and

Faculty of Medicine, Imperial College London, London, United Kingdom.

Reprints: Philip H. Pucher, BSc, MRCS, Department of Surgery and Cancer, 10th Floor QEQM Bldg, St Mary's Hospital, Praed St, London W2 1NY, United Kingdom. E-mail: p.pucher@imperial.ac.uk.

Dr Aggarwal is funded by a Clinician Scientist Award from the National Institute for Health Research, United Kingdom.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.