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Letters to the Editor

Do-It-Yourself Surgical Simulation Kits: One Academic Medical Center’s Response to the COVID-19 Pandemic in Malaysia

Nah, Shireen A MBBS, MRCS, MSurg; Singaravel, Srihari MBBS, MPaedSurg; Sanmugam, Anand MD, MPaedSurg

Author Information
doi: 10.1097/ACM.0000000000003786
  • Free

To the Editor:

The rapidly evolving nature of the COVID-19 pandemic has negatively impacted surgical training by reducing trainees’ operative exposure and curtailing traditional teaching methods. At the University of Malaya, we used easily available materials to construct do-it-yourself (DIY) training and evaluation surgical skill simulation models during a federally mandated lockdown. This effort was spurred by the following:

  • Our historical reliance on hands-on operative exposure as a key part of training meant that we did not have simulation sets/modules readily available on site.
  • Ofsfices of device companies that would typically provide training models were closed, and their staff were working from home.
  • The sudden nature of the lockdown in tandem with rapid hospital-level changes meant that we did not have time to prepare by bringing in simulation models.

Forced to think on our feet, we devised DIY simulation models using the following materials obtained from hardware shops, which were allowed to remain open during the lockdown:

  • Foam mat with silver foil covering
  • Child-safety corner and edge protector foam
  • Plywood cut to 12 inches × 12 inches (edges sanded using an angle grinder)
    • – Covered with clingwrap/cellophane tape to allow reuse
    • – Rubberized nonslip surface
  • Plastic water bottles
  • Nails
  • Wall cable organizer
  • Wall hanger
  • Felt cloth
  • Gloves (nonsterile)
  • Expired sutures

The average cost of materials per set was 35 Malaysian ringgit (approximately $10).

Using these materials, we crafted models for practice of the following skills:

  • Hand-tying at surface and in depth, ligation of the base of a pedicle
  • Basic running instrument suture and instrument ties
  • Bowel anastomosis (with simulation of anatomy of third part of duodenum)
  • Vascular anastomosis (with simulation of a vein)

We created vignettes to provide context for each task to assess the trainees’ understanding of types of suture materials required, choice of needles, and understanding of anatomical structures and tissues at risk. For work simulating bowel and vascular anastomosis, trainees were required to use magnifying loupes, as they would for live surgery. Two sessions were held—one for training (pitched according to trainee seniority) and one for evaluation (convened 10 days after training to allow practice).

We believe these practical suggestions would be easy for others to implement in settings similar to ours. Even programs in resource-abundant settings may find our ideas useful as they may have to deal with diversion of funds to support COVID-19 initiatives.

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