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Leading in Surgical Simulation and Education: Eileen Smith, MD

Inaugural Simulation and Education Fellow Eileen Smith, MD, presents research at Surgical Simulation Summit.

Surgical education has undergone a paradigm shift in recent years. Previously, surgical trainees across the country learned mostly by observing and performing surgery in the operating room. Most of what a trainee learned was dependent on the cases they saw during their years of residency and fellowship training. Today, surgical training at Washington University School of Medicine in St. Louis is more intentional, with residents first learning surgical techniques in a simulation center, where they can practice in labs and on simulated models. Trainees then take the skills they have developed in a simulated environment and employ them in the operating room.

The Washington University Institute for Surgical Education (WISE) Center is an American College of Surgeons (ACS) Accredited Education Institute (AEI) at the forefront of this paradigm shift, offering a broad curriculum in endoscopic, laparoscopic and robotic simulation, training in surgical techniques and instrumentation, and other forms of instruction.

In 2018, the WISE Center established an ACS-AEI accredited simulation and education fellowship. This fellowship is designed to develop future leaders and scholars in the area of surgical education, simulation and training. Residents have the opportunity to spend their lab years focused on simulation and education in a structured academic surgery program. The WISE Center at Washington University is one of a select few institutes in the United States accredited by the ACS-AEI.

The inaugural fellow, Eileen Smith, MD, completed her fellowship this year. During the fellowship, Smith conducted education-related research and helped design and execute curriculum for resident education in the WISE Center. One area of Smith’s research focused on preparing trainees for emergencies in robotic surgery.

In rare cases, robotic surgical procedures might require emergency undocking. During robotic procedures, junior surgical residents often serve as the bedside assistant, meaning the resident would be in a position to initiate emergency undocking. Smith and a team of researchers at the WISE Center designed a new curriculum to train junior residents in undocking the surgical robot in case of emergency.

“We wanted to leverage the power of simulation to better prepare our residents for the rare event of surgical emergencies in robotic operations,” Smith, a general surgery resident at the School of Medicine, says.

Smith presented her research at the 2021 ACS Surgical Simulation Summit this March. Smith was one of 10 presenters, and the only ACS-AEI fellow to present research at the virtual event. Her presentation, titled “Minding the Robotics Gap: A New Curriculum to Equip Surgical Trainees for Emergencies in Robotic Surgery,” reported the findings of a research project Smith led during her fellowship with WISE.

Residents in the study participated in a robotic lab session led by faculty with robotic surgery expertise, completed pre- and post-tests to demonstrate their knowledge, and underwent a follow-up interview one year after completing the curriculum to assess skills retention and confidence in their ability to perform emergency undocking.

Training significantly decreased the time it took residents to emergency undock, the study found. The skills lab resulted in improved ability to complete all essential skills in the rare instances of emergency undocking. In the follow-up interview, residents demonstrated that they retained their understanding of the procedure.

“We are incredibly proud of Eileen, as our inaugural fellow,” says WISE Center Director Michael Awad, MD, PhD. Awad, who is a distinguished educator and minimally invasive surgeon at the School of Medicine, was inducted to the ACS Academy of Master Surgeon Educators in 2020. “Education is now a recognized discipline in surgery. New ways of teaching with simulation excite me. Eileen’s research is a perfect example of this new wave of innovation in surgical education.”

Smith has since returned to her clinical work in the general surgery residency, and she hopes to pursue a career in acute care surgery following her training.