Otolaryngology is a highly technical specialty, with otolaryngologists required to rapidly develop to a high standard, and maintain, a wide variety of skillsets. To become proficient at performing endoscopic sinus surgery, for example, a procedure performed over 400,000 times per annum in the United States, surgeons must apply visuospatial anatomical knowledge, scientifically literate pathological principles, and refined endoscopic and surgical ability all within a high-pressure environment – the operating theatre. This requires many hours of deliberate practice, knowledge enhancement, and clinical exposure.
Traditionally, surgical education has been delivered with a mixture of apprenticeship-style training interspersed with traditional didactic teaching and lecturing. However, several factors have recently led to a paradigm shift. There are increasing societal pressures to deliver demonstrably consistent, high-quality surgical training, focusing on patient safety and efficiency. Nevertheless, restrictions on working hours of higher surgical trainees, such as the European Working Time Directive, have led to a net reduction in total training time. Also, as the total societal cost of providing healthcare increases, there is a renewed focus on ensuring every aspect of surgical training provides value for money and a change of expectations regarding patient safety, with a specific focus on reducing preventable patient harm.
Consequently, surgical training is rapidly becoming increasingly competency-based, with an objective and outcomes-based curriculum design and assessments to provide training bodies and broader society with reproducible evidence of surgical competence. Therefore, there has been an interest in simulation as a method of augmenting these traditional training programs to allow for greater efficacy and standardization of skill acquisition, and thus to putatively increase patient safety.
Simulation-based medical education (SBME) exposes trainees to clinical scenarios in an educational environment to allow for deliberate practice with no risk to patients. These scenarios can vary in their scope and fidelity, from polytrauma disaster response scenarios involving large numbers of simulated patients, faculty, and learners, to inexpensive, low-fidelity tonsil tie simulators utilized by a single learner and trainer. A cornerstone of SBME is the concept of deliberate practice (DP). DP is a set of educational principles that highlights the importance of well-defined learning objectives, focused and repetitive observed practice, and informative feedback in the form of educationally focused debriefing. A meta-analysis of studies comparing SBME with DP to traditional educational methodology demonstrated that SBME with DP is superior for acquiring specific, measurable skills. The apprenticeship model of training can lack standardization, uniformity, and objectivity. SBME can enhance the field of otolaryngology with curriculum-based, standardized, and reproducible training and assessment.