Advancing practical skills and improving confidence in high-acuity, low-occurrence operative trauma using high-fidelity operative simulation.

Abstract

Background: Advancing endovascular approaches and subspecialty vascular care have significantly diminished general surgery residents' exposure to essential trauma techniques, creating a preparedness gap among graduates managing basic trauma emergencies. The Open Surgical Simulation System is a high-fidelity trauma surgery model enabling skill acquisition through hands-on practice. This study evaluates the outcomes of our curriculum development process and its impact on training outcomes.

Methods: A longitudinal analysis of Open Surgical Simulation System simulation training was conducted from 2020 to 2026, encompassing multiple iterations of curriculum refinement based on continuous evaluation and feedback. The curriculum incorporated Kern-guided improvements in instructional design, implementation, and evaluation throughout the study period. Training outcomes were assessed using presimulation and postsimulation surveys with 5-point Likert scales measuring self-assessed knowledge, technical skills, and confidence across 6 procedures: resuscitative thoracotomy, exploratory laparotomy, splenectomy, hepatorrhaphy, small bowel resection, and retroperitoneal exploration. Paired t tests evaluated presimulation to postsimulation improvements across the full development period.

Results: A total of 456 training events were conducted during the curriculum development period, of which 364 included complete paired pretraining and post-training assessments for analysis. The Open Surgical Simulation System curriculum consistently demonstrated significant improvements in confidence scores across all evaluated procedures (P < .001). Prior completion of Advanced Trauma Operative Management or Advanced Surgical Skills for Exposure in Trauma courses did not affect baseline confidence levels, and meaningful gains were observed across all trauma procedures.

Conclusion: Systematic development of the Open Surgical Simulation System curriculum using Kern's model enabled iterative curriculum refinement and successful geographic expansion while maintaining positive training outcomes. This simulation-based approach improved resident self-reported confidence across trauma procedures and supports the value of iterative curriculum development in addressing documented gaps in trauma surgery training.