A Partnership in Surgical Simulation

Michal Kozanek (foreground at right) practices his suturing skills as Lauren Ehrlichman (standing at left), David Lhowe and Samantha Chase watch and advise.

Twelve second-year Orthopedic Surgery residents rolled up their sleeves and picked up power drills and saws. They weren't building houses as part of a community volunteer event; they were participating in the first annual surgical boot camp, a collaboration among the Harvard Orthopedic Trauma Service, Harvard Combined Orthopaedic Residency (HCORP) and the Neil and Elise Wallace STRATUS Center for Medical Simulation at BWH.

The day-long boot camp held last summer was divided into two parts-a soft tissue lab and bone model lab-and featured short faculty lectures followed by hands-on skill sessions. Residents tied off blood vessels, placed pins into a model femur and cut bone with a saw in the STRATUS Center, which is open to any group for training, and was the site of a recent BWH study that showed the life-saving benefits of using checklists in surgical settings. (The results of the study, led by Atul Gawande, MD, MPH, were published in the New England Journal of Medicine this month.)

"I knew the boot camp would be a worthwhile experience, but I had no idea how hands-on and helpful it would be to us," said second-year Orthopedics resident Lauren Ehrlichman, MD. "We were all so happy and excited by what we were doing and came away with a standardized set of basic skills that we could add to our toolbox."

From left: Michal Kozanek, Samantha Chase and Mike Weaver look on as Lauren Ehrlichman (right) places pins in a model femur.

Medical device manufacturer Synthes donated equipment for the training, and participating Harvard Orthopaedic faculty members included Jeremy Smith, MD; HCORP Director George Dyer, MD; and Mark Vrahas, MD, Partners chief of Orthopedic Trauma Services. Partners Orthopaedic Trauma faculty members Michael Weaver, MD, and David Lhowe, MD, also lent their expertise.

The day culminated in repairing a simulated fracture, which residents performed in groups of three, asking one another questions and sharing insights garnered from the day.

"This boot camp provides an opportunity for a safe environment where the focus is education and faculty are there for support," said Michael Weaver, MD, course director for the program. "Residents have the time and opportunity to focus on specific skills, as well as the chance to make mistakes and learn how to fix them."

Weaver says that residents were traditionally first exposed to the skill sets needed in the OR by observing physicians, but this model has shifted, especially here at BWH with the resource of the STRATUS Center, led by Medical Director Charles Pozner, MD.

"Simulation provides the opportunity to learn a skill, while the OR provides the opportunity to hone that skill," he said. "Not many programs around the country are offering orthopedic simulation, but here it's at the forefront. STRATUS realizes that this is the future."

The boot camp currently serves as an introduction to orthopedics and orthopedic surgery techniques. In addition to offering the program every summer, the goal is to lengthen the course and expand it to include more skills and specialties. 

"We had unbelievably positive feedback," said Weaver. "The residents are extremely motivated learners, and the faculty is really interested in teaching. They were excited to work in a setting with residents that was free of the pressures of normal practice. We'd like to incorporate more of these courses into our curriculum during the year. I think the success of the program really came from the collaboration."

Added Ehrlichman: "The number one thing the boot camp has given my colleagues and me is confidence-confidence that we know how to use the instruments, as well as the basic concepts of repairing a fracture, tying off a bleeding vessel, etc. The amount of progress we were able to make in one day was really amazing."

Second-year Orthopedic Surgery residents (pictured above with faculty mentors) practiced basic surgery skills and concepts during a day-long STRATUS boot camp.