Simulating Surgical Skills in Animals: Systematic Review, Costs & Acceptance Analyses

Abstract

Background: Modern surgery demands high-quality and reproducibility. Due to new working directives, resident duty hours have been restricted and evidence exists that pure on-the-job training provides insufficient exposure. We hypothesize that supplemental simulations in animal models provide a realistic training to augment clinical experiences. This study reviews surgical training models, their costs and survey results illustrating academic acceptance. Methods: Animal models were identified by literature research. Costs were analyzed from multiple German and Austrian training programs. A survey on their acceptance was conducted among faculty and medical students. Results: 915 articles were analyzed, thereof 91 studies described in-vivo animal training models, predominantly for laparoscopy (30%) and microsurgery (24%). Cost-analysis revealed single-training costs between 307€ and 5,861€ depending on model and discipline. Survey results illustrated that 69% of the participants had no experience, but 66% would attend training under experienced supervision. Perceived public acceptance was rated intermediate by medical staff and students (4.26; 1-low, 10 high). Conclusion: Training in animals is well-established and was rated worth attending in a majority of a representative cohort to acquire key surgical skills, in light of reduced clinical exposure. Animal models may therefore supplement the training of tomorrow's surgeons to overcome limited hands-on experience until virtual simulations can provide such educational tools.

Keywords: animal model; cost analysis; surgical education; surgical training; survey.

Figure 1

Flowchart. The study selection process is visualized in this Figure, as recommended by the PRISMA guidelines.

Figure 2

Date of included publications. The number of publications identified in this analysis, increased from 2000 to 2020. The decline in 2019–2020 is most likely due to only including the first three months of 2020.

Figure 3

Analyses of the included publications. (Top Left) Surgical specialty that was simulated. (Top Right) Surgical skill that was trained (Please note that for reasons of clarification, laparoscopic surgery was not included into endoscopic surgery.) (Bottom Left) The origin of the included publications was identified by first and last authorship. (Bottom Right) The type of animal models used for simulation.

Figure 4

Survey results on academic acceptance toward animal models in surgical training. (Left) Details of the participants. (Middle) Number of participants with experience with animal models. (Right) Opinions toward participating an animal training model for surgery.