03062nas a2200313   4500000000100000008004100001260003700042653002400079653005700103653004100160653002400201100001300225700001300238700001600251700001300267700001200280700001400292700001600306700001700322700001500339700001500354700001400369245014100383856009900524300000900623490000700632520209500639022001402734       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10atrachomatous trichiasis (TT) surgery10asurgical simulation1 aGower EW1 aKello AB1 aKollmann KM1 aMerbs SL1 aSisay A1 aTadesse D1 aAlemayehu W1 aPedlingham N1 aDykstra RS1 aJohnson JE1 aVinetz JM00aThe impact of incorporating surgical simulation into trichiasis surgery training on operative aspects of initial live-training surgeries  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011125&type=printable  a1-110 v173 a<p><strong>Background:</strong> While surgical simulation is regularly used in surgical training in high-income country settings, it is uncommon in low- and middle-income countries, particularly for surgical training that primarily occurs in rural areas. We designed and evaluated a novel surgical simulator for improving trachomatous trichiasis (TT) surgery training, given that trichiasis is mostly found among the poorest individuals in rural areas.</p>

<p><strong>Methodology/Principal findings:</strong> TT surgery programs were invited to incorporate surgical simulation with a new, high fidelity, low-cost simulator into their training. Trainees completed standard TT-surgery training following World Health Organization guidelines. A subset of trainees received three hours of supplemental training with the simulator between classroom and live-surgery training. We recorded the time required to complete each surgery and the number of times the trainer intervened to correct surgical steps. Participants completed questionnaires regarding their perceptions. We also assessed trainer and trainee perceptions of surgical simulation training as part of trichiasis surgery training.</p>

<p>22 surgeons completed standard training and 26 completed standard training plus simulation. We observed 1,394 live-training surgeries. Average time to first live-training surgery completion was nearly 20% shorter the simulation versus the standard group (vs 34.4 minutes; p = 0.02). Trainers intervened significantly fewer times during initial live-training surgeries in the simulation group (2.7 vs. 4.8; p = 0.005). All trainers indicated the simulator significantly improved training by allowing trainees to practice safely and to identify problem areas before performing live-training surgeries. Trainees reported that simulation practice improved their confidence and skills prior to performing live-training surgeries.</p>

<p><strong>Conclusions:</strong> A single high-fidelity surgical simulation session can significantly improve critical aspects of initial TT surgeries.</p>
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