Facilitator’s Guide

Simulation Learning Objectives

After the simulation exercise, learners will be able to:
 Identify and correct situations in the operating room where setup may put a
surgeon at risk for poor ergonomics
 Demonstrate proper ergonomic posture during open, laparoscopic, and robotic
operative cases.

Patient Scenario for Simulation:

There are three patients the residents will be caring for during your simulation
 One patient just underwent an open inguinal hernia repair. The resident will be
closing his incision at the end of the case.
 One patient has acute cholecystitis. The resident will be performing a
laparoscopic cholecystectomy using the laparoscopic simulator
 One patient has an inguinal hernia. The resident will be repairing his hernia via
the TAPP approach robotically.

Scheduling:
Faculty and Staff Needs:
One faculty facilitator will be present. This faculty member will run the pre-brief and
post-brief sessions and will observe the residents while they complete the three different
operations according to the schedule included below. The residents will be paired, and
therefore will also be observing each other. It is the faculty’s responsibility to be aware
of proper ergonomic postures, common scenarios that put surgeons at risk, and how to
implement changes to help alleviate this risk.

The facilitator will be responsible for reminding the residents when they should be
finishing up the operation and switching roles, as well as observing and providing
feedback to the residents while they operate to help them improve ergonomics.

A staff member from the iExcel team will also need to be present to help groups rotate
between tasks, and to ensure the equipment is set up and ready to go prior to the
simulation.

Overview of Simulation:
There will be 6 residents participating, and they will be paired into three groups of two to
complete the different operations as listed above. This will all take place in a single
room- the iExcel room that includes the laparoscopic trainer and the robotic trainer. The
two briefing sessions will also take place in this room.

After receiving their pre-brief instruction, residents will complete each of the three tasks.
One resident will complete the task and the other will observe. After approximately 10
minutes, the residents will switch roles and repeat the task. For the final 10 minutes, the
residents will discuss their scores and attempt to find ways to improve their posture in
each case. After 30 minutes, each resident pair will switch to the next task and repeat
the process. There will be no time in which the students are not in the simulation or in a
briefing session.

1pm Prebriefing

1:10 Group A: Lap trainer Group B: DaVinci trainer Group C: Suturing skills

1:40 Group C: Lap trainer Group A: DaVinci trainer Group B: Suturing Skills

2:10 Group B: Lap trainer Group C: DaVinci trainer Group A: Suturing skills

2:40 Debriefing

Breakdown of time spent in each 30 minute session:

First 10 min Second 10 min Final 10 min

Resident A Primary surgeon Observer Joint discussion and

practice implementing
Resident B Observer Primary surgeon corrective changes

Equipment
Required Equipment
 Laparoscopic skills trainer (pre-programmed cholecystectomy simulation)
 Davinci Robotic trainer (pre-programmed TAPP simulation)
 OR step stools for each scenario – 2 per station
 Suture (4-0 monocryl if available) - 10
 Simulated skin pad - 1
 Needle driver - 1
 Adsons forceps - 1
 Iris scissors - 1
 Sharps container - 1
Printed Materials
 Rapid Upper Limb Assessment – 3 copies per student + 1 for the facilitator for
reference

Student Preparation Materials:

Residents will have received instruction in ergonomics prior to this simulation, and will
be made familiar with the Rapid Upper Limb Assessment tool including what it is used
for and how to properly assess posture using this tool.

Roles:
 Residents will participate in each role three times throughout this simulation:
o Primary surgeon completing the assigned operation
o Observer and assessor of primary surgeons ergonomics while operating

Observation Checklist
Full checklist in separate Checklist document – See Rapid Upper Limb
Assessment tool

Post-Simulation Reflection Assignment

There will not be a specific post-simulation reflection assignment, however, residents
will be expected to complete reflection discussions with their partner and with the faculty
facilitator multiple times throughout the simulation.

Case-Specific Debrief Questions:

PEARLS or Other Debriefing Tool
PEARLS debriefing will be utilized. Additional questions to discuss with the residents
include:
- Were you surprised by your RULA score?
- Did you agree with your assessment from the observer while you were the lead
surgeon?
- What are some of the most helpful strategies that you found to improve
ergonomics while operating?
- Do you forsee any barriers to implementing these strategies in real life in the
operating room?
- If so, how might we work to overcome these barriers?