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While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various "willingness-to-pay" values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

Directed self-guidance, whereby trainees independently practice a skill-set in a structured setting, may be an effective technique for novice training. Currently, however, most evaluation methods require an expert to be present during practice. The study aim was to determine if absolute symmetry error, a clinically important measure that can be assessed by the trainee, is a feasible assessment tool for self-guided learning of suturing skill. Forty-eight undergraduate medical trainees independently practiced suturing and knot tying skills using a benchtop model. Performance on a pretest, posttest, retention test and a transfer test was assessed using (1) the validated final product analysis (FPA), (2) the surgical efficiency score (SES), a combination of the FPA and hand motion analysis and (3) absolute symmetry error, a new measure that assesses the symmetry of the final product. Absolute symmetry error, along with the other objective assessment tools, detected improvements in performance from pretest to posttest (P less than 0.05). A battery of correlation analyses indicated that absolute symmetry error correlates moderately with the FPA and SES. The development of valid, reliable and feasible technical skill assessments is needed to ensure all training centers evaluate trainee performance in a standardized fashion. Measures that do not require the use of experts or computers have potential for widespread use. We suggest that absolute symmetry error is a useful approximation of novices' suturing and knot tying performance. Future research should evaluate whether absolute symmetry error can enhance learning when used as a source of feedback during self-guided practice.

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost ( p < 0.001) whereas the high-fidelity program had the highest implementation cost ( p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators). [ABSTRACT FROM AUTHOR]

This study examined the validity of tensiometry as an objective method of assessing the improvements in the quality of knots and technical performance due to practice on suturing and knot-tying skills. We evaluated the quality of 1,830 knots produced by undergraduate medical students before training (pre-test), after (post-test), and after a week retention (retention-test) using tensiometry. These results were compared to expert-based assessments of products and performance. Tensiometry, as well as expert-based assessments can detect changes in the quality of knots and technical performance from pre to post and retention-test ( p<0.05). However, these three methods may assess different dimensions of the same products and actions. The development of trainee evaluation criteria for the acquisition of surgical skills is a crucial element in surgical education. Based on our patterns of results it is hypothesized that tensiometry can serve as an economic first approximation of the quality of knots and suturing performance. [ABSTRACT FROM AUTHOR]