• Philip H Pucher, Rajesh Aggarwal, Tharanny Srisatkunam, and Ara Darzi.
• *Division of Surgery, Department of Surgery and Cancer; and †Faculty of Medicine, Imperial College London, London, United Kingdom.
• Ann. Surg.. 2014 Feb 1;259(2):215-21.

ObjectiveTo assess the feasibility of developing a simulated ward environment in which to assess the ward-based care of surgical patients by clinicians of varying levels of experience (construct validation).BackgroundIncreasing evidence points to the importance of the postoperative or ward-based phase of surgical care in determining patient outcomes. Ward-based care is determined by the clinician ward round, with the simulated ward environment potentially providing a safe environment for training and assessment.MethodsA high-fidelity surgical ward environment was developed. Junior and senior trainees conducted ward rounds of 3 standardized surgical patients and were assessed using a checklist of assessment and management care processes, modified NOTECHS score, and fidelity questionnaire.ResultsNine senior and 9 junior trainees were observed. There was no significant difference in time taken to conduct the round (37.6 ± 2.7 vs 32.6 ± 1.9 minutes, P = 0.16). Senior trainees performed significantly more assessment processes (73% ± 2.8% vs 63% ± 2.5%, P = 0.016) and completed more management tasks (73% ± 4.5% vs 59.4% ± 5%, P = 0.058). Fifteen adverse events were committed by junior trainees versus 8 by seniors (P < 0.001). Seniors scored higher on nontechnical ability (NOTECHS score 21.8 ± 0.61 vs 18.1 ± 1.12, P = 0.017). All of subjects felt the ward, patients, and scenarios were realistic.ConclusionsA high-fidelity, immersive, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.

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