• Patricia A Pentiak, Diane Schuch-Miller, Ronald T Streetman, Kimberly Marik, Rose E Callahan, Graham Long, and James Robbins.
• Surgical Learning Center, William Beaumont Hospital, Royal Oak, MI 48073, USA. patricia.pentiak@beaumont.edu
• Surgery. 2013 Jul 1;154(1):23-8.

BackgroundThe American College of Surgeons (ACS) and the Association of Program Directors in Surgery (APDS) jointly developed a standardized skills curriculum for surgical residents. This program was intended to be affordable, reproducible, reliable, and proficiency-based. Some experts have proposed mandating that all residency programs implement the curriculum. Although general surgery program directors have supported uniformly the use of simulation in training, one third of general surgery residencies have no simulation curricula. Our goal was to identify barriers to the implementation of the ACS/APDS curriculum.MethodsThe ACS/APDS skills curriculum was analyzed on the basis of the ACS website. All materials listed in each module in all 3 phases were tabulated. Supply costs per resident were calculated along with the time requirements for each.ResultsThe approximate cost per resident for supplies to complete the entire ACS/APDS skills curriculum exceeds $30,000. The initial cost for the development of our surgery learning center was $4.5 million. Capital equipment and instruments were an additional cost. Time to complete the program was 90 h for each resident, with additional time commitments by surgery faculty, simulation center staff, educational development staff, and veterinary staff. Simulation staffing costs were $22,107.ConclusionThe ACS/APDS skills curriculum has a substantial resource commitment associated with its implementation. These capital, instrument, and personnel costs present a major challenge to residency programs that want to adopt this program. Faculty participation in the program poses an additional logistic challenge. Last, resident involvement must be scheduled within the 80-h work-week limit, impacting resident availability for their obligations of patient care. Re-examination of the scope and complexity appears warranted, along with development of low-fidelity substitutions for the proposed modules as well as opportunities for resource-sharing.Copyright © 2013 Mosby, Inc. All rights reserved.

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