Validation of the Simulated Ward Environment for Assessment of Ward-Based Surgical Care

Objective: To 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). Background: Increasing 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. Methods: A 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. Results: Nine 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. Conclusions: A high-fidelity, immersive, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.