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Journal Information
Vol. 96. Issue 5.
Pages 313-314 (May 2018)
Letter to the Editor
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Simulation as a Surgical Teaching Model
La simulación como modelo de enseñanza en cirugía
Dieter Morales-Garcíaa,e,f,
Corresponding author

Corresponding author.
, Jose Antonio Alcazar-Monterob,e, Mercedes Sanz-Sanchezc,e, Jose María Miguelena-Bobadillad,e
a Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
b Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca, Salamanca, Spain
c Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
e Sección de Formación Posgraduada, Asociación Española de Cirujanos (AEC), Spain
f Instrucción en Simulación Clínica por el Center for Medical Simulation, Massachusetts, USA
Related content
Cir Esp. 2018;96:12-710.1016/j.cireng.2017.09.011
José Luis Ruiz-Gómez, José Ignacio Martín-Parra, Mónica González-Noriega, Carlos Godofredo Redondo-Figuero, José Carlos Manuel-Palazuelos
Article information
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Dear Editor,

We have read with interest the article published by Ruiz-Gómez et al.,1 “Simulation as a Surgical Teaching Model”. We would like to congratulate the authors for its content and share our reflections on this topic in a constructive manner.

The article reiterates the known advantages and philosophy of teaching through clinical simulation,2 which is of great interest for teaching in a safe environment and due to the fundamental role that simulation can play in the training of surgeons. However, there is also the need for adequate and structured training of instructors in simulation, and it is in this aspect where we would like to contribute a series of considerations that were not discussed in the article and which we think are necessary for the success of this type of teaching.

We are referring to the importance of “teaching the teachers” and the certification of hospitals and individuals to provide this type of teaching.3 It is clear that the Ruiz-Gómez et al. group and the hospital where they teach by simulation, the Hospital Virtual Valdecilla (www.hvvaldecilla.es), certified by the American College of Surgeons, are an example of this type of teaching. The issue is that we are witnessing a generalized use of clinical simulation as a teaching tool in which a large number of professionals are involved, but this development has not been complemented by parallel developments in formal training in medical education. Therefore, the increased use of new technologies is giving rise to the paradoxical situation in which there are many professionals with experience in training surgeons yet no experience in research techniques in education or methods of analysis and evaluation.4 It is here where we think the Postgraduate Training Division of the Spanish Association of Surgeons (AEC) should become involved if we want this teaching model to be fully integrated into the training program of our residents as a method for skill acquisition. References about the best way to promote educators specialized in simulation are scarce, even though there are defined standards for how to develop a curriculum for developing skills through simulation.4,5 Some of the solutions that we propose from the Division, which coincide with the suggestions of other authors, would be the implementation of continuous professional development programs, competitive funding through grants for research projects in medical education, qualitative data analysis,4 specialized in-person or on-line workshops, and the creation of fellowship programs for educators in clinical simulation.5

Thus, we believe that it is necessary to promote proper training for educators, who in turn will be able to develop skill training programs, and as a result teaching by simulation will be more effective.


The authors would like to acknowledge the board members of the Postgraduate Training Division of the AEC.

J.L. Ruiz-Gomez, J.I. Martín-Parra, M. Gonzalez-Noriega, C.G. Redondo-Figuero, J.C. Manuel-Palazuelos.
La simulación como modelo de enseñanza en cirugía.
D. Gaba.
Patient Simulation Center of Innovation at VA Palo Alto health care system, center for immersive and simulation-based learning Stanford University, Anesthesia Service.
Acad Emerg Med, 11 (2004), pp. 931-937
D. Morales-García.
Clinical simulation in the surgical training in the XXI century.
R. Phitayakorn, A. Salles, J.L. Falcone, A.R. Jensen, S. Steinemann, L. Torbeck.
A needs assessment of education research topics among surgical educators in the United States.
Am J Surg, 213 (2017), pp. 346-352
E.I. Opazo, E. Rojo, J.M. Maestre.
Modalidades de formación de instructores en simulación clínica: el papel de una estancia o pasantía.
Educ Med, 18 (2017), pp. 22-24

Please cite this article as: Morales-García D, Alcazar-Montero JA, Sanz-Sanchez M, Miguelena-Bobadilla JM. La simulación como modelo de enseñanza en cirugía. Cir Esp. 2018;96:313–314.

Copyright © 2018. AEC
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