Benefits and barriers to using a portable thoracoscopic esophageal atresia simulator as perceived by surgical trainees.

Introduction: Simulation-based education (SBE) offers a controlled training environment for complex procedures, such as thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula (EA/TEF). Identifying and overcoming the barriers to SBE is imperative for surgical training programs to be effective and efficient. This study investigated surgical trainees' attitudes to a portable thoracoscopic EA/TEF simulator and changes in the perceptions of surgical trainees following its use as a measure of its benefits and possible barriers for learning.

Methods: Twenty New Zealand surgical trainees across both Paediatric Surgery and General Surgery, completed a pre- and post-simulation survey assessing their attitudes and perceptions toward the thoracoscopic simulator. Content manifest analysis was performed to identify trainee-perceived barriers and benefits to the use of the simulator model.

Results: Trainees expressed positive attitudes toward the simulator, with the most common identified benefits being "increased expertise and confidence" and "time for practice". However, despite this, actual hours of simulator use was lower than predicted, with the majority of trainees spending less than one hour per week on the simulator. Barriers identified by trainees included "access to equipment" and "time and motivation" although these decreased significantly in the post-simulation survey.

Conclusions: The portable thoracoscopic EA/TEF simulator was supported by trainees as being a valuable tool for surgical education, in this case, of acquiring technical skills for a challenging neonatal surgical procedure. There were significant reductions observed in trainee-perceived barriers to SBE after use of the simulator although further efforts are required to translate this into increased actualised hours of use.