Medical Simulation Best Practices From 8 Years of American College of Surgeons Accredited Education Institutes

Medical simulation best-practices from 8 years of the American College of Surgeons’ (ACS) Accredited Education Institutes (AEI) are now available for the global clinical simulation community thanks to the new Elsevier published article “Overarching themes from ACS-AEI accreditation survey best practices 2011–2019” (Cooke et al.). Here today, Dr. James Cooke, MD, Executive Director of the Clinical Simulation Center within the Department of Family Medicine at the University of Michigan Medical School submitted this recap of the article and to share more about the power behind the ACS Accredited Education Institutes.

The American College of Surgeons launched the Accredited Education Institutes (AEIs) program in 2005 to create a network of simulation centers to offer the highest-quality surgical education and training. The ACS-AEIs was also launched to provide and pursue cutting-edge scholarship opportunities.

The program’s specific standards and criteria were developed to accredit simulation centers and decisions made based on the application, site surveyor visit, and ACS-AEI Accreditation Committee review. In addition to granting accreditation and providing recommendations for improvement, site surveyors and the accreditation committee together identify best practices defined as either areas far exceeding the accreditation standards or novel methods of advancing high-quality, impactful education.


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Best practices were compiled into a list beginning in 2011 for dissemination to all members of the ACS-AEI Consortium. This list was then distributed through on-line videos, newsletters, and workshops at the Annual ACS Surgical Simulation Summit. Using thematic analysis, the authors who conducted the research classified common themes from the 337 best practices identified during 247 accreditation reviews between June 2011 and June 2019.

During this process, two of the authors reviewed the reports of the site reviewers for best practices identified during site reviews. Using inductive category development, a commonly employed method in social science, the same two authors independently extracted and coded data, then counted frequencies. Next they grouped the frequencies into meaningful categories or clusters and interpreted them into overarching themes. The two authors then generated codes from the native text and independently coded the data for subthemes. They counted frequencies of themes and subthemes and recorded them individually for theme prioritization. Coding or thematic discrepancies were discussed, reaching agreement through consensus between the two reviewers and a third author (DMR) using standardized methodology similar to that used by the Accreditation Council for Graduate Medical Education

Codes, categories, frequencies, and overarching themes were then reviewed by all authors, and themes were refined and ranked by a follow-up independent survey to ensure quality and rigor of the analysis. The authors behind this research include James Cooke, MD, Alexis Thomas-Perez, Deborah Rooney, PhD, Catherine Sormalis, BS, Robery Rege, MD, and Ajit K. Sachdeva, MD.

Within the research, the authors discussed themes in the context of their practical relevance and highlighted strategies used at different centers. The authors place an emphasis on the importance of each theme in developing a successful simulation program. They all reviewed best practice themes and subthemes and provided reflections on context, applications, and recommendations for simulation programs. Methodology and reporting structure were consistent with other work on theme development from accreditation data.


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All authors reviewed best practice themes and subthemes and provided reflections on context, applications, and recommendations for simulation programs. As best practices were extracted, they compiled them into a single database with eight overarching themes identified. These themes included approaches to faculty development, scholarly activity, development of curricula, use of resources, delivery of educational content, assessment of learners, and collaboration between centers.

Through the examination of these research results, the benefits of data-gathering surrounding accreditation site visits have begun to bear fruit with common themes emerging from hundreds of reviews. These themes can be used to inform the community on lessons learned from the myriad of operational and educational experiments conducted in and around simulation centers and to further best practices within the ASC-AEI Consortium. Ongoing data collection, analysis, and discussion will serve to further refine these themes and advance simulation-based education.

More About the American College of Surgeons Accredited Education Institutes

The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. The American College of Surgeons Accredited Education Institutes (AEI) is a consortium of comprehensive and focused accredited education institutes. It offers global opportunities for collaboration, research, and access to resources from fellow Institutes and the ACS Division of Education.

Within the college, the consortium of comprehensive and focused accredited education institutes is an academic resource that educates and trains practicing surgeons, surgical residents, trainees, and members of a surgical team using simulation-based learning. The work of the consortium is supported by 12 volunteer committees (Administration and Management, Curriculum, Dissemination of Educational Resources for AEIs, Faculty Development, Fellowship, International, Patient Education, Program and Review, Research and Development, Revisions, Technologies and Simulation, and Virtual Grand Rounds), all of which provide resources and education to consortium institutes.

The ACS-AEI sets standards for how surgical education and training should be offered at Accredited Education Institutes. The fellowship program’s goal is to promote patient safety through the use of simulation, to develop new education and technologies, identify best practices, and promote research and collaboration among the American College of Surgeons’ institutes.

The fellowship further evaluates the impact of education through long-term follow-up of learners and analyzes how to best incorporate aspects of surgical research into surgical education. Professionals and learners can take advantage of ACS-AEI benefits this program by applying for accreditation. Benefits include the ability to collaborate, network, and share best practices with sim centers that are at the forefront of simulation-based surgical education and training.

Other benefits of ACS-AEI accreditation include being able to interact with colleagues worldwide on the AEI Community and being able to post questions or pursue research. Members can additionally seek support for the delivery of their education and training programs. They can follow the ACS-AEI roadmap to building a strong surgical simulation program based on national standards and accreditation requirements as well.

Learn More About the ACS Accredited Education Institutes


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