Accreditation by the American College of Surgeons as an Accredited Education Institute and the acquisition of a new surgical skills simulator signify that KU School of Medicine-Wichita's commitment to simulation training has never been greater.

Ascension Via Christi purchased the simulator for KU Wichita's surgical skills lab, which is located on the third floor of Ascension Via Christi St. Francis.

"The hospital was really gracious in funding it for us," said Marilee McBoyle, M.D., who is the lab's surgical director. "It really upgraded that aspect of the skills lab."

The lab, located near the hospital's operating rooms, is used by surgery residents and medical students to enhance technical skills. Labs involve suturing (both traditional and laparoscopic), knot tying, interpreting X-rays, emergent chest procedures, vascular anastomosis, breast procedures with sonographic and mammographic interpretation, colonoscopy, and bowel anastomosis. The surgical simulator enhances aspects of suturing and surgical procedures, including hernia repair, cholecystectomy and colon resection.

"It's doing things that really mirror the real thing," McBoyle said. "But not with the dire consequences if something goes awry."

Occasionally, a surgeon will use the lab to practice a new technique.

Currently, the new simulator is being used by residents on their own. John L. Smith, M.D., clinical professor at KU Wichita and the lab's education director, is developing a curriculum that will enhance the structure of the sessions.

That curriculum will have two chief goals, Smith said. The first is to advance a resident's primary skills prior to the time a patient is encountered in the operating room. The second is to prepare the resident to pass the Fundamental of Laparoscopic Surgery examination, which is required for the trainee to sit for the American Board of Surgery Examinations.

McBoyle credits Alex Ammar, M.D., a vascular surgeon and chair of KU Wichita's Department of Surgery since 1998, with putting her in touch with Todd Conklin, then COO at Ascension Via Christi, regarding the need for a simulator.

The current COO, Kevin Strecker, said Wichita is "blessed to have a wealth of surgical talent and expertise, making it possible for patients throughout Kansas to access specialized care in the best possible place - close to home and family. Our purchase of the surgical simulator was an investment designed to ensure that we continue to have that same level of top-notch surgeons for years to come."

It replaces an older simulator that McBoyle said "was great, but it was nine years old. The other one had served its purpose, but it was wearing out. This is really a tremendous upgrade."

The skills lab was started about 13 years ago to make surgical education and skills training more efficient. There are 30 residents in the surgery program at any one time. The 800-square-foot lab can easily accommodate about a half-dozen learners at a time, although when certain simulations are underway - like placing an aortic valve in a pig's heart - "we probably have 18 learners involved," McBoyle said.

Almost two years ago, the surgical residency began the process of seeking accreditation for its skills lab from the American College of Surgeons. The exhaustive process for accreditation, which was completed in June 2019, extended for 18 months. "We received the exciting notice of our successful accreditation in June just before the arrival of the new simulator," McBoyle said. The new training tool "really shows we're on track with the American College of Surgeons. We're trying to raise the standard high for simulation."

The accreditation process requires applicants to meet exhaustive criteria. According to the ACS, the Wichita skills lab is one of 11 with its type of focused level accreditation. The accreditation is good for five years, with compliance reports due to the ACS annually.

"It wasn't a small task," McBoyle said of accreditation. "We worked for it for well over a year, then had a site visit in February 2019. What's the benefit of that? Well, when you have an accreditation, it raises the bar of excellence."

One benefit of the accreditation process, McBoyle said, was the formation of a steering committee of surgeons who teach skills sessions. "Having that committee and meeting about every other month really solidified the need for raising the bar on skills sessions."

Another was that it led to working with Wichita State University Tech, which recently moved facilities for training surgical technicians to the former Airbus building in Old Town. "They have beautiful operating rooms in that complex," McBoyle said. "Our medical students and residents have the opportunity to participate in simulation sessions with the surgical tech students."

"It's another example that by working on accreditation one starts to see opportunities that are very close at hand. I believe it demonstrated to the ACS accreditation team that we were reaching beyond our own walls."

As for a new simulator, Brad Rukes, development director for KU Wichita, said it's part of a larger goal of using simulators in many areas of medical training, not just surgery.

"Our overall goal is to improve medical simulation in the city," he said. That's where everything is pointing to."

"It's a burgeoning field," Rukes added. "Simulation is relatively new."

Not surprisingly, considering his job, Rukes is already trying to raise money for another simulator. It is called the GI Mentor and it would allow residents to better prepare for the GAGES exam (Global Assessment of Gastrointestinal Endoscopic Skills), which tests upper and lower endoscopy performance and must be successfully passed prior to completing residency. "We have some money raised," he said, "and we'll be reaching out to alumni."