Background. Recent studies comparing inexpensive low-fidelity box trainers to expensive computer-based virtual reality systems demonstrate similar acquisition of surgical skills and transferability to the clinical setting. With new mandates emerging that all surgical residency programs have access to a surgical skills laboratory, we describe our cost-effective approach to teaching basic and advanced open and laparoscopic skills utilizing inexpensive bench models, box trainers, and animate models.Methods. Open models (basic skills, bowel anastomosis, vascular anastomosis, trauma skills) and laparoscopic models (basic skills, cholecystectomy, Nissen fundoplication, suturing and knot tying, advanced in vivo skills) are constructed using a combination of materials found in our surgical research laboratories, retail stores, or donated by industry. Expired surgical materials are obtained from our hospital operating room and animal organs from food-processing plants. In vivo models are performed in an approved research facility. Operation, maintenance, and administration of the surgical skills laboratory are coordinated by a salaried manager, and instruction is the responsibility of all surgical faculty from our institution.Results. Overall, the cost analyses of our initial startup costs and operational expenditures over a 3-year period revealed a progressive decrease in yearly cost per resident (2002-2003, $1,151; 2003-2004, $1,049; and 2004-2005, $982).Conclusions. Our approach to surgical skills education can serve as a template for any surgery program with limited financial resources.

An 11-year-old African American boy with a medical history significant for attention deficit and hyperactivity disorder presented with a 4-day history of intermittent epigastric and periumbilical pain associated with nausea, anorexia, and decreased oral intake. A low-grade fever began the day before admission. Upon further questioning, the patient admitted to swallowing a few days before the onset of the abdominal discomfort multiple small magnets that were pieces of a toy. The patient had a temperature of 100.38F. Other vital signs were within normal limits for his age. Physical examination revealed a tender epigastrium and periumbilical region without guarding or peritoneal signs. The rest of the examination was unremarkable. White blood cell count was elevated. On abdominal x-ray, there was no free air or dilated loops of bowel; however, 3 opaque foreign bodies were seen in the area of the antrum-duodenal junction. Given that the patient showed neither signs of systemic illness nor peritonitis, an abdominal x-ray was repeated the following morning. This showed no change in position of the magnets (Fig. 1). The magnets were presumed to be in the stomach; therefore, an esophagogastroduodenoscopy was performed in an attempt to retrieve the foreign bodies by aid of an

OBJECTIVES:To determine whether interdepartmental educational and technical resources could be combined to successfully train surgery and emergency medicine residents in common diagnostic and therapeutic trauma skills outside the traditional hospital setting.DESIGN:Curriculum improvement survey.SETTING:Surgical Skills Laboratory, Temple University School of Medicine, Philadelphia, Pennsylvania.PARTICIPANTS:A total of 35 surgery residents (PGY 1 to 5) and 26 emergency medicine residents (PGY 1 to 3).METHODS:Emergency medicine attendings used human volunteers to train surgery residents in Focused Assessment with Sonography in Trauma (FAST). Trauma surgery attendings used a porcine model to teach emergency medicine residents tracheostomy, peripheral venous cutdown, diagnostic peritoneal lavage, tube thoracostomy, and bilateral thoracotomy. Upon completion of the courses, all residents were surveyed using a 5-point Likert scale to assess this teaching model.RESULTS:The percentage of residents reporting an improvement in knowledge levels after the course increased significantly (p < 0.003) for all skill modules (FAST, 14% vs 73%; tracheostomy, 20% vs 64%; peripheral venous cutdown, 25% vs 71%; diagnostic peritoneal lavage, 16% vs 60%; tube thoracostomy, 42% vs 92%; thoracotomy, 15% vs 42%). A significant (p < 0.05) increase in comfort levels during performance of the procedures in the clinical setting was also anticipated for all skills modules (FAST, 11% vs 60%; tracheostomy, 12% vs 50%; peripheral venous cutdown, 15% vs 31%; diagnostic peritoneal lavage, 12% vs 58%; tube thoracostomy, 35% vs 73%; thoracotomy, 0% vs 15%). PGY 1 to 4 surgery residents and PGY 1 and 2 emergency medicine residents perceived the greatest benefit (p < 0.05) from their respective courses. The overwhelming majority (89% to 100%) of surgery and emergency medicine residents felt the course was valuable and transferable to the clinical trauma setting.CONCLUSIONS:Interdepartmental collaboration between the Department of Surgery and Department of Emergency Medicine offered a unique training relationship that was a positive educational experience for all residents.