by Elizabeth Hofheinz, M.P.H., M.Ed., June 21, 2019
It is widely-known that surgical volume has a lot to do with outcomes…and those just beginning to summit the surgical volume mountain, they need all of the practice they can get.
For the fortunate residents and fellows at Hospital for
Special Surgery (HSS), the highest-level of hands-on training is just down the
hall. 
The dawn of the HSS Bioskills Education Laboratory
Edwin Su, M.D., Associate Attending Orthopaedic Surgeon at HSS, is director of the Adult Reconstruction and Joint Replacement (ARJR) service portion of the lab. He told OSN: “In the late 1990s there was an increasing realization that when it comes to surgical procedures there is nothing like hands-on experience. In the past, we had connections with Weill Cornell Medicine where our trainees could perform, among other things, cadaveric dissections. But because the venue and processes were not fully under HSS control and were more difficult to access, the decision was made to create our own facility.”
Beginning in 2000, the lab started out slowly, with residents primarily using it for dissections. It soon morphed into a refined facility capable of simulating entire surgical procedures.
Dr. Su, noting that the HSS Bioskills Lab now boasts 4 dry/wet stations that can accommodate 4 to 12 trainees, says, “The facility is open to all residents and is under the guidance of a coordinator who communicates with trainees on the available specimens and times. Trainees may also include physician assistants and nurses who come in for practice on suturing or on the examination of anatomy.”
“As for residents, they have an anatomical dissection curriculum where they each select a joint or a body part to work on. Afterwards, they present their experiences to other residents. Whether handling power instruments, working with the latest arthroscopic simulators, or trying out different surgical approaches, trainees at our lab have many unique opportunities. They can, for example, view the anatomical structures around the hip joint, perform a surgical approach while looking at the relevant neurovascular structures, and see a true-to-life representation of what they will encounter in the OR.”
The gold is in the “pause”
If a surgeon notices some nuance about, say, a particular instrument, he or she is not going to stop the live procedure and point out why it was designed that way. That, says Dr. Su, is a discussion for the Bioskills Lab. “In this setting we have the ability to do things that aren’t normally possible in an OR, an environment designed around efficiency. You can’t just stop to talk in an OR and say, ‘Hey, look how close that muscle is to the nerve!’ But you can in our lab. You also have more time to examine the instruments and delve into why they are designed a certain way.”
“Because trainees have access to this lab, they can get an authentic tactile feel for the soft tissues and develop a deep understanding of the real-life connections of anatomy to the surgical field. You can look at Netter’s Orthopaedics all day, but you are not necessarily going to get the feeling of soft tissues.”
Asked what he personally enjoys about the lab, Dr. Su noted, “I like being able to take time outside the OR to go through the relevant anatomy and intricacies of the procedure; you can also expose anatomical structures that you wouldn’t normally see in the operating room…which is a deep dive that an insurance company is not going to pay for.”
Equipped with excellence
“In the last couple of years, we have expanded the lab, installing surgical grade lighting and augmenting the number of tables and instruments available. Each workstation has been supplied with suction, irrigation, and electrical power.”
And the consensus of the physicians and allied health professionals who have trained there to date? “Universally positive,” says Dr. Su. “They feel it is one of the highlights of the HSS curriculum.”
In addition to HSS employees, the Bioskills lab is available to outside parties for educational purposes—including members of industry—who want to pursue training on, and use of, specialized medical instrumentation and devices that are in development. Dr. Su: “We have a large on-site training area that can accommodate 112 participants and we have electronic capability to offer educational seminars and anatomy workshops onsite at HSS and offsite at teaching hospitals and select meeting locations.”
Totally authentic…almost
“As much as we attempt to simulate the OR, cadaver tissue is not always the same as that of a live person. The tissues have slightly different elasticity and pliability because they have been frozen and don’t have living muscle tension…but it’s pretty close.”
And such validity has been recognized by the American College of Surgeons (ACS). Numerous strengths were acknowledged in the ACS’s reaccreditation report, including HSS’s commitment to residency skills development, its extensive faculty involvement (a senior surgeon is present for each training session), a robust longitudinal assessment system, ongoing support from HSS Alumni, and impressive best practices for the boot camp/new resident orientation and anatomy program.
Dream lab
In the event that a substantial grant landed in his lap, Dr. Su indicates that a few more things would be in order for the lab. “I would want more space so as to be able to host multiple events and conferences. In addition, more specimens would be helpful. We are mindful of the value of each specimen, and thus we do not use one for a massive procedure right away: first we do an exposure, then a primary knee, then a revision knee, etc. We do try to get the most use out of each specimen, but we could always use more. For example, some residents and fellows are pursuing research projects in the lab. Having additional specimens would allow them to take the inquiries even further.”
From a surgical perspective, the old adage, “practice makes perfect” has never been more possible.