Simulation for Medical Specialty Initial Certification and Maintenance ofCertification in the United States of America

Abstract

Surgical skills simulation (SSS) tests the application of factual knowledge and shows how knowledge is applied, representing the second and third levels of Miller’s Pyramid of Learning. SSS permits high-stakes scenario testing in safe environments. Therefore, SSS incorporation into initial specialty certification began in 2002 in Australia and New Zealand. The United States began SSS incorporation into specialty certification in 2008. This paper will determine where the United States stands in the process of SSS incorporation into specialty certification. Google scholar Internet and PubMed searches phrased “medical board certification surgical skills simulation”, performed on September 1, 2016 yielded 16 relevant articles. Hand search on September 1, 2016 yielded 7 additional articles. In 2008, cardiac catheterization simulation was required for interventional cardiology maintenance of certification (MOC). In 2010 the American Board of Anesthesiology (ABA) required SSS as part of the MOC program. In 2014, the summative assessment, Colorectal Objective Assessment of Technical Skills became part of the American Board of Colon and Rectal Surgery certification. In 2017, SSS will be added to the ABA initial certification examination. The United States has been slow to incorporate SSS into initial certification and MOC. Assessment validation, capital and recurring costs, personnel, physical facility and time requirements are barriers limiting SSS expansion into specialty certification processes. As SSS allows rapid technical skill assessment, without posing a threat to patients, expansion of SSS into initial certification and MOC programs represents non-maleficence and beneficence, and should be encouraged.