Impact of low-cost simulator-based liver trauma surgery training on technical skills and short-term retention among general surgeons

Abstract Background General surgeons in low-volume trauma systems may be required to perform emergency damage-control surgery for liver trauma despite limited operative trauma exposure. Simulation-based training has the potential to provide a scalable approach to improving preparedness for these rare but critical procedures. This study evaluated the educational effectiveness and short-term retention of a low-cost simulator-based liver trauma surgery curriculum for general surgeons. Methods This prospective single-arm educational intervention study included general surgeons 5–20 years after graduation with limited experience as primary operators in trauma surgery. Participants underwent video-based instruction followed by hands-on simulation training. The curriculum focused on emergency laparotomy, five-point abdominal packing, liver injury packing with manual compression and liver hilar blockade, liver injury suturing, and temporary abdominal closure. Technical skills were assessed using the Abdominal Trauma Objective Structured Assessment of Technical Skills. Knowledge and self-assessed confidence were assessed as secondary outcomes. Assessments were performed before training, immediately after training, and 3–6 months after training. Pairwise Wilcoxon signed-rank tests were used for statistical analysis. Results Forty-two general surgeons participated in the training. The median technical skill score increased significantly from 26.5 before training to 39 immediately after training (P < 0.001). At follow-up, completed by 26 participants at 15–20 weeks, the median technical skill score decreased to 34 but remained significantly higher than baseline (P < 0.001). The median knowledge score increased from 4 to 7 immediately after training (P < 0.001). At follow-up, completed by 39 participants at 15–24 weeks, the median knowledge score decreased to 5 but remained higher than baseline (P = 0.010). Self-assessed confidence improved significantly after training for all procedures directly practiced during the curriculum and remained higher than baseline at follow-up for these procedures. Conclusions A focused, low-cost simulator-based liver trauma surgery curriculum improved technical skills, knowledge, and self-assessed confidence among general surgeons, with partial retention at 3–6 months. This curriculum may provide a scalable approach to strengthening operative trauma preparedness in low-volume trauma systems.