Low-cost simulation helps surgical trainees practice crisis skills for major hemorrhage

Editor's Note

A novel, low-cost simulation of intraoperative hemorrhage successfully challenged surgical residents and fellows to practice both technical and nontechnical crisis management skills. According to a study published in Surgery on August 19, the model replicated a lacerated vena cava bleed and allowed learners to rehearse vascular repair, teamwork, and leadership in a high-stress environment.

As detailed in the study, 33 participants completed three sessions using the custom simulator, which used porcine aorta tissue and 3D-printed anatomy to mimic high-volume abdominal bleeding. Residents and fellows worked in teams to achieve hemostasis within 20 minutes while managing distractions and coordinating team dynamics. Faculty assessed performance with the Objective Structured Assessment of Technical Skills (OSATS), the Non-Technical Skills for Surgeons Scale (NOTSS), and self-reported measures of stress and cognitive load.

The study found fellows outperformed residents in technical repair, with 80% of fellows versus 30% of residents achieving hemostasis in the allotted time. Fellows also scored higher on OSATS, averaging 3.9 compared with 3.4 among residents. However, both groups reported similar stress and cognitive load, and there were no significant differences in NOTSS scores. The outlet reports blood loss exceeded 1 liter in most cases, affecting 74% of residents and 60% of fellows.

Qualitative analysis revealed three themes:

1. Technical and nontechnical skills were closely interdependent: effective communication and leadership supported technical success, while technical control of bleeding improved team coordination.
2. Methodical approaches to crisis helped learners manage chaos, with fellows more confident in returning to “basics” under stress.
3. Perceived stress was tied to experience, with residents reporting higher anxiety and fellows describing calmer responses, even though some still showed visible signs of strain.

Participants reportedly valued the chance to practice leadership and crisis management in a safe environment, particularly since many surgical trainees may not experience major hemorrhage during residency. The simulator’s affordability—less than $70 per model—was highlighted as a strength, enabling wider adoption compared with costly cadaveric or high-fidelity alternatives.

Limitations included lower realism, small sample size, and the absence of interdisciplinary team members such as anesthesiologists and nurses, which the authors identified as a future direction. The study concludes that integrating technical and teamwork skills in a simulation grounded in crisis resource management principles can improve trainee preparedness for intraoperative emergencies.