A tool designed to help surgical trainees practice skills such as knot tying, suturing, vascular and bowel anastomoses, and other techniques has helped eliminate barriers to simulation resources. The results of a recent study show that of the 30 general surgery residents surveyed, having access to the tool named GlobalSurgBox significantly improved their ability to practice essential surgical skills.

In quantifying the utility and usefulness of GlobalSurgBox for surgical residents, researchers at the University of Colorado School of Medicine Department of Surgery (Aurora, CO, USA) found that of those surveyed, only 3.3% reported routinely using institutional simulation resources such as simulation centers on campus. The most commonly reported barriers were lack of convenient access and lack of time. After using GlobalSurgBox, 90% of residents surveyed stated that lack of convenience or time was no longer a barrier for practice.

The GlobalSurgBox was originally envisioned at the CU School of Medicine as a more portable and affordable method of simulation. Using a wooden board as the platform for all the surgical exercises and commonly available supplies, the researchers included fishing line and shoelaces to practice knot tying, hair ties for suturing practice, and linear balloons for vascular anastomoses. They organized all the supplies in a 12-inch toolbox for portability, creating the GlobalSurgBox. In May 2021, the group assembled the first 50 GlobalSurgBoxes. The idea was that for every box created for a CU School of Medicine student or resident, participants would create a second box for medical partners in low- or middle-income countries.

Through several iterations, the GlobalSurgBox has now evolved into a training tool that can be assembled with inexpensive, readily available items and adapted to various countries or medical contexts. As more CU School of Medicine students and residents have participated in making and adapting GlobalSurgBox, some have created a website and instructional videos with skills training. Students have put together a comprehensive guide on how to assemble a box, from links to purchase each of the materials, documents to guide in assembling a GlobalSurgBox, and even templates on how to write grants so that this can be scaled up to other institutions. This will support students and surgical trainees in countries outside the U.S. to assemble boxes with locally available materials.

Students and residents have also been creative about adapting the box and continuing to create cheaper and better iterations. Students initially were using synthetic skin samples commonly used by tattoo artists to practice suturing, but later found that yoga mats were just as helpful and at a fraction of the cost. In Kenya, where yoga mats are not as ubiquitous as in the U.S., medical students and residents modified the GlobalSurgBox to use flip-flops instead. Others have cultivated relationships across campus so they can collect unused surgical instruments such as needle drivers and forceps that otherwise would be thrown away.

“The beauty of this box is that it’s truly adaptable to any setting, and the user is in charge of creating a simulator that fits their specific needs,” said Yihan Lin, MD, MPH, a cardiothoracic surgery fellow in the University of Colorado School of Medicine Department of Surgery, who originally envisioned the GlobalSurgBox. “It has been used by medical students, residents, fellows, and teaching faculty in multiple programs and countries around the world. This is a resource that’s easy to put together and easy to use.”

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