Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-resource Settings: A Scoping Review.

[BACKGROUND] Simulation is an educational tool that can be used to augment surgical training. We sought to provide an overview of existing pediatric surgical simulation models, with a focus on low-cost models amenable for use in low-resource settings.

[METHODS] PubMed and Google Patents were searched for studies describing simulation models for pediatric surgery. Studies were included if cost, construct validity, face validity, or reproducibility were described, and if the model was either already utilized in low-resource settings or amenable for use in low-resource settings.

[RESULTS] A total of 18 studies and 7 patents were included. Over half (58.3 %) of the models were created in the last five years. Only four models were created in an upper-middle income country, and none were created in a low or lower-income middle income country (LMIC) (16.7 %). Most models were designed for general pediatric surgical procedures, with esophageal atresia repair being the most common procedure (20.8 %). The cost of models ranged between $0.61 USD to $301.44 USD, and cost per simulation episode ranged from $0.61 to $38 USD. Seven models (41.1 %) were 3D printed. Thirteen models (54.2 %) were simulators for minimally-invasive procedures. Sixteen models (66.7 %) were deemed to be reproducible based on their descriptions in published manuscripts or available patents.

[CONCLUSION] The utilization of simulation models in pediatric surgery is growing. Unfortunately, there are few validated models that can be used for training in low-resource settings. Significant work remains to be done on developing educational simulation tools for pediatric surgery in low-resource settings.