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Dr. Janani Arun, left, uses a laparoscopic device to demonstrate her knot-tying skills while being evaluated by Dr. Moustafa El Khatib on Friday in the Multidisciplinary Simulation Center at Mayo Clinic in Rochester.

Friday afternoon, surgical resident Paul Nickerson sorted through a pile of felt, yarn, straws and puff balls, searching for a part to best represent the fascia in the neck he was building in front of him.

The station looked more like an elementary school craft project than a rigorous test of Nickerson's anatomical knowledge, but as he constructed, he rattled off name after name of tissues and muscles, placing a piece of yarn here, a puff ball there and finishing it off with a layer of pink felt for the skin.

This colorful station was one of five in the Surgical X-Games, a competition and test that objectively evaluates the skills and shortcomings of surgical residents in tasks ranging from surgery to reading X-rays.

It is part of the Mayo Clinic Multidisciplinary Simulation Center's attempt to maximize educational hours with hands-on practice as surgical residents deal with less clinic time and patient contact.

"We think adult learners learn better with their hands," said David Farley, director of surgery in the simulation center.

In 2003, new standards went into effect, limiting a resident's hours to 80 per week.

"[It] felt like we were losing repetition," Farley said.

The simulation center, started in 2005, is an attempt to compensate for that through simulation sessions and evaluations like the one Friday afternoon. Though hands-on experience in the clinic is preferable, Farley said, the upside of simulation is that it can be programmed and scheduled, offering plenty of repetition.

He said there is data that it is working well, but whether it's better than the 1960s method of "living in the hospital," he said he's not sure.

The most beneficial aspect, however, is the ability to analyze the residents' performances objectively, with video and audio to back up the analyses.

Resident Edwin Onkendi said he has learned from the detailed feedback, telling him exactly what he missed or didn't say. On Friday, he performed a Pancreatico-Jejunostomy on a hot dog and pieces of felt.

"Most of the time we read how to do a procedure," Onkendi said. "I get to assist in the OR, but to get to do it and try to do the whole thing myself on a model helps me see where my skills are."

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