TableĀ 4

Assessment criteria used in this study to assess function strengths based on indicators related to surgical simulation training in a Swedish context

System functionAssessment criteria for function strength
F1Knowledge development and diffusionMarket and technological knowledge (supply side) were assessed by expert opinions of the technological level and market position for the Swedish VR companies
Scientific knowledge was assessed with bibliometric analysis of the temporal development of the number of publications in scientific journals and in comparison with other European nations
F2LegitimationRequirements for surgical simulation training (demand side). No requirements by any professional medical society reflected function weakness, whilst requirements by all societies indicated function strength
Social acceptance for the technology was assessed with qualitative expert opinions and bibliometric analysis of the temporal development of the number of articles in daily Swedish newspapers
F3Resource mobilisationTraining capabilities and infrastructure were assessed by the numbers of clinical skills centres at university hospitals (demand side). Function weakness was indicated if no centres were established, and function strength was indicated by the establishment of centres at all university hospitals
Training capacities were assessed with available staff and budgets for surgical training in clinical skills centres at university hospitals (demand side). Function weakness indicated by lack of targeted staff and budgets for surgical simulation training. Function strength was indicated by targeted budgets and staff at all centres
F4Guidance of searchQualitative assessment for simulation training expressed and demonstrated by clinical experts (demand side)
Quantitative assessment of the temporal development of the number of editorials published in scientific journals (demand side)
F5Entrepreneurial experimentationQuantitative assessment of the number of Swedish VR companies in relation to European VR companies (supply side)
Qualitative assessment of the temporal development of variety of training modules provided by the supply side Swedish VR companies
F6Market formationQuantitative assessment of the temporal development of annual revenues to reflect the number of installations and type of simulators. Function weakness is indicated by no installations; function strength is indicated by installations for all surgical specialities at all university hospitals and an exponential growth of annual revenues
The temporal development of the number of procurements was analysed to assess the ratio of simulators acquired through public tenders in comparison to simulators acquired for research purposes. Function weakness is indicated by a majority of installations related to research
F7System-wide synergiesRegulatory requirement for simulation-based training for accreditation purposes (demand side). Function weakness indicated by no regulatory requirement. Function strength indicated by regulatory requirements for all surgical specialists
Accreditation of clinical skills centres based on widely agreed standards in regard to simulation training. Function strength indicated by accreditation of clinical skills centres at all university hospitals

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