Richard H Feins1, Harold M Burkhart2, John V Conte3, Daniel N Coore4, James I Fann5, George L Hicks6, Jonathan C Nesbitt7, Paul S Ramphal8, Sharon E Schiro9, K Robert Shen2, Amaanti Sridhar10, Paul W Stewart10, Jennifer D Walker11, Nahush A Mokadam12. 1. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: rfeins@med.unc.edu. 2. Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. 3. Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland. 4. Department of Computing, University of West Indies (Mona), Kingston, Jamaica. 5. Department of Cardiothoracic Surgery, Stanford University, Stanford, California. 6. Division of Cardiac Surgery, University of Rochester, Rochester, New York. 7. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 8. Department of Surgery, School of Clinical Medicine and Research, University of the West Indies, Nassau, Bahamas. 9. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 10. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 11. Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts. 12. Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
Abstract
BACKGROUND: Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons. METHODS: Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function. Using deliberate practice, first-year cardiothoracic surgical residents at eight institutions were trained and evaluated on component tasks for each module and later on full cardiac operations. Evaluations were based on five-point Likert-scale tools indexed by module, session, task items, and repetitions. Statistical analyses relied on generalized linear model estimation and corresponding confidence intervals. RESULTS: The 27 residents who participated demonstrated improvement with practice repetitions resulting in excellent final scores per module (mean ± two SEs): cardiopulmonary bypass, 4.80 ± 0.12; coronary artery bypass grafting, 4.41 ± 0.19; aortic valve replacement, 4.51 ± 0.20; massive air embolism, 0.68 ± 0.14; acute intraoperative aortic dissection, 4.52 ± 0.17; and sudden deterioration in cardiac function, 4.76 ± 0.16. The transient detrimental effect of time away from training was also evident. CONCLUSIONS: Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.
BACKGROUND: Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons. METHODS: Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function. Using deliberate practice, first-year cardiothoracic surgical residents at eight institutions were trained and evaluated on component tasks for each module and later on full cardiac operations. Evaluations were based on five-point Likert-scale tools indexed by module, session, task items, and repetitions. Statistical analyses relied on generalized linear model estimation and corresponding confidence intervals. RESULTS: The 27 residents who participated demonstrated improvement with practice repetitions resulting in excellent final scores per module (mean ± two SEs): cardiopulmonary bypass, 4.80 ± 0.12; coronary artery bypass grafting, 4.41 ± 0.19; aortic valve replacement, 4.51 ± 0.20; massive air embolism, 0.68 ± 0.14; acute intraoperative aortic dissection, 4.52 ± 0.17; and sudden deterioration in cardiac function, 4.76 ± 0.16. The transient detrimental effect of time away from training was also evident. CONCLUSIONS: Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.
Authors: Joshua B Gafford; Scott Webster; Neal Dillon; Evan Blum; Richard Hendrick; Fabien Maldonado; Erin A Gillaspie; Otis B Rickman; S Duke Herrell; Robert J Webster Journal: Ann Biomed Eng Date: 2019-07-24 Impact factor: 3.934
Authors: Ali Alakhtar; Alexander Emmott; Cornelius Hart; Rosaire Mongrain; Richard L Leask; Kevin Lachapelle Journal: BMJ Simul Technol Enhanc Learn Date: 2021-06-21