Darren S Bryan1, Mark K Ferguson2, Mara B Antonoff3, Leah M Backhus4, Thomas J Birdas5, Shanda H Blackmon6, Daniel J Boffa7, Andrew C Chang8, Gary W Chmielewski9, David T Cooke10, Jessica S Donington11, Henning A Gaissert12, Jeffrey A Hagen13, Wayne L Hofstetter3, Michael S Kent14, Ki Wan Kim15, Seth B Krantz16, Jules Lin8, Linda W Martin17, Shari L Meyerson18, John D Mitchell19, Daniela Molena20, David D Odell21, Mark W Onaitis22, Varun Puri23, Joe B Putnam24, Christopher W Seder25, Joseph B Shrager4, Harmik J Soukiasian26, Brendon M Stiles27, Betty C Tong28, Nirmal K Veeramachaneni29. 1. Department of Surgery, University of Chicago, Chicago, Illinois. 2. Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: mferguso@bsd.uchicago.edu. 3. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California. 5. Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana. 6. Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. 7. Section of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut. 8. Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan. 9. Section of Thoracic Surgery, Advocate Aurora Healthcare, Aurora, Illinois. 10. Section of General Thoracic Surgery, University of California, Davis Health, Davis, California. 11. Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, Illinois. 12. Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. 13. Division of Thoracic Surgery, Sanger Heart and Vascular Institute, Charlotte, North Carolina. 14. Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 15. Wellstar Health System, Marietta, Georgia. 16. Division of Thoracic Surgery, NorthShore University Health System, Evanston, Illinois. 17. Division of Thoracic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia. 18. Section of Thoracic Surgery, University of Kentucky, Lexington, Kentucky. 19. Division of Cardiothoracic Surgery, Section of General Thoracic Surgery, University of Colorado Denver, Aurora, Colorado. 20. Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York. 21. Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 22. Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, California. 23. Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri. 24. Department of Thoracic Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida. 25. Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois. 26. Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California. 27. Division of Thoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. 28. Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. 29. Department of Cardiovascular and Thoracic Surgery, University of Kansas Health System, Kansas City, Kansas.
Abstract
BACKGROUND: Simulation-based training is a valuable component of cardiothoracic surgical education. Effective curriculum development requires consensus on procedural components and focused attention on specific learning objectives. Through use of a Delphi process, we established consensus on the steps of video-assisted thoracoscopic surgery (VATS) left upper lobectomy and identified targets for simulation. METHODS: Experienced thoracic surgeons were randomly selected for participation. Surgeons voted and commented on the necessity of individual steps comprising VATS left upper lobectomy. Steps with greater than 80% of participants in agreement of their necessity were determined to have established "consensus." Participants voted on the physical or cognitive complexity of each, or both, and chose steps most amenable to focused simulation. RESULTS: Thirty thoracic surgeons responded and joined in the voting process. Twenty operative steps were identified, with surgeons reaching consensus on the necessity of 19. Components deemed most difficult and amenable to simulation included those related to dissection and division of the bronchus, artery, and vein. CONCLUSIONS: Through a Delphi process, surgeons with a variety of practice patterns can achieve consensus on the operative steps of left upper lobectomy and agreement on those most appropriate for simulation. This information can be implemented in the development of targeted simulation for VATS lobectomy.
BACKGROUND: Simulation-based training is a valuable component of cardiothoracic surgical education. Effective curriculum development requires consensus on procedural components and focused attention on specific learning objectives. Through use of a Delphi process, we established consensus on the steps of video-assisted thoracoscopic surgery (VATS) left upper lobectomy and identified targets for simulation. METHODS: Experienced thoracic surgeons were randomly selected for participation. Surgeons voted and commented on the necessity of individual steps comprising VATS left upper lobectomy. Steps with greater than 80% of participants in agreement of their necessity were determined to have established "consensus." Participants voted on the physical or cognitive complexity of each, or both, and chose steps most amenable to focused simulation. RESULTS: Thirty thoracic surgeons responded and joined in the voting process. Twenty operative steps were identified, with surgeons reaching consensus on the necessity of 19. Components deemed most difficult and amenable to simulation included those related to dissection and division of the bronchus, artery, and vein. CONCLUSIONS: Through a Delphi process, surgeons with a variety of practice patterns can achieve consensus on the operative steps of left upper lobectomy and agreement on those most appropriate for simulation. This information can be implemented in the development of targeted simulation for VATS lobectomy.
Authors: Daniel T DeArmond; Mohammed S Rahman; Stewart R Miller; Christian P Jacobsen; Scott B Johnson; Duy C Nguyen; Nitin A Das Journal: J Thorac Dis Date: 2022-08 Impact factor: 3.005