Basic Cardiac Surgery Skills on Sale for $22.50: An Aortic Anastomosis Simulation Curriculum

doi:10.1016/j.athoracsur.2015.08.005

The Annals of Thoracic Surgery

Volume 101, Issue 1, January 2016, Pages 316-322

Presented at the Fifty-first Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 24–28, 2015.

https://doi.org/10.1016/j.athoracsur.2015.08.005 Get rights and content

Background

Current resident and student duty-hour restrictions necessitate efficient training, which may be aided by simulation. Data on the utility of low-cost simulation in cardiothoracic surgery are scant. We evaluated the effect and value of a low-cost, low-fidelity aortic anastomosis simulation curriculum.

Methods

Twenty participants (11 medical students, 9 residents) completed an aortic anastomosis on a porcine heart as a pretest. Participants were then provided access to a 14-minute online video created by a cardiac surgeon and given a low-cost task trainer for self-directed practice. Five weeks later, participants performed another aortic anastomosis on a porcine heart as a posttest. Pretest and posttest performances were filmed, deidentified, and graded blindly and independently by two cardiac surgeons using a standardized assessment tool (perfect score, 110; passing score, 58 or higher). Participants were surveyed anonymously after the posttest.

Results

The mean (SD) aortic anastomosis performance score improved significantly from pretest (53.3 [25.3]) to posttest (83.6 [15.3]; p < 0.001). Pass rates also improved significantly (35% versus 95%, p < 0.001). Medical students’ scores improved most (p = 0.01). All 20 participants reported improved confidence in performing the task, and 18 believed that the online video was essential to better performance. The cost of the curriculum totaled $22.50 per participant, with 6 hours of total staff time required for assessment.

Conclusions

An aortic anastomosis training and simulation curriculum improves the skills of student and resident trainees with minimal expense and staff time commitment. Such a curriculum may be of great value to both cardiothoracic training programs and their trainees.

Section snippets

Participants

Twenty trainees of various levels participated in our aortic anastomosis simulation curriculum. Of these 20 participants, 11 were first- and second-year medical students; 9 were integrated cardiac, thoracic, and vascular surgery residents (postgraduate year 1 or 2, n = 5; postgraduate year 3 or more, n = 4). Most participants (70%) had no experience in performing any vascular anastomosis before the study. Of the 6 participants who did have experience with an anastomosis, 3 had performed one

Assessment

All 20 participants completed both the pretest and posttest. The mean pretest score was 53.3 (25.3), and 7 participants (35%) passed the pretest (Table 1). Mean pretest scores were 38 (13.5) for medical students, 58.4 (24.4) for junior residents, and 88.8 (13.1) for senior residents. The mean overall posttest score was 83.6 (15.3), with 19 participants (95%) passing. This mean score improved significantly from pretest (p < 0.001), as did the pass rate (p < 0.001). Mean posttest scores were 76.5

Comment

In this study, we created an aortic anastomosis curriculum consisting of an instructional video and a portable task trainer. After enrollment in the curriculum, all residents and students had improved scores on an assessment using a high-fidelity porcine model. Interval improvement from pretest to posttest was greatest among medical students. This finding suggests that integrated cardiothoracic surgical residents can be exposed and evaluated early in training (ie, postgraduate year 1 level) to

References (8)

J.K. O’Herrin et al.
Medical student operative experience correlates with a match to a categorical surgical program
Am J Surg
(2003)
J.I. Fann et al.
Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: the boot camp experience
J Thorac Cardiovasc Surg
(2010)
D.J. Anastakis et al.
Assessment of technical skills transfer from the bench training model to the human model
Am J Surg
(1999)
D.J. Scott et al.
The new ACS/APDS skills curriculum: moving the learning curve out of the operating room
J Gastrointest Surg
(2008)

There are more references available in the full text version of this article.

Cited by (15)

Coronary Anastomosis Simulation: Directed Interventions to Optimize Success
2021, Annals of Thoracic Surgery
The role of simulation-based training in coronary artery bypass grafting remains undefined. Barriers to simulator use include clinical and personal obligations, insufficient materials, and lack of mentorship. The purpose of this study was to implement a longitudinal, residency-wide coronary anastomosis simulation curriculum.
A prospective observational study was conducted from 2018 to 2019 at a single academic center. All residents of the Thoracic Surgery training program participated. Each participant was provided a low-fidelity coronary anastomosis simulator, high-quality instruments, and faculty mentor. Formal assessments were held quarterly, and residents were encouraged to practice alone and with their mentor. Baseline and follow-up metrics were compared with simple descriptive statistics.
Seventeen residents and 12 faculty participated in the study. Residents demonstrated increased use of the simulator, with 21% participating in independent practice at baseline and 82% in the fourth quarter (P = .02). The median score on the Thoracic Surgery Directors Association Vessel Anastomosis Assessment improved from 42 out of 65 at baseline to 54 out of 65 in the fourth quarter (P = .04), and mean anastomosis time was reduced by 5 minutes 6 seconds (P = .02). Over 12 months, junior residents demonstrated a mean reduction in anastomosis time of 6 minutes 36 seconds, and senior residents decreased anastomosis time by 3 minutes 6 seconds (P = .02).
Providing residents with a low-fidelity coronary anastomosis trainer with high-quality instruments and a faculty mentor improved rates of independent practice, Thoracic Surgery Directors Association assessment scores, and anastomosis time. Our next step is validating the coronary simulator curriculum by measuring improvement of resident performance in the operating room.
Invited Commentary
2018, Annals of Thoracic Surgery
Simulation-Based Skill Training for Trainees in Cardiac Surgery: A Systematic Review
2018, Annals of Thoracic Surgery
Citation Excerpt :
The MERSQI median score was 12.5 (Fig 4). Thirteen studies (81.3%) met the threshold for high quality, with a MERSQI score of 12 or higher [12, 14, 44–47, 50, 51, 53–57]. No studies provided data on all three criteria for assessment validation.
Simulation-based training has been an important part of the solution to address the shortfalls in cardiac surgery training. This review was conducted to identify and systematically summarize existing evidence on outcomes and methodological quality of simulation-based skills training for cardiac surgery trainees.
MEDLINE, Embase, and ERIC (Education Resources Information Center) databases were searched. Studies included peer-reviewed publications with simulation-based skill training in cardiac surgery programs with outcome measures of performance. Data extraction covered the type of skills training, simulator type and fidelity, the level of trainees, assessment tools, assessors, study design and its components, strengths and limitations, and elements required for the Medical Education Research Study Quality Instrument score. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Of 16 studies that met the criteria, only four (25%) randomized controlled trials were identified, and the remaining were observational studies. Seven observational studies (43.7%) were single-group pre-post tests. The mean number of trainees was 20.4 (SD, 14.1). Low-fidelity simulators were used in 13 studies (81.2%). Most of the studies (81.3%) were high quality based on a Medical Education Research Study Quality Instrument score of 12 or more. Evidence of assessment tool validation was absent among all studies. No study outcome measures were directed to skills transfer to the operating room or patient outcomes. Overall learning outcomes’ effect sizes were consistently high (2.2; SD, 1.6), with junior residents benefitting most (effect size, 2.8; SD, 2.2)
Simulation-based skill training is associated with improved learning outcomes for cardiac surgery trainees with large effect sizes, but more behavior-level outcomes are required to fully assess its value.
The Economics of Surgical Simulation
2017, Otolaryngologic Clinics of North America
How Andre Agassi helped me during my cardiothoracic surgery training
2017, Journal of Thoracic and Cardiovascular Surgery
Cardiac surgery simulation: The future of teaching in our specialty?
2017, Cirugia Cardiovascular
La simulación como herramienta docente se está estableciendo como una prioridad en los currículos de nuestra especialidad en determinados países, principalmente anglosajones, y cada vez se están desarrollando escenarios más sofisticados y completos.
Se ha fomentado la creación de un equipo multidisciplinar con profesores de universidad, estudiantes de Medicina y médicos con el objetivo de mejorar la docencia del Grado en Medicina y valorar su potencial exportación a la formación especializada en Cirugía Cardiovascular.
Los alumnos de Medicina participantes demostraron una clara mejoría en la asimilación de información, así como en sus habilidades clínico-prácticas, conforme se fueron estableciendo escenarios de simulación. Del mismo modo, esta herramienta permitió una evaluación objetiva tanto de los resultados in situ como de la evolución temporal de los mismos.
Dado el rendimiento positivo en estudiantes de Medicina, y debido a la cada vez mayor dificultad en la formación de residentes en nuestros hospitales (cuestiones ético-legales, escasez de tiempo de formación, complejidad de casos), se debería plantear la creación de un grupo de Simulación a nivel nacional para valorar la inclusión de la misma en el currículo de la especialidad.
Simulation is becoming a powerful teaching tool of our specialty in certain countries, particularly in English-speaking ones, in which sophisticated scenarios are being increasingly developed.
We have encouraged the creation of a multidisciplinary team with university professors, medical students, and physicians in order to improve teaching in the School of Medicine and to assess the potential use of the developed teaching techniques into specialised training in Cardiovascular Surgery.
Medical students showed a clear improvement in the assimilation of information and skills in clinical practice when they were setting up scenarios. Similarly, this tool allowed an objective assessment of the results in situ as well as over time.
Given the positive performance by medical students, and because of the increasing difficulty in training residents in our hospitals (ethical and legal issues, shortage of patients, complexity of cases), Simulation groups should be created at national level to assess the inclusion of this into the curriculum of the specialty.

View all citing articles on Scopus

View full text

Original articleEducationBasic Cardiac Surgery Skills on Sale for $22.50: An Aortic Anastomosis Simulation Curriculum

Background

Methods

Results

Conclusions

Section snippets

Participants

Assessment

Comment

Am J Surg

J Thorac Cardiovasc Surg

Am J Surg

J Gastrointest Surg

Original article
Education
Basic Cardiac Surgery Skills on Sale for $22.50: An Aortic Anastomosis Simulation Curriculum