Simulation in cardiothoracic surgical training: Where do we stand? (original) (raw)
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Simulation‐based surgical education in cardiothoracic training
ANZ Journal of Surgery, 2019
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Simulation-Based Training in Cardiac Surgery
The Annals of thoracic surgery, 2016
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. 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. The 27 residents who participated demonstrated improvement with prac...
The Annals of thoracic surgery, 2016
The Cardiac Surgery Simulation Curriculum was developed at 8 institutions from 2010 to 2013. A total of 27 residents were trained by 18 faculty members. A survey was conducted to gain insight into the initial experience. Residents and faculty were sent a 72- and 68-question survey, respectively. In addition to demographic information, participants reported their view of the overall impact of the curriculum. Focused investigation into each of the 6 modules was obtained. Participants evaluated the value of the specific simulators used. Institutional biases regarding implementation of the curriculum were evaluated. Twenty (74%) residents and 14 (78%) faculty responded. The majority (70%) of residents completed this training in their first and second year of traditional-track programs. The modules were well regarded with no respondents having an unfavorable view. Both residents and faculty found low, moderate, and high fidelity simulators to be extremely useful, with particular emphasis...
The Journal of Thoracic and Cardiovascular Surgery
Objective: The provision of high-quality cardiothoracic surgical training faces many challenges. This has generated an increased interest in simulation-based learning, which can provide a less stressful environment for deliberate practice. We developed a comprehensive, structured program of knowledge and simulation-based learning aligned to the official cardiothoracic surgery curriculum. Methods: A portfolio of 10 curriculum-aligned training courses was designed for cardiothoracic surgical trainees during their 6-year training program. The courses were delivered through a multitude of education methods, including live porcine operating simulation models, and were evaluated through a series of quantitative (5-point Likert-scale) and qualitative assessments. The trainees (n ¼ 15-21 per course) also completed pre-and postsession self-confidence and competency levels for each training episode of knowledge and skill, respectively. In addition, board examination pass rates were assessed in the 3-year periods before and after implementation of the courses. Results: Quantitative analysis of the trainees' feedback demonstrated an extremely positive view of the portfolio of the simulation-based training courses with excellent satisfaction scores (out of 5) for teaching sessions (4.44 AE 0.07), faculty (4.64 AE 0.07), content and materials (4.63 AE 0.07), and facilities (4.73 AE 0.05). The courses have shown a significant improvement in the post-self-confidence (7.98 AE 0.13 vs 5.62 AE 0.20, P < .01) and perceived self-competency (8.10 AE 0.10 vs 5.67 AE 0.11, P <.01) scores for all courses. Examination pass rates significantly improved in the 3-year period after attendance at the courses (94.82% AE 2.34% vs 76.26% AE 3.23%, P <.005). Conclusions: This study has described the implementation of the only extensive program of structured simulation-based courses that has been developed to complement clinical training in cardiothoracic surgery.
Innovations in surgery simulation: a review of past, current and future techniques
Annals of Translational Medicine, 2016
As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future. Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.
To the point: medical education review of the role of simulators in surgical training
American Journal of Obstetrics and Gynecology, 2008
Simulation-based training (SBT) is becoming widely used in medical education to help residents and medical students develop good technical skills before they practice on real patients. SBT seems ideal because it provides a nonthreatening controlled environment for practice with immediate feedback and can include objective performance assessment. However, various forms of SBT and assessment often are being used with limited evidence-based data to support their validity and reliability. In addition, although SBT with high-tech simulators is more sophisticated and attractive, this is not necessarily superior to SBT with low-tech (and lower cost) simulators. Therefore, understanding the types of surgical simulators and appropriate applications can help to ensure that this teaching and assessment modality is applied most effectively. This article summarizes the key concepts that are needed to use surgical simulators effectively for teaching and assessment.
Simulator Training in Interventional Cardiology
Interventional Cardiology Review, 2016
Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.
Annals of Surgery, 2006
Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training.
Journal of Vascular Surgery, 2013
Objective: There is mounting evidence supporting the benefit of surgical skills training in a simulated environment. However, the use of simulation in vascular surgery has been limited, and its value has been poorly understood. Access to simulation is presumed to be a major barrier to its widespread implementation. While a great deal of discussion is taking place at the national level, input from current trainees has not been obtained. Methods: The Association of Program Directors in Vascular Surgery Committee on Education and Simulation sent a survey to all vascular surgical trainees assessing access to vascular simulation, the perceived value of simulation, and expectations for the future. Data were analyzed for junior (postgraduate year # #4; n [ 73) and senior (postgraduate year $ $5; n [ 110) level and program type (traditional [ 5 D 2/4 D 2; integrated [ 0 D 5). Results: A total of 183 of 326 (56%) trainees completed the survey, 72 (0-5), 5 (4D2), 111 (5D2), respectively. Of the respondents, 86% believe there is educational value in simulation. Cadaver dissections, followed by peripheral endovascular simulators and endovascular aortic aneurysm repair simulators, were ranked the most valuable tools by seniors, while anastomotic models are valued most by juniors, followed by cadavers and endosimulators. Fifty-six percent of programs currently offer simulation training, most commonly in the form of peripheral endovascular simulators (70%), anastomotic models (58%), or endovascular aortic aneurysm repair simulation (53%). Senior residents are more likely than juniors to have attended outside simulation courses (37% vs 19%). Overall, 57% of trainees expect that technical skills assessment will be incorporated into the certification process, and 52% endorse skills assessment for certification. Conclusions: Trainees report limited operative experience and confidence, and confidence levels are improved for a number of index procedures among those trainees with access to simulation. Trainees endorse the use of simulation to augment their surgical training, and a significant proportion of them already have access to it. These data support a perceived need and utility for implementation of a standardized simulation curriculum in vascular surgical training.