William P. Robinson1, Donald T. Baril1, Odette Taha1, Andres Schanzer1, Anne C. Larkin1, Jean Bismuth3, Erica L. Mitchell2, Louis M. Messina1
1University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; 2Oregon Health & Science University, Portland, OR; 3Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX.
OBJECTIVES: We assessed the impact of AAA-specific simulation training on resident performance in simulated open abdominal aortic aneurysm repair (SOAAAR) and determined whether simulation training required dedicated faculty instruction.
METHODS: We randomized 18 residents (PGY3-5) to an AAA simulation course consisting of either two mandatory practice sessions proctored by a surgical skills lab coordinator (Group A, n=8) or two sessions led by a vascular faculty instructor (Group B, n=10). All residents received a detailed manual and video demonstrating the technique of open AAA repair. Blinded faculty graded SOAAAR performance at baseline and post-course using a validated tool.
RESULTS: Characteristics and baseline scores between Groups A and B were not different. Post-course, there was a trend towards improved performance in Group A as measured by procedural checklist scores (34.8±9.5 vs. 31±12.6,p=.08). Group B performance was improved from baseline with regard to procedural checklist scores (44.1±6.3 vs. 34.9±.5, p=.02), global rating scores (28.4±.6 vs. 25.3±5.0, p=.049), and overall assessment of operative competence (p=.02), with a trend toward significance in quality of final product (p=.1). Time to complete SOAAAR improved in both groups (p=.02). Baseline performance varied significantly with year of training (PGY3: 42±15 - PGY5: 67±15, p=.008). Improvement varied inversely with year of training (p<.05) and post-course scores were equivalent for PGY3-5 residents.
CONCLUSIONS: An AAA-specific simulation training course improved resident performance in simulated open AAA repair. Dedicated faculty instruction during the simulation training was required for significant improvement in resident performance. The impact of simulation training was greatest in more junior residents. Procedure-specific simulation training with dedicated faculty can be used to effectively teach operative procedures and should focus on early residency training.
AUTHOR DISCLOSURES: D. T. Baril, Nothing to disclose; J. Bismuth, Nothing to disclose; A. C. Larkin, Nothing to disclose; L. M. Messina, Nothing to disclose; E. L. Mitchell, Nothing to disclose; W. P. Robinson, Nothing to disclose; A. Schanzer, Nothing to disclose; O. Taha, Nothing to disclose.
Posted April 2012