Simulation-Based Training in Cardiac Surgery.

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.

• Authors: Richard H Feins, Harold M Burkhart, John V Conte, Daniel N Coore, James I Fann, George L Hicks Jr, Jonathan C Nesbitt, Paul S Ramphal, Sharon E Schiro, K Robert Shen, Amaanti Sridhar, Paul W Stewart, Jennifer D Walker, Nahush A Mokadam
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 103 Issue 1 Pg. 312-321 (Jan 2017) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 27570162 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Cardiac Surgical Procedures (education)
• Clinical Competence
• Computer Simulation
• Education, Medical, Graduate (methods)
• Humans
• Internship and Residency (methods)
• Thoracic Surgery (education)