Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
J Thorac Cardiovasc Surg. 2012 Jul;144(1):7-16. doi: 10.1016/j.jtcvs.2012.03.026. Epub 2012 Apr 12.
A paradigm shift in surgical training has led to national efforts to incorporate simulation-based learning into cardiothoracic residency programs. Our goal was to determine the feasibility of developing a cardiac surgery simulation curriculum using the formal steps of curriculum development.
Cardiothoracic surgery residents (n = 6) and faculty (n = 9) evaluated 54 common cardiac surgical procedures to determine their need for simulation. The highest scoring procedures were grouped into similarly themed monthly modules, each with specific learning objectives. Educational tools consisting of inanimate, animate, and cadaveric facilities and a newly created virtual operating room were used for curriculum implementation. Resident satisfaction was evaluated by way of a 5-point Likert scale. Perceived competency (scale of 1-10) and pre-/post-self-confidence (scale of 1-5) scores were collected and analyzed using cumulative mean values and a paired t-test.
Of the 23 highest scoring procedures (mean score, ≥ 4.0) on the needs assessment, 21 were used for curriculum development. These procedures were categorized into 12 monthly modules. The simulation curriculum was implemented using the optimal simulation tool available. Resident satisfaction (n = 57) showed an overwhelmingly positive response (mean score, ≥ 4.7). The perceived competency scores highlighted the procedures residents were uncomfortable performing independently. The pre-/post-self-confidence scores increased throughout the modules, and the differences were statistically significant (P < .001).
It is feasible to develop and implement a cardiac surgery simulation curriculum using a structured approach. High-fidelity, low-technology tools such as a fresh tissue cadaver laboratory and a virtual operating room could be important adjuncts.
外科培训模式的转变促使全国范围内努力将基于模拟的学习纳入心胸 residency 项目。我们的目标是确定使用课程开发的正式步骤开发心脏手术模拟课程的可行性。
心胸外科住院医师（n=6）和教师（n=9）评估了 54 种常见的心脏手术程序，以确定它们对模拟的需求。得分最高的程序被分为类似主题的每月模块，每个模块都有特定的学习目标。使用无生命、有生命和尸体设施以及新创建的虚拟手术室等教育工具来实施课程。通过 5 分李克特量表评估住院医师的满意度。收集和分析感知能力（1-10 分）和预/后自我信心（1-5 分）得分，使用累积平均值和配对 t 检验。
在需求评估中，得分最高的 23 项程序（平均得分≥4.0）中有 21 项用于课程开发。这些程序被分类为 12 个每月模块。使用最佳的模拟工具来实施模拟课程。住院医师满意度（n=57）显示出压倒性的积极反应（平均得分≥4.7）。感知能力得分突出了住院医师独立执行感到不舒服的程序。预/后自我信心得分在整个模块中增加，差异具有统计学意义（P<.001）。
使用结构化方法开发和实施心脏手术模拟课程是可行的。高保真、低技术工具，如新鲜组织尸体实验室和虚拟手术室，可以是重要的辅助手段。
