Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Division of Critical Care/Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
J Surg Educ. 2019 May-Jun;76(3):844-855. doi: 10.1016/j.jsurg.2018.09.007. Epub 2018 Oct 23.
We sought to examine the feasibility of a home practice curriculum of vascular anastomosis in cardiovascular surgery using a low-fidelity simulation platform and to examine its effectiveness in skill acquisition in senior surgical trainees.
We organized a multicenter prospective randomized study of senior residents and fellows, who were oriented to a low-fidelity cardiac simulator and an 8-week curriculum of independent practice of aortic and coronary anastomosis. "Treatment" trainees received a simulator and the curriculum. Control trainees received only their usual operative experience. The groups then crossed over; all were studied for 16 weeks in total. Video skill assessments were captured at 0, 8, and 16 weeks and were scored by one blinded investigator using the Joint Council on Thoracic Surgery Education Assessment tool. A post-hoc survey was distributed to invited participants following study completion.
University of Minnesota Department of Surgery, Mayo Clinic Department of Cardiovascular Surgery, and the University of Texas Health Science Center at Houston. Participants used the simulator in offices, call rooms, and their homes.
Program participation in the study was solicited through the Thoracic Education Cooperative Group. Four institutions expressed interest and a total of 29 trainees were invited to the study and randomized. Of these, 12 (38%) completed the curriculum and submitted the requisite 3 sets of videos (6 treatment, 6 control). All were senior residents and fellows in general and cardiothoracic surgery.
No significant differences were detected in assessment scores before and after the curriculum nor before or after the control period in the overall or postgraduate year-stratified populations. Participant case numbers during the study did not have a significant effect on assessment scores. Randomized participants reported strong interest in deliberate practice of technical skills but identified competing clinical and personal obligations and significant barriers to simulation.
Considerable variability in performance existed among participants who completed the study, but overall, the curriculum alone was insufficient to improve simulator Joint Council on Thoracic Surgery Education scores compared to those not undergoing the curriculum. Among senior residents and fellows, provision of a practice curriculum and simulator for repeated practice is feasible but clinical and personal responsibilities were barriers to repetitive practice.
我们旨在使用低保真模拟平台检验心血管外科血管吻合术家庭实践课程的可行性，并研究其对高年资外科受训者技能获取的效果。
我们组织了一项多中心前瞻性随机研究，纳入高年资住院医师和研究员，他们接受了低保真心脏模拟器和 8 周主动脉和冠状动脉吻合术自主实践课程的指导。“治疗”组受训者接受模拟器和课程。对照组受训者仅接受常规手术经验。然后两组交叉进行；总共进行了 16 周的研究。在 0、8 和 16 周时采集视频技能评估，并由一名盲法调查员使用胸外科教育联合委员会评估工具进行评分。研究完成后，向受邀参与者分发了一份事后调查。
明尼苏达大学外科学系、梅奥诊所心血管外科和德克萨斯大学休斯顿健康科学中心。参与者在办公室、值班房和家中使用模拟器。
该研究通过胸科教育合作组征求项目参与。有 4 家机构表示有兴趣，共有 29 名受训者受邀参加研究并随机分组。其中，12 名（38%）完成了课程并提交了 3 套规定的视频（6 名治疗组，6 名对照组）。所有参与者均为普通和心胸外科的高年资住院医师和研究员。
在课程前后以及在整体或研究生年分层人群中，对照组前后的评估分数均无显著差异。在研究期间，参与者的病例数量对评估分数没有显著影响。随机参与者报告说对刻意练习技术技能非常感兴趣，但他们认为存在临床和个人责任方面的竞争以及模拟的重大障碍。
尽管完成研究的参与者之间存在相当大的表现差异，但总体而言，与未接受课程的参与者相比，仅课程本身不足以提高胸外科教育联合委员会模拟器评分。在高年资住院医师和研究员中，提供实践课程和模拟器以进行重复练习是可行的，但临床和个人责任是重复练习的障碍。
