Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
Department of Congenital Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, England, UK.
Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3). doi: 10.1093/icvts/ivac122.
To demonstrate that improvement in technical performance of congenital heart surgical trainees during ventricular septum defect (VSD) closure simulation translates to better patient outcomes.
Seven trainees were divided into 2 groups. Experienced-fellows group included 4 senior trainees who had performed >5 VSD closures. Residents group consisted of 3 residents who had never performed a VSD closure. Experienced-fellows completed 3 VSD closures on real patients as a pretest. Both groups participated in a 4-week simulation requiring each participant to complete 2 VSD closures on three-dimensional printed models per week. One month later, all trainees returned for a post-test operation in real patients. All performances were recorded, blinded and scored independently by 2 cardiac surgeons using the validated Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS). Predefined surgical outcomes were analysed.
The median HOST-CHS score increased significantly from week 1 to 4 [50 (39, 58) vs 73 (65, 74), P < 0.001] during simulation. The improvement in the simulation of experienced-fellows successfully transferred to skill acquisition [HOST-CHS score 72.5 (71, 74) vs 54 (51, 60), P < 0.001], with better patients outcomes including shorter total cross-clamp time [pretest: 86 (70, 99) vs post-test: 60 (53, 64) min, P = 0.006] and reduced incidence of major patch leak requiring multiple pump runs [pretest: 4/11 vs post-test: 0/9, P = 0.043]. After simulation, the technical performance and surgical outcomes of Residents were comparable to Experienced-fellows in real patients, except for significantly longer cross-clamp time [Residents: 76.5 (71.7, 86.8) vs Experienced-fellows: 60 (53, 64) min, P = 0.002].
Deliberate practice using simulation translates to better performance and surgical outcomes in real patients. Residents who had never completed a VSD closure could perform the procedures just as safely and effectively as their senior colleagues following simulation.
证明先天性心脏外科受训者在室间隔缺损（VSD）封堵模拟中的技术表现的改善可转化为更好的患者结局。
将 7 名受训者分为 2 组。经验丰富的学员组包括 4 名已完成 >5 例 VSD 封堵术的高级学员。学员组由 3 名从未进行过 VSD 封堵术的住院医师组成。经验丰富的学员在真实患者上完成了 3 次 VSD 封堵术，作为预测试。两组均参加了为期 4 周的模拟训练，要求每位学员每周在三维打印模型上完成 2 次 VSD 封堵术。一个月后，所有学员均返回真实患者进行术后测试手术。所有操作均由 2 名心脏外科医生独立记录、盲法和评分，采用经过验证的动手外科培训-先天性心脏病手术（HOST-CHS）。分析了预先定义的手术结果。
模拟过程中，从第 1 周到第 4 周，HOST-CHS 评分明显升高[50（39，58）比 73（65，74），P < 0.001]。经验丰富的学员在模拟中的进步成功地转化为技能获取[HOST-CHS 评分 72.5（71，74）比 54（51，60），P < 0.001]，并带来了更好的患者结局，包括总体外循环时间更短[预测试：86（70，99）比术后测试：60（53，64）min，P = 0.006]和需要多次泵运行的主要补片漏的发生率降低[预测试：4/11 比术后测试：0/9，P = 0.043]。模拟后，住院医师的技术表现和手术结果与真实患者中的经验丰富的学员相当，除体外循环时间明显延长外[住院医师：76.5（71.7，86.8）比经验丰富的学员：60（53，64）min，P = 0.002]。
使用模拟进行刻意练习可转化为真实患者中更好的表现和手术结果。从未完成过 VSD 封堵术的住院医师在模拟后可以像他们的高级同事一样安全有效地进行这些操作。
