Development of a pulsatile cadaver-based simulation for training of open abdominal vascular surgery skills

Faizer, Rumi; Singal, Ashish; Ojo, Clarence; Reed, Amy B.

doi:10.1016/j.jvs.2019.11.043

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Even though it demonstrated satisfying pulsatile flow in the upper arm, ascending aorta, and arch branches (all of which were close to the inflow cannulation), we unfortunately encountered a fluid leakage problem that adversely affected our ability to create peripheral vascular pulsatility in the lower extremities. To enhance the realism of vessel flow, a focus on the area of practice is important, such as clamping proximally and distally to the area of interest [ 18 ]. We did not apply an arterial balloon to create rhythmic pulsation in a peripheral artery due to the complexity of this procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, the abdominal surgery and vascular surgery survey items were scored the highest by workshop study participants (mean score for both: 4.73). Previous studies reported that a focus on organ-specific procedures when using a perfused cadaveric model enhances decision-making in bleeding-related procedures and dynamic scenarios [ 5 , 8 , 18 ]. However, the realism of simulated circulation in our study received the lowest score of 3.53.…”

Section: Discussionmentioning

confidence: 99%

“…This problem was also previously reported [ 5 , 7 , 8 , 21 ]. Measures that have been reported to remedy this tissue leakage and edema outcome include perfusing only as needed during simulated bleeding or vascular procedure, adjusting the flow of fluid with a pressure monitor, ligation of the pulmonary artery to reduce flow to lungs, bilateral iliac vein clamping, selective flow to a specific area of the body where a procedure is being performed, or use of the air perfusion technique [ 4 , 8 , 10 , 11 , 16 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

et al. 2022

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Background To develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training. Methods Fourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty. Results The results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods—mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures—mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence—mean score: 4.24/5.00, high score: 4.47/5.00. Conclusion The developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included ‘a more realistic training experience’ and ‘improved facilitation of decision-making and damage control practice during trauma surgery’.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

et al. 2022

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“…Cadaver training involves the handling of cadavers. In the cadaver fixation method, in addition to our SSS method, there is a report using N-vinyl-2-pyrrolidone [20], and there is also a report of creating a perfusion model by cannulating the cadaver's blood vessels [21][22][23][24][25]. In this way, cadaver training using a model closer to the living body may change the training effect of the participants and the result of their skills maintenance.…”

Section: Discussionmentioning

confidence: 99%

Repeated participation in the cadaver-based educational seminar for trauma surgery (C-BEST) could maintain training effects: skill retention at a 2-year follow-up

Homma¹,

Oda²,

Sano³

et al. 2021

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Although the effectiveness of cadaver surgical training has been clarified, the decline in training effects over time has become a problem. This study examined whether repeated participation in cadaver-based educational seminar for trauma surgery (C-BEST) could suppress the decline in training effects. Basic and advanced C-BEST have pelvic package (PP) and fasciotomy of the lower extremity (FLE) as common training skills. For participants of these skills twice each, we examined the changes in a 10-point self-assessment of confidence levels (SACL) at six time points: (1) before the seminar of basic C-BEST, (2) immediately after basic C-BEST, (3) half a year after basic C-BEST, (4) before advanced C-BEST, (5) immediately after advanced C-BEST, and (6) half a year after advanced C-BEST. Data were collected from 28 basic C-BESTs and 5 advanced C-BESTs conducted from January 2013 to January 2020. Statistical analysis was performed by comparing SACL results from seminar evaluations at the six points, with significance at P < 0.05. A total of 60 participants were enrolled (postgraduate year, 16.5 ± 5.7). The interval between basic and advanced C-BEST was 27.1 ± 6.9 months. In PP, the SACL did not decrease at all six points. In FLE, SACL did not decrease at all six points, had a greater increase before versus immediately after advanced C-BEST, and did not decrease thereafter (P < 0.05). After participants retook the seminar, FLE-like procedures, which are unfamiliar to nonorthopedic surgeons, had increased and maintained self-evaluation values, whereas PP-like procedures, which are familiar to abdominal surgeons, had maintained high self-evaluation values. Therefore, repeated seminar participation could maintain the effects of cadaver training.

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“…The potential of cadaver-based pedagogy, and in particular, cadaver-based simulation (CBS) is striking, particularly with respect to educating clinicians to be prepared for High Accuity, Low Occurrence (HALO) events, like emergency intubations (Kovacs et al, 2018 ), as well as in the context of surgical skills training (Faizer et al, 2020 ; Kim et al, 2016 ; Lovasik et al, 2021 ) and even, in some cases, to support humanities endeavours (Böckers et al, 2010 ; Lempp, 2005 ; Ross et al, 2021 ). Much in the same way there is skill and strategy associated with other educational work (for example, developing reliable and valid assessment tools, or writing an effective problem-based learning case), there is a specific expertise associated with preparing cadavers for CBS.…”

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confidence: 99%

Negotiating humanity: an ethnography of cadaver-based simulation

MacLeod

Cameron

Luong

et al. 2022

Adv in Health Sci Educ

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Human body donation (HBD) serves an essential function in many medical schools, particularly in institutions where people engage in cadaver-based simulation (CBS) as a pedagogical approach. The people who facilitate HBD and CBS have a highly specialized skill set, yet their expertise remains largely unacknowledged, and takes place out of sight from the broader medical school community. This manuscript, based on a two-year practice-based ethnography (Structured Observations n = 68 h, Unstructured Observations n = 150 + hours; Interviews n = 24; and Document/Policy Analysis n = 14) illuminates the complex work of HBD. We identify three primary functions of HBD and CBS (1. Cadaver Intake & Administration, 2. Cadaver Preparation, and 3. Cadaver-Based Pedagogy). We describe how medical educators involved in CBS have developed a skillset specific to their role: negotiating humanity.

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Development of a pulsatile cadaver-based simulation for training of open abdominal vascular surgery skills

Cited by 8 publications

References 5 publications

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

Repeated participation in the cadaver-based educational seminar for trauma surgery (C-BEST) could maintain training effects: skill retention at a 2-year follow-up

Negotiating humanity: an ethnography of cadaver-based simulation

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