Learn EVAR sizing from scratch: The results of a one-day intensive course in EVAR sizing and stent graft selection for vascular trainees

Abstract

Background and aim Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. Methods Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. Results All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30–48:20) min (median and range). The participants’ overall test scores (lower is better) were in median 17.9 (11.9–28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7–25.2) (<200 EVAR’s) ( p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 –18.7) (≥200 EVAR’s) ( p = .01). The sub-score for anatomical measurements was 10.6 (3.9–18.8) and comparable with the experienced group 9.7 (8.1–12.8) ( p = .83) but inferior to the expert operators 6.5 (5.2–10.2) ( p = .04). The sub-score for stent graft selection was 7.5 (4.9–14.1) and comparable with experienced operators scoring 4.5 (3.6–12.3) ( p = .09) but inferior to the expert operators score of 5.0 (3.6–8.4) ( p = .01). Conclusion This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.

A Systematic Review of Simulation-Based Training in Vascular Surgery

“…Strøm et al held a 1-d intensive course for EVAR sizing and stent-graft selection, using a CT Angiography computer program. 78 The test score comprised a subscore for anatomy measurements and modular stent-graft selection, which was devised by experts (content ¼ 2/2). An improvement in knowledge and skill was recorded, scoring an LoE ¼ 2/5.…”

A view from the top: A qualitative exploration of top‐level health care leaders’ perceptions on the implementation of simulation‐based education in postgraduate medical education

“…For instance, the simulation-based course in open and endovascular aortic aneurysm repair was developed based on the results of a needs assessment and is now offered to all vascular surgery trainees in the country. [22][23][24][25] Other available simulation-based courses include flexible bronchoscopy for residents in respiratory medicine, thoracoscopy for thoracic surgical trainees, knee arthroscopy and hip fracture surgery for orthopaedic surgical trainees. While these evidence-based simulation-based courses are available, they are not implemented as mandatory requirement for completing residency training.…”

“…These led to the development of simulation‐based courses that are offered nationally. For instance, the simulation‐based course in open and endovascular aortic aneurysm repair was developed based on the results of a needs assessment and is now offered to all vascular surgery trainees in the country 22–25 . Other available simulation‐based courses include flexible bronchoscopy for residents in respiratory medicine, thoracoscopy for thoracic surgical trainees, knee arthroscopy and hip fracture surgery for orthopaedic surgical trainees.…”

Simulation-based procedure training (SBPT) in rarely performed procedures: a blueprint for theory-informed design considerations

“…Simulation-based procedure training (SBPT) is now firmly integrated into health professions curriculums [ 6 – 8 ] with evidence suggesting it can be used either alongside or in replacement of traditional clinical experience for both low-stakes routine procedures [ 9 , 10 ] and high-stakes emergency procedures [ 11 – 14 ]. There is heterogeneity in reported outcomes of SBPT with some studies reporting improvement in high-level translational outcomes [ 15 – 18 ] such as reduced intensive care costs and infection rates, and others focusing on lower level outcomes such as time taken to perform a procedure [ 19 , 20 ].…”