Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: The Boot Camp experience

Abstract

Objective We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station. Methods At “Boot Camp,” 33 first-year cardiothoracic surgical residents participated in 4-hour coronary anastomosis sessions (6–7 attending surgeons per group of 8–9 residents). At beginning, midpoint, and session end, anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months. Results Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 ± 0.58 (forceps use) to 2.44 ± 0.48 (needle angles). Midpoint scores ranged from 1.76 ± 0.63 (forceps use) to 1.91 ± 0.49 (needle angles). Session end scores ranged from 1.29 ± 0.45 (needle holder use) to 1.58 ± 0.50 (needle transfer and suture management and tension; P < .001). Video recordings confirmed improved performance (interrater reliability > 0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room. Conclusions Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary.

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“…The assessment tool, which is based on a modified Objective Structured Assessment of Technical Skills (OSATS), included 12 component skills scored on a 5-point Likert scale (1 ¼ poor; 5 ¼ excellent), with descriptive anchors specific to each component [2,5,9,11]. Also, a pass-fail grade was given based on overall performance in executing the coronary anastomosis, as judged by the rater.…”

“…A range of low-fidelity and high-fidelity models have been considered for use [2][3][4], including simple to lifelike synthetic models, explant tissues, and cadaver or animal tissues. An annual "boot camp" has been established to provide CT fellows an opportunity to train on available models [5,6]. Although not quantified in the literature, it is clear that trainees entering CT surgery have variable baseline technical skills.…”

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“…Strategies have been developed in thoracic surgery and in surgical education as a whole to incorporate more simulation, more structured curricula, and clear outlines for achieving educational goals in a particularly challenging environment [1,5,6]. New training paradigms have been developed, and faculty programs to "educate the educators" have gained momentum [7][8][9].…”

Incorporating simulation into gynecologic surgical training

“…But this early simulation will better prepare them for complex procedures when they are senior residents. 22,23 Currently, we do not grade or evaluate residents during simulation exercises.…”