Simulation Improves Resident Performance in Catheter-Based Intervention:Results of a Randomized Controlled Study
Rabih A. Chaer, MD*, Brian G. DeRubertis, MD*, Stephanie C. Lin, MD*, Harry L. Bush, MD*, John K. Karwowski, MD*, Daniel Birk, BA*, Nicholas J. Morrissey, MD*, Peter L. Faries, MD*, James F. McKinsey, MD*, K Craig Kent, MD
Columbia, Weill Cornell Division of Vascular Surgery @ New York Presbyterian Hospital, New York, NY, Columbia, Weill Cornell Division of Vascular Surgery @ New York Presbyterian Hospital, New York, NY
OBJECTIVE(S): Surgical simulation has become an important component of the training of general surgery residents. Since catheter-based techniques have become a critical part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents.
METHODS: Twenty general surgery residents received a handbook as well as didactic training in the techniques of catheter intervention. Residents were then randomized with 10 receiving additional training with the Procedicus, computer-based, haptic simulator. All 20 residents then participated in two consecutive mentored catheter-based interventions for lower extremity occlusive disease in an OR/angiography suite. Resident performance was graded by attending surgeons blinded to the residents training status, using 18 procedural steps (table 1-perfect score=72) as well as a subjective evaluation (table-2-perfect score=48).
RESULTS: Resident groups were equivalent with regard to demographics and scores on a visuospatial test administered at study outset. Residents exposed to simulation uniformly scored higher than controls during the first angio/OR intervention (simulation/control): procedural steps (50±6 vs. 33±9, p=0.0015); subjective evaluation (30±7 vs. 19±5, p=0.0052). Moreover, the advantage of simulator training persisted with the second intervention procedural steps (53±6 vs. 36±7, p=0.0006); subjective evaluation (33±6 vs. 21±6, p=0.0015). Simulation training led to enhancement in almost all of the individual measures of performance (tables 1&2).
CONCLUSIONS: Simulation is a valid tool for teaching surgical residents basic endovascular skills and should be incorporated into surgical training programs. Moreover, simulators may also benefit the large number of vascular surgeons who seek retraining in catheter-based intervention.
|Table1. Selected examples of procedural steps||Simulator (mean score)||Control (mean score)||P-value||Table 2. Selected examples of subjective evaluation||Simulator (mean score)||Control (mean score)||P- value|
|Advance wire atraumatically||2.8||2.0||0.03||Wire and catheter handling||3.0||1.9||0.009|
|Constantly visualize wire tip||3.1||1.9||0.001||Awareness of wire position||3.0||1.8||0.01|
|Walk catheter back over wire||3.4||2.7||0.05||Wire stability||3.0||2.1||0.04|
|Advance balloon over wire||3.4||2.6||0.02||Fluoroscopy usage||2.0||1.1||0.003|
|Center balloon over stenosis||2.9||1.9||0.003||Precision of wire/catheter technique||2.8||1.7||0.005|
|Walk balloon back over wire||3.3||2.0||0.006||Flow of operation||2.8||1.2||0.002|
|Advance stent over wire||3.4||2.2||0.01||Ability to complete the case||2.6||1.4||0.01|
|Center stent over stenosis||2.9||1.8||0.01||Need for verbal prompts||2.4||1.4||0.01|
|Accurately deploy stent||3.3||2.0||0.006||Attending takeover||2.6||1.7||0.01|
Back to Scientific Program