American Surgical Association
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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.
Table 1&2
Table1. Selected examples of procedural stepsSimulator (mean score)Control (mean score)P-valueTable 2. Selected examples of subjective evaluationSimulator (mean score)Control (mean score)P- value
Advance wire atraumatically2.82.00.03Wire and catheter handling3.01.90.009
Constantly visualize wire tip3.11.90.001Awareness of wire position3.01.80.01
Walk catheter back over wire3.42.70.05Wire stability3.02.10.04
Advance balloon over wire3.42.60.02Fluoroscopy usage2.01.10.003
Center balloon over stenosis2.91.90.003Precision of wire/catheter technique2.81.70.005
Walk balloon back over wire3.32.00.006Flow of operation2.81.20.002
Advance stent over wire3.42.20.01Ability to complete the case2.61.40.01
Center stent over stenosis2.91.80.01Need for verbal prompts2.41.40.01
Accurately deploy stent3.32.00.006Attending takeover2.61.70.01

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