Simulation and skills training in mitral valve surgery. J Thorac Cardiovasc Surg 2011 Jan;141(1):107-12
Date
11/16/2010Pubmed ID
21074189DOI
10.1016/j.jtcvs.2010.08.059Scopus ID
2-s2.0-78650266921 (requires institutional sign-in at Scopus site) 71 CitationsAbstract
OBJECTIVE: Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery.
METHODS: After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score.
RESULTS: Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency.
CONCLUSIONS: Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement.
Author List
Joyce DL, Dhillon TS, Caffarelli AD, Joyce DD, Tsirigotis DN, Burdon TA, Fann JIMESH terms used to index this publication - Major topics in bold
AnimalsCardiac Surgical Procedures
Clinical Competence
Education, Medical, Graduate
Feedback, Psychological
Humans
Internship and Residency
Learning
Mitral Valve
Models, Anatomic
Models, Animal
Motor Skills
Swine
Time Factors
Video Recording
