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Ricard C, Plewa D, Vernamonti J, Scott EM, Nepomnayshy D, Benoit E. Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region. JOURNAL OF SURGICAL EDUCATION 2023; 80:1843-1849. [PMID: 37770295 DOI: 10.1016/j.jsurg.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs. METHODS An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum. RESULTS The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR). CONCLUSIONS This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs.
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Affiliation(s)
- Caroline Ricard
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Deanna Plewa
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jack Vernamonti
- General Surgery Department, Maine Medical Center, Portland, Maine
| | - Erin M Scott
- General Surgery Department, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Dmitry Nepomnayshy
- Simulation Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Eric Benoit
- General Surgery Department, Lahey Hospital and Medical Center, Burlington, Massachusetts; Trauma and Acute Care Surgery Department, Lahey Hospital and Medical Center, Burlington Massachusetts
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Clifford E, Stourton F, Willers J, Colucci G. Development of a Low-Cost, High-Fidelity, Reusable Model to Simulate Clamshell Thoracotomy. Surg Innov 2023; 30:739-744. [PMID: 37876028 PMCID: PMC10656785 DOI: 10.1177/15533506231208572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Clamshell thoracotomy (CST) is an emergency procedure performed during traumatic cardiac arrest. Emergency physicians and surgeons are expected to perform this procedure in the Emergency Department. However, the procedure has a low occurrence rate, therefore physicians are often poorly prepared. Current teaching methods include expensive simulators and anatomically inaccurate animal models. The goal of this study was to design, produce and test, a low-cost, high-fidelity model for the teaching of CST. DESIGN, SETTING AND PARTICIPANTS The model was produced from inexpensive, commercially available materials as well as ADAMgel; a custom, recyclable, inexpensive tissue analogue. The model was tested across 19 physicians, mostly consultants and senior registrars in emergency medicine, anaesthesia and surgery. Participants completed comparative questionnaires before and after testing the model. The questionnaires were adapted from previous anaesthetic-based simulation studies and used a modified Likert scale to assess prior knowledge, anatomical realism and the teaching benefits of the model. RESULTS Participants had varied prior knowledge and experience before testing the model. Results showed that 89.47% (n = 17) of trainees felt the model was a reasonable substitute for practice and 100% (n = 19) agreed that the model was a good training aid for inexperienced trainees and would recommend it to others. CONCLUSIONS The model proved a successful teaching tool, improving physicians' knowledge and confidence with performing CST. This high fidelity, low cost model demonstrated that a high standard simulation teaching tool can be made which improves teaching of CST.
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Affiliation(s)
| | - Frederick Stourton
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Johann Willers
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
| | - Gianluca Colucci
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK
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3
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Whittaker G, Ghita IA, Taylor M, Salmasi MY, Granato F, Athanasiou T. Current Status of Simulation in Thoracic Surgical Training. Ann Thorac Surg 2023; 116:1107-1115. [PMID: 37201622 DOI: 10.1016/j.athoracsur.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Simulation is playing an increasingly important role in surgical training but is not yet a mandatory part of most surgical curricula. A simulator must undergo rigorous validation to verify it as a reliable tool. The aim of this study was to review the literature to identify simulators that are currently available to augment thoracic surgical training and to analyze any evidence supporting or validating them. METHODS A literature search of the MEDLINE (1946 to November 2022) and Embase (1947 to November 2022) databases was performed to identify simulators for basic skills and procedures in thoracic surgery. A selection of keywords were used to perform the literature search. After identification of appropriate articles, data were extracted and analyzed. RESULTS Thirty-three simulators were found in 31 articles. Simulators for basic skills (n = 13) and thoracic lobectomy (n = 13) were most commonly described, followed by miscellaneous (n = 7). Most models were of a hybrid modality (n = 18). Evidence of validity was established in 48.5% (n = 16) of simulators. In total, 15.2% (n = 5) of simulators had 3 or more elements of validity demonstrated, and only 3.0% (n = 1) accomplished full validation. CONCLUSIONS Numerous simulators of varying modality and fidelity exist for a variety of thoracic surgical skills and procedures, although validation evidence is frequently inadequate. Simulation models may be able to provide training in basic surgical and procedural skills; however, further assessment of validity needs to be undertaken before consideration of their integration into training programs.
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Affiliation(s)
- George Whittaker
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - Ioana-Alexandra Ghita
- Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - M Yousuf Salmasi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Evans K, Woodruff J, Cowley A, Bramley L, Miles G, Ross A, Cooper J, Baxendale B. GENESISS 2-Generating Standards for In-Situ Simulation project: a systematic mapping review. BMC MEDICAL EDUCATION 2022; 22:537. [PMID: 35818052 PMCID: PMC9272657 DOI: 10.1186/s12909-022-03401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. METHODS A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. RESULTS Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. CONCLUSIONS This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
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Affiliation(s)
- Kerry Evans
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | | | - Alison Cowley
- Nottingham University Hospitals Trust, Research & Innovation, Nottingham, UK
| | - Louise Bramley
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Giulia Miles
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
| | - Alastair Ross
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Joanne Cooper
- Nottingham University Hospitals Trust, Institute of Care Excellence, Nottingham, UK
| | - Bryn Baxendale
- Trent Simulation & Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, Notts UK
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Miller DT, Zaidi HQ, Sista P, Dhake SS, Pirotte MJ, Fant AL, Salzman DH. Creation and Implementation of a Mastery Learning Curriculum for Emergency Department Thoracotomy. West J Emerg Med 2020; 21:1258-1265. [PMID: 32970583 PMCID: PMC7514402 DOI: 10.5811/westjem.2020.5.46207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Emergency department thoracotomy (EDT) is a lifesaving procedure within the scope of practice of emergency physicians. Because EDT is infrequently performed, emergency medicine (EM) residents lack opportunities to develop procedural competency. There is no current mastery learning curriculum for residents to learn EDT. The purpose of this study was to develop and implement a simulation-based mastery learning curriculum to teach and assess EM residents’ performance of the EDT. Methods We developed an EDT curriculum using a mastery learning framework. The minimum passing standard (MPS) for a previously developed 22-item checklist was determined using the Mastery Angoff approach. EM residents at a four-year academic EM residency program underwent baseline testing in performing an EDT on a simulation trainer. Performance was scored by two raters using the checklist. Learners then participated in a novel mastery learning EDT curriculum that included an educational video, hands-on instruction, and deliberate practice. After a three-month period, residents then completed initial post testing. Residents who did not meet the minimum passing standard after post testing participated in additional deliberate practice until mastery was obtained. Baseline and post-test scores, and time to completion of the procedure were compared with paired t-tests. Results Of 56 eligible EM residents, 54 completed baseline testing. Fifty-two residents completed post-testing until mastery was reached. The minimum passing standard was 91.1%, (21/22 items correct on the checklist). No participants met the MPS at the baseline assessment. After completion of the curriculum, all residents subsequently reached the MPS, with deliberate practice sessions not exceeding 40 minutes. Scores from baseline testing to post-testing significantly improved across all postgraduate years from a mean score of 10.2/22 to 21.4/22 (p <0.001). Mean time to complete the procedure improved from baseline testing (6 minutes [min] and 21 seconds [sec], interquartile range [IQR] = 4 min 54 sec - 7 min 51 sec) to post-testing (5 min 19 seconds, interquartile range 4 min 17sec - 6 min 15 sec; p = 0.001). Conclusion This simulation-based mastery learning curriculum resulted in all residents performing an EDT at a level that met or exceeded the MPS with an overall decrease in time needed to perform the procedure.
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Affiliation(s)
- Danielle T Miller
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Hashim Q Zaidi
- University of Chicago School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Priyanka Sista
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Sarah S Dhake
- NorthShore University Health System, Department of Emergency Medicine, Chicago, Illinois
| | - Matthew J Pirotte
- Vanderbilt University School of Medicine, Department of Emergency Medicine, Nashville, Tennessee
| | - Abra L Fant
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - David H Salzman
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
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Life-saving interventions in pediatric trauma: A National Trauma Data Bank experience. J Trauma Acute Care Surg 2020; 87:1321-1327. [PMID: 31464866 DOI: 10.1097/ta.0000000000002478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergent procedures are infrequent in pediatric trauma. We sought to determine the frequency and efficacy of life-saving interventions (LSI) performed for pediatric trauma patients within the first hour of care at a trauma center. METHODS The National Trauma Data Bank (2010-2014) was queried for patients 19 years or younger who underwent LSIs within 1 hour of arrival to the emergency department. Life-saving interventions included emergency department thoracotomy (EDT) and emergent airway procedures (EAP). Multivariable logistic regression was used to evaluate the influence of patient and hospital characteristics on mortality. RESULTS Of 725,284 recorded traumatic encounters, only 1,488 (0.2%) pediatric patients underwent at least one of the defined LSI during the 5-year study period (EDT, 1,323; EAP, 187). Most patients (85.6%) were 15 years or older. Mortality was high but varied by procedure type (EDT, 64.3%; EAP, 28.3%). Mortality for patients younger than 1 year undergoing EDT was 100%, decreasing to 62.6% in patients aged 15 years to 19 years. For EAP, mortality ranged from 66.7% for infants to 27.2% in 15-year-old to 19-year-old patients. Lower Glasgow Coma Scale score, higher Injury Severity Score, presence of shock, and a blunt mechanism of injury were independently associated with mortality in the EDT cohort. On average, trauma centers in this study performed approximately one LSI per year, with only 13.8% of cases occurring at a verified pediatric trauma center. CONCLUSION Life-saving interventions in the pediatric trauma population are uncommon and outcomes variable. Novel solutions to keep proficient at such interventions should be sought, especially for younger children. Guidelines to improve identification of appropriate candidates for LSI are critical given their rare occurrence. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Bengiamin DI, Toomasian C, Smith DD, Young TP. Emergency Department Thoracotomy: A Cost-Effective Model for Simulation Training. J Emerg Med 2019; 57:375-379. [PMID: 31378446 DOI: 10.1016/j.jemermed.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/05/2019] [Accepted: 06/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation provides a safe learning environment where high-stakes, low-frequency procedures can be practiced without the fear of being unsuccessful or causing harm. Emergency department thoracotomy (EDT) is one such procedure. Realistic thoracotomy models are expensive and not readily available. OBJECTIVE Our objective is to describe a cost-effective, realistic, reproducible, and reusable thoracotomy model for simulation training. METHODS We modified a commercially available clothes mannequin torso to expose the chest and abdominal cavity. A plastic skeleton composed of a spinal cord and ribs was placed inside the torso. Tubing was used to simulate the aorta and esophagus; both tubes were secured to the distal spine with zip ties. Commercially available lungs and heart were placed inside the chest cavity. A small rubber ball simulated the left lung to be able to maneuver the lung. The heart was covered with plastic wrap to simulate the pericardium. Thick tape was used to simulate the pleural cavity. Yoga mats were used to simulate the intercostal muscles, subcutaneous tissue, and skin. RESULTS This model was tested with Emergency Medicine (EM) residents during a simulation session. A voluntary survey was available for residents to provide feedback. Survey results confirmed that the model provided valuable education, with overall positive feedback. CONCLUSION This EDT model provides a valuable teaching opportunity to EM residents who otherwise might not have the opportunity to perform this procedure. Residents agreed that the model improved their confidence and is an effective method in providing the opportunity to practice this low-frequency, high-stakes procedure.
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Affiliation(s)
- Deena I Bengiamin
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Cory Toomasian
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Dustin D Smith
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
| | - Timothy P Young
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University Medical Simulation Center, Loma Linda, California
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The epidemiology of emergency department thoracotomy in a statewide trauma system: Does center volume matter? J Trauma Acute Care Surg 2019; 85:311-317. [PMID: 29672440 DOI: 10.1097/ta.0000000000001937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. METHODS We queried the Pennsylvania Trauma Outcomes Study registry from 2007 to 2015 for all EDTs performed at Level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume, and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. RESULTS 1,399 EDTs were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared with patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). CONCLUSIONS Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared with those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower-volume centers. LEVEL OF EVIDENCE Prognostic/Epidemiological, level III; Therapeutic, level IV.
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Bohnen JD, Demetri L, Fuentes E, Butler K, Askari R, Anand RJ, Petrusa E, Kaafarani HMA, Yeh DD, Saillant N, King D, Briggs S, Velmahos GC, Moya MD. High-Fidelity Emergency Department Thoracotomy Simulator With Beating-Heart Technology and OSATS Tool Improves Trainee Confidence and Distinguishes Level of Skill. JOURNAL OF SURGICAL EDUCATION 2018; 75:1357-1366. [PMID: 29496361 DOI: 10.1016/j.jsurg.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Resuscitative Thoracotomy or Emergency Department Thoracotomy (EDT) is a time-sensitive and potentially life-saving procedure. Yet, trainee experience with this procedure is often limited in both clinical and simulation settings. We sought to develop a high-fidelity EDT simulation module and assessment tool to facilitate trainee education. DESIGN Using the Kern model for curricular development, a group of expert trauma surgeons identified EDT as a high-stakes, low-frequency procedure. Task analysis identified 5 key steps of EDT: (1) opening chest/rib spreader utilization; (2) pericardiotomy/cardiac repair; (3) open cardiac massage; (4) clamping aorta; and (5) control of pulmonary hilum. A high-fidelity simulator with beating-heart technology was built. The previously validated Objective Structured Assessment of Technical Skills (OSATS) was adapted to create the "EDT-OSATS" which assessed performance along several domains: (1) Surgical technique (key steps); (2) general skills; and (3) global rating. A pilot test was performed to compare board-certified trauma surgeons (i.e., Experts) with categorical general surgery interns (i.e., Novices). Each subject received preparatory materials, completed a presimulation quiz, performed a videotaped procedure on the EDT simulator, and completed a postmodule survey. Two independent raters scored performances using the EDT-OSATS. Groups were compared in descriptive and unadjusted analyses. We hypothesized that our EDT simulation module would distinguish between expert vs novice performance and improve trainee confidence. SETTING Simulation laboratory at Massachusetts General Hospital in Boston, MA. PARTICIPANTS Trauma surgeons (Experts, n = 6) and categorical general surgery interns (Novices, n = 8). RESULTS Experts scored significantly higher than Novices on nearly all components of the EDT-OSATS, including: (1) surgical technique: pericardiotomy (4.2 vs 3.4, p = 0.040), cardiac massage (3.6 vs 2.4, p = 0.028), clamping aorta (4.1 vs 3.3, p = 0.035), control of pulmonary hilum (4.8 vs 3.4, p < 0.001); (2) general skills: time/motion (4.1 vs 2.9, p = 0.011), knowledge and handling of instruments (4.3 vs 3.1, p = 0.004), and (3) global rating (3.9 vs 2.9, p = 0.026). There was no statistical difference between groups on opening chest/rib spreader utilization (3.8 vs 3.3, p = 0.352) or procedure time (204sec vs 227sec, p = 0.401), though Experts scored numerically higher than Novices on every measure. Novices reported significantly increased confidence after the simulation (3.1 vs 1.4, p = 0.001). Ninety-three percent (13/14) of participants found the simulator realistic. CONCLUSIONS Our novel high-fidelity beating-heart EDT simulator is realistic and improves trainee confidence in this low-frequency, high-stakes emergency procedure. The EDT-OSATS tool differentiates between performances of experienced surgeons vs novice trainees on the beating-heart simulator. This training module and accompanying assessment instrument hold promise as a learning tool for clinicians who may perform emergency department thoracotomy.
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Affiliation(s)
- Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Leah Demetri
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Eva Fuentes
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Kathryn Butler
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts; Learning Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Susan Briggs
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin-Froedtert Trauma Center, Milwaukee, Wisconsin.
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The narrow field of view: challenges in sustaining a robotic open-heart program. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-018-0656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Ribeiro IB, Ngu JM, Lam BK, Edwards RA. Simulation-Based Skill Training for Trainees in Cardiac Surgery: A Systematic Review. Ann Thorac Surg 2018; 105:972-982. [DOI: 10.1016/j.athoracsur.2017.11.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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12
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Ott T, Gerth MA, Emrich L, Buggenhagen H, Werner C. Simulation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0135-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Brunette V, Thibodeau-Jarry N. Simulation as a Tool to Ensure Competency and Quality of Care in the Cardiac Critical Care Unit. Can J Cardiol 2016; 33:119-127. [PMID: 28024550 DOI: 10.1016/j.cjca.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Cardiac critical care units are high-risk clinical environments. Medical emergencies are frequent and require the intervention of a cohesive, efficient, and well trained interprofessional team. In modern clinical practice there is increased emphasis on safety but also increased lack of acceptance of medical errors and as a consequence, increased litigation. In the past decade, simulation-based learning has arisen as an effective and safe means to learn and practice acute care setting skills. It has been used and studied in different contexts including procedural skills training, crisis resource management and team training, patient and family member communication skills, and health care system quality improvement. Simulation-based education is a relatively recent teaching strategy and evidence of its efficacy continues to grow. Nevertheless, many influential medical societies are now promoting a simulation-based approach for cardiovascular training and continuing medical education. In this article we review the simulation literature in the intensive care unit and evaluate its integration in coronary care units and postoperative cardiovascular intensive care units. We also provide resources for educators and clinicians who wish to implement simulation workshops in these settings.
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Affiliation(s)
- Véronique Brunette
- Critical Care Department, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, Québec, Canada; Surgical Department, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
| | - Nicolas Thibodeau-Jarry
- Masters of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, Massachusetts, USA
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Gause CD, Hsiung G, Schwab B, Clifton M, Harmon CM, Barsness KA. Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses. J Laparoendosc Adv Surg Tech A 2016; 26:663-70. [PMID: 27352106 DOI: 10.1089/lap.2016.0249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. MATERIALS AND METHODS After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data. RESULTS Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely. CONCLUSION Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.
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Affiliation(s)
- Colin D Gause
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Grace Hsiung
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Ben Schwab
- 2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Matthew Clifton
- 4 Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta , Atlanta, Georgia .,5 Division of Pediatric Surgery, Department of Surgery, Emory University , Children's Hospital of Atlanta, Atlanta, Georgia
| | - Carroll M Harmon
- 6 Division of Pediatric Surgery, Department of Surgery, Women and Children's Hospital of Buffalo , Buffalo, New York.,7 Department of Surgery, State University of New York at Buffalo , Buffalo, New York
| | - Katherine A Barsness
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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