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Caradu C, Poggi E, di Lorenzo G, Settembre N, Webster C, Raffort J, Lareyre F. Simulation training in vascular and endovascular surgery: A nationwide survey among surgeon educators and trainees in France. Ann Vasc Surg 2024:S0890-5096(24)00395-9. [PMID: 39013488 DOI: 10.1016/j.avsg.2024.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Vascular surgical training is evolving towards simulation-based methods to enhance skill development, ensure patient safety, and adapt to changing regulations. This study aims to investigate the utilization of simulation training among vascular surgeons in France, amidst ongoing shifts in teaching approaches and educational reforms. METHODS A national survey assessed the experiences and perceptions of vascular surgery professionals regarding simulation training. Participation was open to self-reported health professionals specialized (or specializing) in vascular surgery, including interns or fellows. Participants were recruited through various channels, and data were collected via a questionnaire covering participant characteristics, simulation experiences, and perceptions. RESULTS Seventy-six participants, predominantly male (74%) took part in the survey. While 58% reported access to simulation laboratories, only 17% had organized simulation sessions 1 to 3 times a year, and 5% had sessions more than 10 times annually. High fidelity simulators were available in 57% of institutions, while low fidelity simulators were available in 50%. Regarding funding, 20% received financial assistance for training, predominantly from industry (18%). One third of the participants experienced 9 or more sessions (34%), lasting between 1 to 2 hours (34%), 30% expressed satisfaction with access to simulation, while 33% were dissatisfied with communication of simulation training opportunities. CONCLUSION Despite recognizing the benefits of simulation training, its integration into vascular surgery education in France remains incomplete. Challenges such as limited access and communication barriers hinder widespread adoption. Collaborative efforts are needed to ensure uniformity and enhance the effectiveness of simulation training in vascular surgery education.
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Affiliation(s)
- Caroline Caradu
- Bordeaux University Hospital, Department of Vascular Surgery, Bordeaux, France.
| | - Elise Poggi
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Gilles di Lorenzo
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France
| | - Nicla Settembre
- Nancy University Hospital, Department of Vascular Surgery, Nancy, France
| | - Claire Webster
- Imperial College London, Department of Vascular Surgery, London, UK
| | - Juliette Raffort
- Université Côte d'Azur, CNRS, UMR7370, LP2M, Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France; Clinical Chemistry Laboratory, University Hospital of Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, CNRS, UMR7370, LP2M, Nice, France
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Faner Capó X, Flota Ruiz D, Boqué Torrmorell M, Constenla García I, Bellmunt Montoya S. Evaluation of the Carbon Footprint of a Simulation Course in Vascular Surgery: Initial Steps Towards Carbon Neutral Events. Eur J Vasc Endovasc Surg 2024; 68:129-130. [PMID: 38316353 DOI: 10.1016/j.ejvs.2024.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/13/2024] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Xavier Faner Capó
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David Flota Ruiz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | - Iván Constenla García
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Bellmunt Montoya
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Roche AF, Moneley D, Lawler T, Boyle E, Gosi G, O'Callaghan A, Cahir C, O'Keeffe D, Condron CM. Remote feedback in endovascular simulation training: a mixed-methods study. Adv Simul (Lond) 2024; 9:24. [PMID: 38863034 PMCID: PMC11165733 DOI: 10.1186/s41077-024-00297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND There is an increasing need to increase simulation-based learning opportunities for vascular surgery residents in endovascular skills training. This study aims to explore the effectiveness of remote expert instructional feedback of endovascular simulation-based education, as a means of increasing training opportunities in this area for vascular surgery residents. METHODS A mixed-methods study design was adopted. Twelve vascular surgery residents from Ireland were tasked with completing two endovascular renal artery procedures: one with in-person expert feedback and the other with remote instruction. Participants ranged in experience levels from second year to final year of residency. Following the training activities, interviews and a questionnaire were employed to gather information on the usefulness of remote feedback. RESULTS There was no significant difference reported by participants using a post-event validated questionnaire between remote and in-person feedback. During the interviews, participants expressed mixed feelings about the presence of the educator while practicing, but they eventually saw no limiting factors to their practice when the trainer provided remote feedback. When receiving performance feedback remotely, clear communication and a shared knowledge of the task development are critical to success. CONCLUSIONS We believe these findings can inform the design and development of remote learning and assessment of endovascular skills training and ultimately provide increased opportunities for more skills practice for vascular surgical residents.
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Affiliation(s)
- Adam F Roche
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- RCSI SIM Centre for Simulation Education & Research, 26 York Street, Dublin 2, D02 P796, Ireland.
| | | | - Tim Lawler
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emily Boyle
- Tallaght University Hospital, Dublin, Ireland
| | - Greg Gosi
- University Hospital Waterford, Waterford, Ireland
| | | | - Caitriona Cahir
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dara O'Keeffe
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire M Condron
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Goins SM, Thornton S, Horne E, Hoehn B, Brush E, Thamby J, Hemesath A, Cantrell S, Greenwald E, Tracy E. Educational Strategies in Pediatric Trauma Resuscitation Across Disciplines: A Scoping Review. J Surg Res 2024; 298:230-239. [PMID: 38626721 DOI: 10.1016/j.jss.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Trauma is the leading cause of death and disability in children. Differences in mechanism, injury pattern, severity, and physiology in this population distinguish pediatric trauma patients from adults. Educational techniques including simulation and didactics may improve pediatric readiness in this setting. We summarize the literature across disciplines, highlighting the curricular approaches, target provider population, educational content, content delivery method, and Kirkpatrick level for pediatric trauma resuscitation education. METHODS The MEDLINE (via Ovid), Embase (via Elsevier), Cumulative Index to Nursing & Allied Health Literature Complete (via EBSCO), Education Database (via ProQuest), and Web of Science Social Science Citation Index and Science Citation Index (via Clarivate) were searched. We reviewed 90 manuscripts describing pediatric trauma resuscitation education programs. When available, target provider population, curricular content, delivery method, and Kirkpatrick level were obtained. RESULTS Nurses (50%), residents (45%), and attending physicians (43%) were the most common participants. Airway management (25%), shock (25%), and general trauma (25%) were the most frequently taught concepts, and delivery of content was more frequently via simulation (65%) or didactics (52%). Most studies (39%) were Kirkpatrick Level 1. CONCLUSIONS This review suggests that diverse strategies exist to promote pediatric readiness. Most training programs are interdisciplinary and use a variety of educational techniques. However, studies infrequently report examining the impact of educational interventions on patient-centered outcomes and lack detail in describing their curriculum. Future educational efforts would benefit from heightened attention to such outcome measures and a rigorous description of their curricula to allow for reproducibility.
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Affiliation(s)
- Stacy M Goins
- Duke University School of Medicine, Durham, North Carolina.
| | | | | | - Brooke Hoehn
- Duke University School of Medicine, Durham, North Carolina
| | - Erin Brush
- Duke University School of Medicine, Durham, North Carolina
| | - Julie Thamby
- Duke University School of Medicine, Durham, North Carolina
| | | | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina; Duke University Medical Center Library & Archives, Durham, North Carolina
| | - Emily Greenwald
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Brian R, Rodriguez N, Rapp J, Chern H, O'Sullivan P, Gomez-Sanchez C. Vascular Anastomoses and Dissection: A Six-Part Simulation Curriculum for Surgical Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11406. [PMID: 38957530 PMCID: PMC11219091 DOI: 10.15766/mep_2374-8265.11406] [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: 06/14/2023] [Accepted: 02/28/2024] [Indexed: 07/04/2024]
Abstract
Introduction As surgical technologies grow, so too do demands on surgical trainees to master increasing numbers of skill sets. With the rise of endovascular surgery, trainees have fewer opportunities to practice open vascular techniques in the operating room. Simulation can bridge this gap. However, existing published open vascular simulation curricula are basic or based on expensive models. Methods We iteratively developed an open vascular skills curriculum for second-year surgery residents comprising six 2-hour sessions. We refined the curriculum based on feedback from learners and faculty. The curriculum required skilled facilitators, vascular instruments, and tissue models. We evaluated the latest iteration with a survey and by assessing participants' technical skills using the Objective Structured Assessment of Technical Skills (OSATS) form. Results Over the past 10 years, 101 residents have participated in the curriculum. Nine of 13 residents who participated in the latest curricular iteration completed the survey. All respondents rated the sessions as excellent and strongly agreed that they had improved their abilities to perform anastomoses with tissue and prosthetic. Facilitators completed 18 OSATS forms for residents in the fifth and sixth sessions of the latest iteration. Residents scored well overall, with a median 26.5 (interquartile range: 24-29) out of a possible score of 35, with highest scores on knowledge of instruments. Discussion This simulation-based curriculum facilitates open vascular surgical skill acquisition among surgery residents. The curriculum allows residents to acquire critical vascular skills that are challenging to learn in an increasingly demanding operative setting.
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Affiliation(s)
- Riley Brian
- Research Resident, Department of Surgery, University of California, San Francisco
| | - Natalie Rodriguez
- Third-Year Resident, Department of Surgery, University of California, San Francisco
| | - Joseph Rapp
- Professor Emeritus of Surgery, Department of Surgery, University of California, San Francisco
| | - Hueylan Chern
- Professor of Surgery, Department of Surgery, University of California, San Francisco
| | - Patricia O'Sullivan
- Professor of Medicine and Surgery, School of Medicine, University of California, San Francisco
| | - Clara Gomez-Sanchez
- Assistant Professor of Surgery, Department of Surgery, University of California, San Francisco
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Skov RAC, Lawaetz J, Stroem M, Van Herzeele I, Resch TA, Eiberg JP. Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment. Eur J Vasc Endovasc Surg 2024; 67:672-680. [PMID: 37979611 DOI: 10.1016/j.ejvs.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) is being used increasingly for the treatment of infrarenal abdominal aortic aneurysms. Improvement in educational strategies is required to teach future vascular surgeons EVAR skills, but a comprehensive, pre-defined e-learning and simulation curriculum remains to be developed and tested. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), an assessment tool for simulation based education (SBE) in EVAR, has previously been designed to assess EVAR skills, and a pass limit defining mastery level has been set. However, EVARATE was developed for anonymous video ratings in a research setting, and its feasibility for real time ratings in a standardised SBE programme in EVAR is unproven. This study aimed to test the effect of a newly developed simulation based modular course in EVAR. In addition, the applicability of EVARATE for real time performance assessments was investigated. METHODS The European Society of Vascular Surgery (ESVS) and Copenhagen Certification Programme in EVAR (ENHANCE-EVAR) was tested in a prospective cohort study. ENHANCE-EVAR is a modular SBE programme in EVAR consisting of e-learning and hands-on SBE. Participants were rated with the EVARATE tool by experienced EVAR surgeons. RESULTS Twenty-four physicians completed the study. The mean improvement in EVARATE score during the course was +11.8 (95% confidence interval 9.8 - 13.7) points (p < .001). Twenty-two participants (92%) passed with a mean number of 2.8 ± 0.7 test attempts to reach the pass limit. Cronbach's alpha coefficient was 0.91, corresponding to excellent reliability of the EVARATE scale. Differences between instructors' EVARATE ratings were insignificant (p = .16), with a maximum variation between instructors of ± 1.3 points. CONCLUSION ENHANCE-EVAR, a comprehensive certifying EVAR course, was proven to be effective. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE) is a trustworthy tool for assessing performance within an authentic educational setting, enabling real time feedback.
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Affiliation(s)
- Rebecca A C Skov
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Michael Stroem
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Timothy A Resch
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
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Foresti R, Fornasari A, Bianchini Massoni C, Mersanne A, Martini C, Cabrini E, Freyrie A, Perini P. Surgical Medical Education via 3D Bioprinting: Modular System for Endovascular Training. Bioengineering (Basel) 2024; 11:197. [PMID: 38391683 PMCID: PMC10886183 DOI: 10.3390/bioengineering11020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
There is currently a shift in surgical training from traditional methods to simulation-based approaches, recognizing the necessity of more effective and controlled learning environments. This study introduces a completely new 3D-printed modular system for endovascular surgery training (M-SET), developed to allow various difficulty levels. Its design was based on computed tomography angiographies from real patient data with femoro-popliteal lesions. The study aimed to explore the integration of simulation training via a 3D model into the surgical training curriculum and its effect on their performance. Our preliminary study included 12 volunteer trainees randomized 1:1 into the standard simulation (SS) group (3 stepwise difficulty training sessions) and the random simulation (RS) group (random difficulty of the M-SET). A senior surgeon evaluated and timed the final training session. Feedback reports were assessed through the Student Satisfaction and Self-Confidence in Learning Scale. The SS group completed the training sessions in about half time (23.13 ± 9.2 min vs. 44.6 ± 12.8 min). Trainees expressed high satisfaction with the training program supported by the M-SET. Our 3D-printed modular training model meets the current need for new endovascular training approaches, offering a customizable, accessible, and effective simulation-based educational program with the aim of reducing the time required to reach a high level of practical skills.
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Affiliation(s)
- Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Arianna Mersanne
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Diagnostic Department, University-Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Elisa Cabrini
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
| | - Paolo Perini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University-Hospital of Parma, 43126 Parma, Italy
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Shayan AM, Singh S, Gao J, Groff RE, Bible J, Eidt JF, Sheahan M, Gandhi SS, Blas JV, Singapogu R. Measuring hand movement for suturing skill assessment: A simulation-based study. Surgery 2023; 174:1184-1192. [PMID: 37597999 PMCID: PMC10592328 DOI: 10.1016/j.surg.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND To maximize patient safety, surgical skills education is increasingly adopting simulation-based curricula for formative skills assessment and training. However, many standardized assessment tools rely on human raters for performance assessment, which is resource-intensive and subjective. Simulators that provide automated and objective metrics from sensor data can address this limitation. We present an instrumented bench suturing simulator, patterned after the clock face radial suturing model from the Fundamentals of Vascular Surgery, for automated and objective assessment of open suturing skills. METHODS For this study, 97 participants (35 attending surgeons, 32 residents, and 30 novices) were recruited at national vascular conferences. Automated hand motion metrics, especially focusing on rotational motion analysis, were developed from the inertial measurement unit attached to participants' hands, and the proposed suite of metrics was used to differentiate between the skill levels of the 3 groups. RESULTS Attendings' and residents' performances were found to be significantly different from novices for all metrics. Moreover, most of our novel metrics could successfully distinguish between finer skill differences between attending and resident groups. In contrast, traditional operative skill metrics, such as time and path length, were unable to distinguish attendings from residents. CONCLUSION This study provides evidence for the effectiveness of rotational motion analysis in assessing suturing skills. The suite of inertial measurement unit-based hand motion metrics introduced in this study allows for the incorporation of hand movement data for suturing skill assessment.
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Affiliation(s)
| | - Simar Singh
- Department of Bioengineering, Clemson University, SC
| | - Jianxin Gao
- Department of Electrical and Computer Engineering, Clemson University, SC
| | - Richard E Groff
- Department of Electrical and Computer Engineering, Clemson University, SC
| | - Joe Bible
- School of Mathematical and Statistical Sciences, Clemson University, SC
| | - John F Eidt
- Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX
| | - Malachi Sheahan
- Division of Vascular and Endovascular Surgery, Department of Surgery, Louisiana State University Health Sciences Centre, New Orleans, LA
| | - Sagar S Gandhi
- University of South Carolina School of Medicine-Greenville, SC; Division of Vascular Surgery, Greenville Health System, SC
| | - Joseph V Blas
- University of South Carolina School of Medicine-Greenville, SC; Division of Vascular Surgery, Greenville Health System, SC
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Soenens G, Lawaetz J, Doyen B, Fourneau I, Moreels N, Konge L, Eiberg J, Van Herzeele I. Massed Training is Logistically Superior to Distributed Training in Acquiring Basic Endovascular Skills. Eur J Vasc Endovasc Surg 2023; 66:730-737. [PMID: 37482280 DOI: 10.1016/j.ejvs.2023.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE A "PROficiency based StePwise Endovascular Curricular Training" (PROSPECT) has proven its superiority over traditional training in a randomised controlled trial to acquire basic endovascular skills outside theatre, but real life adherence is low. This study aimed to compare the original distributed training format, where trainees learn at their own pace, with a massed training format offering the same content within a limited time span while exempt from clinical duties. Secondly, long term skills retention was evaluated. METHODS A multicentre, prospective study allocated participants to the distributed D-PROSPECT or to a massed, compact version (C-PROSPECT) based on logistics such as travel time, participant and instructor availability. A multiple choice question (MCQ) test (max. score 20) tested cognitive skills. Technical skills were assessed using a global rating scale (GRS) (max. score 55), examiner's checklist (max. score 85), and validated simulator metrics. Data were collected pre- and post-programme and at three, six, and 12 months after programme completion. RESULTS Over four years and in two countries, D-PROSPECT was implemented in two centres and C-PROSPECT in three. A total of 22 participants completed D-PROSPECT with a 41% dropout rate, and 21 completed C-PROSPECT with 0% dropout rate. All participants showed significant improvement for all performance parameters after programme completion: MCQ test (median 14.5 vs. 18; p < .001), GRS (median 20 vs. 41; p < .001), examiner's checklist (median 49 vs. 78.5; p < .001), and simulation metrics (p < .001). Scores of C- or D-PROSPECT participants were not significantly different. No significant differences were seen between groups during the retention period. CONCLUSION PROSPECT significantly improves the quality of simulated endovascular performances using a massed or distributed training format. A massed training format of PROSPECT may be preferred to decrease dropout during standardised training to obtain basic endovascular skills in existing surgical curricula.
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Affiliation(s)
- Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Jonathan Lawaetz
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas Eiberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark; Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Lawaetz J, Soenens G, Eiberg J, Van Herzeele I, Konge L, Nesbitt C, Gentile F, Stavroulakis K, Weiss S, Nayahangan LJ. Facilitators and Barriers to Implementation of Simulation Based Education in Vascular Surgery in Europe. Eur J Vasc Endovasc Surg 2023; 66:428-436. [PMID: 37330202 DOI: 10.1016/j.ejvs.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/27/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study explored the status and availability of simulation based education (SBE) for learning vascular surgical procedures identified in the 2019 General Needs Assessment in vascular surgery in Europe (GNA-2019) and identified facilitators and barriers to SBE implementation in vascular surgery. METHODS A three round iterative survey was distributed via the European Society for Vascular Surgery and the Union Européenne des Médecins Spécialistes. Members from leading committees and organisations within the European vascular surgical community were invited to participate as key opinion leaders (KOLs). Three online survey rounds explored demographics, SBE availability, and facilitators and barriers to SBE implementation. RESULTS Overall, 147 KOLs (target population 338) accepted invitation to round 1, representing 30 European countries. The dropout rates for rounds 2 and 3 were 29% and 40%, respectively. Most respondents (88%) were senior, consultant level or higher. No mandatory SBE training was required in their department before training on patients, according to 84% of the KOLs. There was high consensus on the need for structured SBE (87%) and mandatory SBE (81%). SBE is available for the top three prioritised procedures in GNA-2019 (basic open skills, basic endovascular skills, and vascular imaging interpretation) in 24, 23, and 20 of the 30 represented European countries, respectively. The highest ranking facilitators were structured SBE programmes, availability of simulation equipment locally and regionally, good quality simulators, and having a dedicated person running the SBE. The highest ranked barriers were lack of structured SBE curriculum, equipment costs, lack of SBE culture, no or limited dedicated time for faculty to teach in SBE, and clinical work overload. CONCLUSION Based largely on the opinions of KOLs in vascular surgery in Europe, this study revealed that SBE is needed in vascular surgery training and that systematic and structured programmes are required to ensure successful implementation.
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Affiliation(s)
- Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Craig Nesbitt
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | | | | | - Salome Weiss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Copenhagen, Denmark
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Maguire SC, O'Callaghan AP, Traynor O, Strawbridge JD, Kavanagh DO. A National Needs Assessment in Simulation Based Training in Vascular Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1039-1045. [PMID: 37271598 DOI: 10.1016/j.jsurg.2023.05.005] [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: 10/22/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this research was to ascertain the highest need areas for vascular simulation, in order to tailor training for the highest impact. DESIGN, PARTICIPANTS AND SETTING A needs assessment was conducted according to best practices using the Delphi method. All consultant vascular surgeons/trainers in the training jurisdiction (n=33) were approached through an independent intermediary to contribute and generate a prioritized list of procedures for training. The research team were blinded to participant identities. Three rounds were conducted according to the Delphi process and scored according to the Copenhagen Needs Assessment Formula (CAMES-NAF). RESULTS A final list of 34 vascular procedures was selected and prioritized by surgical trainers. Principles of arterial repair and endarterectomy/patching were considered the highest priority. Complex major interventions such as open abdominal aortic aneurysm (AAA) repair, carotid endarterectomy, and endovascular aortic repair (EVAR) consistently ranked higher than rarer, such as first rib resection and more basic procedures, such as foam injection for varicose veins. Major lower limb amputations typically ranked lower overall compared to arterial interventions. Surgical trainers generally agreed with the ranking according to the CAMES-NAF. There was some disagreement for a select few procedures such as iliac stenting (which rose 13 places) and open radial artery exposure (which fell 6 places) on subsequent iterations. CONCLUSIONS Core operative principles and common major operative cases should remain the priority for vascular technical skills training. Other procedures which may be less invasive, but have the potential for major complications should also not be overlooked. In designing simulators the main focus should center on specific skill acquisition for commonly performed major procedures and management of the recognized potential complications. Lower limb amputations are considered adequately taught in clinical practice, or are too challenging to simulate in simulator models apart from cadaveric models.
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Affiliation(s)
- Seán C Maguire
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland.
| | - Adrian P O'Callaghan
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Judith D Strawbridge
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland (RCSI), Stephen's Green, Dublin 2, Ireland
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Scali ST, Stone DH. The role of big data, risk prediction, simulation, and centralization for emergency vascular problems: Lessons learned and future directions. Semin Vasc Surg 2023; 36:380-391. [PMID: 37330249 DOI: 10.1053/j.semvascsurg.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Vascular specialists remain in high demand in current practice and commonly oversee care delivery for a variety of clinical emergencies. Accordingly, the contemporary vascular surgeon must be facile with treating a spectrum of problems, including a complex, heterogeneous group of acute arteriovenous thromboembolic and bleeding diatheses. It has been documented previously that there are substantial current workforce limitations placing constraints on vascular surgical care provision. Moreover, with the aging at-risk population, there remains a considerable national urgency to improve timely diagnoses, specialty consultation, and appropriate transfer of patients to centers of excellence capable of providing a comprehensive compendium of emergency vascular services. Clinical decision aids, simulation training, and regionalization of nonelective vascular problems are all strategies that have been increasingly recognized to address these service gaps. Notably, clinical research in vascular surgery has traditionally focused on identification of patient- and procedure-related factors that influence outcomes by using resource-intensive causal inference methodology. By comparison, large data sets have only more recently been recognized to be a valuable tool that can provide heuristic algorithms to address more complex health care problems. Such data can be manipulated to generate clinical risk scores and decision aids, as well as robust outcome descriptions, which stand to inform stakeholders regarding best practice. The purpose of this review was to provide a robust overview of the lessons derived from the application of big data, risk prediction, and simulation in the management of vascular emergencies.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, 1600 SW Archer Road, Suite NG45, PO Box 100128, Gainesville, FL, 32608.
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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