Development of a saphenous vein harvest model for simulation-based assessment

Simulation-based training in cardiac surgery: a systematic review

OBJECTIVES

The increase in the complexity of operations, the rising quest for improved outcomes and the scrutiny of surgical practice and its associated complications have led to a decreased educational value of in-patient surgical training within cardiac surgery. Simulation-based training has emerged as an adjunct to the apprenticeship model. In the following review, we aimed to evaluate the currently available evidence regarding simulation-based training in cardiac surgery.

METHODS

A systematic database search was conducted as per PRISMA guidelines, of original articles that explored the use of simulation-based training in adult cardiac surgery programs in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to 2022. Data extraction covered the study characteristics, simulation modality, main methodology and main outcomes.

RESULTS

Our search yielded 341 articles, of which 28 studies were included in this review. Three main areas of focus were identified: (i) validity testing of the models; (ii) impact on surgeons' skills; and (iii) impact on clinical practice. Fouteen studies reported animal-based models and 14 reported on non-tissue-based models covering a wide spectrum of surgical operations. The results of the included studies suggest that validity assessment is scarce within the field, being carried out for only 4 of the models. Nonetheless, all studies reported improvement in trainees' confidence, clinical knowledge and surgical skills (including accuracy, speed, dexterity) of trainees both at senior and junior levels. The direct clinical impact included initiation of minimally invasive programmes and improved board exam pass rates, and creating positive behavioural changes to minimize further cardiovascular risk.

CONCLUSIONS

Surgical simulation has been shown to provide substantial benefits to trainees. Further evidence is needed to explore its direct impact on clinical practice.

The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: a systematic review

OBJECTIVES

With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula.

METHODS

Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity.

CONCLUSIONS

Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons.

Simulation in Upper and Lower Limb Trauma Skill Acquisition: A Review

SUMMARY STATEMENT

This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management.