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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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Osztrogonacz P, Benfor B, Haddad P, Barnes R, Chinnadurai P, Dang V, Hess JP, Corr SJ, Rahimi M. Cadaveric aortic aneurysm creation: A life-like model for training endovascular repair. J Vasc Surg Cases Innov Tech 2023; 9:101115. [PMID: 37692905 PMCID: PMC10492191 DOI: 10.1016/j.jvscit.2023.101115] [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: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 09/12/2023] Open
Abstract
The recent decline in RAAA incidence and the fast paced scenario with associated challenges regarding training calls for initiative for a better training environment to maximize learning. This led us to the creation of a pulsatile human cadaveric RAAA model. Fresh frozen cadaver was used to create RAAA with BioTissue in hybrid suite with ability to perform CBCTA for sizing. As a proof of concept, the model was used to perform REVAR with proximal CODA balloon control. The model proved to be feasible and we believe it is a better environment to train and gain adequate proficiency in RAAA management.
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Affiliation(s)
- Peter Osztrogonacz
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Bright Benfor
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Paul Haddad
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Rebecca Barnes
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
| | - Ponraj Chinnadurai
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
- Advanced Therapies, Siemens Medical Solutions USA Inc, Malvern, PA
| | - Vy Dang
- School of Medicine, Texas A&M, Bryan, TX
| | - John Paul Hess
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stuart J Corr
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
- Department of Bioengineering, Rice University, Houston, TX
- Institute of Life Science 2, Swansea University Medical School, Sketty, Swansea, United Kingdom
- Weill Cornell Medical College, Cornell University, New York, NY
| | - Maham Rahimi
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX
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Isaak A, Wolff T, Zdoroveac A, Taher F, Gürke L, Richarz S, Akifi S. Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation Simulation Training in a Lifelike Flow Model. Bioengineering (Basel) 2022; 9:bioengineering9110659. [PMID: 36354570 PMCID: PMC9687548 DOI: 10.3390/bioengineering9110659] [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: 09/26/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: To assess the feasibility and training effect of simulation training for ultrasound-guided percutaneous arteriovenous fistula (pAVF) creation in a lifelike flow model. Methods: Twenty vascular trainees and specialists were shown an instructional video on creating a pAVF in a dedicated flow model and then randomized to a study or control group. The procedure was divided into five clearly defined steps. Two observers rated the performance on each step, and the time to perform the exercise was recorded. The study group participants underwent supervised hands-on training on the model before performing a second rated pAVF creation. All participants subsequently completed a feedback questionnaire. Results: After supervised simulation training, the study groups participants increased their mean performance rating from 2.2 ± 0.9 to 3.2 ± 0.7. A mean of 3.8 ± 0.8 procedure steps was accomplished independently (control group 2.1 ± 1.4; p < 0.05). The time taken to perform the procedure was 15.6 ± 3.8 min in the study group (control group 27.2 ± 7.3, p < 0.05). The participants with previous experience in ultrasound-guided vascular procedures (n = 5) achieved higher overall mean scores 3.0 ± 0.8 and accomplished more steps without assistance (2.0 ± 1.0) during the simulation training compared to their inexperienced peers (1.5 ± 0.3 and 0.8 ± 0.4, respectively). The feedback questionnaire revealed that the study group participants strongly agreed (n = 7) or agreed (n = 3) that training on the simulation model improved their skills regarding catheter handling. Conclusions: The study group participants increased their overall performance after training on the simulator. More experienced attendees performed better from the beginning, indicating the model to be lifelike and a potential skill assessment tool. Simulation training for pAVF creation using a lifelike model may be an intermediate step between acquiring ultrasound and theoretical pAVF skills and procedure guidance in theatre. However, this type of training is limited by its reliance on the simulator quality, demonstration devices and costs.
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Affiliation(s)
- Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
- Correspondence: ; Tel.: +41-62-838-45-13
| | - Thomas Wolff
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Andrei Zdoroveac
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Fadi Taher
- Vascular and Endovascular Surgery, Klinik Ottakring, Montlearstrasse 37, 1160 Wien, Austria
| | - Lorenz Gürke
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Sabine Richarz
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Shuaib Akifi
- Vascular and Endovascular Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
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Siegl G, Ott T, Cohnert T. Simulation-based training as a continuous means of vascular surgical education—a roadmap. Eur Surg 2022. [DOI: 10.1007/s10353-022-00758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Summary
Background
Simulation-based training has become an important part of the educational approach in many professions. Over the past decades it has slowly found recognition in the medical field and in surgery in particular. Research has clearly shown the advantages of learning and honing skills on simulators in safe environments, especially for junior doctors. For this purpose, a number of models and methods have been developed to enable open vascular surgery training.
Methods
Extensive research was performed for the development of simulation-based training for vascular surgery. Different types of models and techniques were investigated. Aspects of specific theoretical and practical means of education and training were considered. This initiated the development of a simulation center for open vascular surgery.
Results
Perfused simulators and necessary surgical instruments were acquired for open vascular surgery training at the Simulation Center of the Styrian state hospitals, located at the University Hospital, Graz Medical University, in Graz. A fully equipped mock operating room is available for simulation. In-house junior and senior doctors from the Department of Vascular Surgery have the monthly opportunity to perform simulation-based training. Courses for all state hospitals are planned twice per year.
Conclusion
Simulation-based training is a safe, efficient, and well-manageable possibility for improving the education of future experts in open vascular surgery. It can help hone simple skills such as suture techniques as well as prepare for complex surgical procedures. In time we hope to further integrate simulation-based training in the existing curriculum.
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Torres IO, Becari A, Escudeiro GDPM, de Carvalho JPLM, Simão da Silva E, Puech-Leão P, De Luccia N. The use of a low-fidelity simulator to improve vascular anastomosis skills of residents during the COVID-19 pandemic. Ann Vasc Surg 2022; 83:87-96. [PMID: 35398200 PMCID: PMC8985405 DOI: 10.1016/j.avsg.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
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Lal BK, Cambria R, Moore W, Mayorga-Carlin M, Shutze W, Stout CL, Broussard H, Garrett HE, Nelson W, Titus JM, Macdonald S, Lake R, Sorkin JD. Evaluating the optimal training paradigm for transcarotid artery revascularization based on worldwide experience. J Vasc Surg 2022; 75:581-589.e1. [PMID: 34562569 PMCID: PMC8792193 DOI: 10.1016/j.jvs.2021.08.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) is a new hybrid approach to carotid artery revascularization. Proctored training on live cases is an effort-, time-, and resource-intensive approach to learning new procedures. We analyzed the worldwide experience with TCAR to develop objective performance metrics for the procedure and compared the effectiveness of training physicians using cadavers or synthetic models to that of traditional in-person training on live cases. METHODS Physicians underwent one of three mandatory training programs: (1) in-person proctoring on live TCAR procedures, (2) supervised training on human cadavers, and (3) supervised training on synthetic models. The training details and information from all subsequent independently performed TCAR procedures were recorded. The composite clinical adverse events (ie, transient ischemic attack, stroke, myocardial infarction, death) and composite technical adverse events (ie, aborted procedure, conversion to surgery, bleeding, dissection, cranial nerve injury, or device failure, occurring within 24 hours were recorded). Four procedural proficiency measures were recorded: procedure time, flow-reversal time, fluoroscopy time, and contrast volume. We compared the adverse event rates between the procedures performed by physicians after undergoing the three training modes and tested whether the proficiency measures achieved during TCAR after training on cadavers and synthetic models were noninferior to proctored training. RESULTS From March 3, 2009 to May 7, 2020, 1160 physicians had undergone proctored (19.1%), cadaver-based (27.4%), and synthetic model-based (53.5%) TCAR training and had subsequently performed 17,283 TCAR procedures. The proctored physicians had treated younger patients and more patients with asymptomatic carotid stenosis and had had more prior experience with transfemoral carotid stenting. The overall 24-hour composite clinical and technical adverse event rates, adjusted for age, sex, and symptomatic status, were 1.0% (95% confidence interval, 0.8%-1.3%) and 6.0% (95% confidence interval, 5.4%-6.6%), respectively, and did not differ significantly by training mode. The proficiency measures of cadaver-trained and synthetic model-trained physicians were not inferior to those for the proctored physicians. CONCLUSIONS We have presented key objective proficiency metrics for performing TCAR and an analytic framework to assess adequate training for the procedure. Training on cadavers or synthetic models achieved clinical outcomes, technical outcomes, and proficiency measures for subsequently performed TCAR procedures similar to those achieved with training using traditional proctoring on live cases.
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Affiliation(s)
- Brajesh K Lal
- Department of Vascular Surgery, University of Maryland, Baltimore, Md.
| | - Richard Cambria
- Division of Vascular Surgery, St Elizabeth's Medical Center, Boston, Mass
| | - Wesley Moore
- Division of Vascular Surgery, University of California, Los Angeles, Los Angeles, Calif
| | | | - William Shutze
- Division of Vascular Surgery, Texas Vascular Associates, The Heart Hospital Plano, Plano, Tex
| | | | - Heath Broussard
- Division of Vascular Surgery, The Jackson Clinic PA, Jackson, Tenn
| | - H Edward Garrett
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
| | - Wayne Nelson
- Division of Vascular Surgery, St Charles Medical Center, Bend, Ore
| | - Jessica M Titus
- Division of Vascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn
| | | | - Rachel Lake
- Department of Vascular Surgery, University of Maryland, Baltimore, Md
| | - John D Sorkin
- Department of Medicine, University of Maryland, Baltimore, Md
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Lin JC, Welle N, Ding J, Chuen J. A look to the future: Pandemic-induced digital technologies in vascular surgery. Semin Vasc Surg 2021; 34:139-151. [PMID: 34642034 PMCID: PMC8502076 DOI: 10.1053/j.semvascsurg.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.
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Affiliation(s)
- Judith C Lin
- Michigan State University College of Human Medicine 4660 S. Hagadorn Rd. Ste. #600 East Lansing, MI 48823.
| | - Nicholas Welle
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Joel Ding
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
| | - Jason Chuen
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
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Pantoja JL, Archie MM, Baril DT, Moore WS, Lawrence PF. Trainee Experience in Simulation-Based Education of Open Vascular Surgery. Ann Vasc Surg 2020; 73:147-154. [PMID: 33373767 DOI: 10.1016/j.avsg.2020.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Simulation continues to be an important adjunct to vascular surgery training, yet the optimal implementation of simulation to complement conventional surgical training continues to evolve. This study aims to find areas for improvement in current simulation-based training of open vascular skills by characterizing the experience of vascular trainees attending a national simulation-based course. METHOD This was a survey study conducted at the simulation course of the Annual UCLA/SVS Symposium: A Comprehensive Review and Update of What's New in Vascular and Endovascular Surgery, a national vascular surgery meeting. The survey consisted of 17 questions and was administered on paper or electronically via the Audience Response System, before the start of the course. The survey assessed the participants' experience in formal training, simulation training, and comfort with open surgical procedures. RESULTS Between 2013 and 2018, the survey was completed by 150 participants of which 65% were vascular fellows. Only 48% of the participants had formal training in suturing and surgical instruments. Most participants had formal training in basic vascular techniques and advanced vascular operations. In 71%, simulation was incorporated into basic technique training and 60% in open surgical training. Simulation training was most commonly utilized in learning anastomotic techniques and open abdominal aortic aneurysm repair. Simulation skills were deemed translatable to the operating room by 59% of participants. Most participants were comfortable performing open vascular procedures. However, 68% of participants were uncomfortable performing an abdominal aortic aneurysm repair. CONCLUSIONS There continues to be a significant portion of trainees who do not undergo a simulation-based education. Current simulation training is being targeted to meet trainee needs in open vascular surgery, specifically open aneurysm repair. Nonetheless, trainees continue to have doubts regarding applicability of simulation-based skills to the operating theater. Further studies investigating access to simulation education as well as its translatability are needed.
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Affiliation(s)
- Joe L Pantoja
- Division of Vascular Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA.
| | - Meena M Archie
- Division of Vascular Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Donald T Baril
- Division of Vascular Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Wesley S Moore
- Division of Vascular Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Peter F Lawrence
- Division of Vascular Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
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Lu J, Cuff RF, Mansour MA. Simulation in surgical education. Am J Surg 2020; 221:509-514. [PMID: 33358139 DOI: 10.1016/j.amjsurg.2020.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023]
Abstract
Simulation is becoming an important tool in surgical education. Surgical faculty have been forced to modify how they teach technical skills. Instead of a complete reliance on teaching in the operating room, a structured curriculum and dedicated time in the simulation center are being used in many centers. Some of the advantages of this approach include the ability to learn and practice new procedures in a safe and nurturing environment. The disadvantages include the significant cost of virtual reality simulators and the competition, between various training programs, to gain access to simulation.
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Affiliation(s)
- Joyce Lu
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States
| | - Robert F Cuff
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States
| | - M Ashraf Mansour
- Spectrum Health Medical Group, Department of Surgery, Michigan State University College of Human Medicine, United States.
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Taher F, Plimon M, Isaak A, Falkensammer J, Pablik E, Walter C, Kliewer M, Assadian A. Ultrasound-Guided Percutaneous Arterial Puncture and Closure Device Training in a Pulsatile Model. JOURNAL OF SURGICAL EDUCATION 2020; 77:1271-1278. [PMID: 32205111 DOI: 10.1016/j.jsurg.2020.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/20/2020] [Accepted: 02/29/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The current study assesses the feasibility of in vitro practice of percutaneous puncture techniques in a pulsatile flow-model. DESIGN Prospective, controlled, randomized study. SETTING The percutaneous access to endovascular aortic repair is considered safe, but success rates may be dependent on surgeon experience with the technique. PARTICIPANTS Fourteen vascular surgery trainees and consultants were enrolled and randomized to a study or control group with both groups receiving instructions by a tutor on how to perform ultrasound guided percutaneous puncture and closure using a suture-mediated closure device. The study group received additional hands-on training on a pulsatile flowmodel of the groin and the performance of both groups was then graded. Study group participants were timed during and after their training on the model. RESULTS The study group achieved higher overall grading than the control group on a 5-point scale with higher scores indicating a better performance (mean overall scores 4.0 ± 0.7 versus 2.8 ± 1.0, respectively; p = 0.03). Experienced participants (more than 20 punctures performed before the study) achieved higher overall scores than trainees (3.8 ± 0.4 versus 2.5 ± 0.8, respectively; p = 0.01). Five participants in the study group could deploy and close the ProGlide closure device correctly without the help of a tutor while being graded (71% in the study versus 0% in the control group; p = 0.02). Study group participants improved their overall score from 3.2 ± 0.9 to 4.0 ± 0.7 during training (p = 0.02). Time needed to complete the puncture and closure reduced from 456 seconds on average before, to 302 seconds after training (p < 0.001). CONCLUSIONS Study group participants could improve their overall score while working on the simulator. More experienced participants performed better during the simulation, which may indicate the model to be life-like and a potential skills assessment tool. Simulation training may be a valuable adjunct to traditional forms of training when teaching an endovascular technique but is limited by its reliance on simulators and demo devices.
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Affiliation(s)
- Fadi Taher
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria.
| | - Markus Plimon
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Switzerland
| | - Juergen Falkensammer
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Eleonore Pablik
- Section for Medical Statistics - CeMSIIS, Medical University of Vienna, Austria
| | - Corinna Walter
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Miriam Kliewer
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
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Nayahangan LJ, Van Herzeele I, Konge L, Koncar I, Cieri E, Mansilha A, Debus S, Eiberg JP. Achieving Consensus to Define Curricular Content for Simulation Based Education in Vascular Surgery: A Europe Wide Needs Assessment Initiative. Eur J Vasc Endovasc Surg 2019; 58:284-291. [DOI: 10.1016/j.ejvs.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 10/26/2022]
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Fletcher B, De La Ree J, Drougas J. Development of a pulsatile, tissue-based, versatile vascular surgery simulation laboratory for resident training. J Vasc Surg Cases Innov Tech 2017; 3:209-213. [PMID: 29349426 PMCID: PMC5765174 DOI: 10.1016/j.jvscit.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/15/2017] [Indexed: 01/22/2023] Open
Abstract
Simulation in surgery is becoming an important component of surgical education. Training on bench top models has been demonstrated to improve technical skills. The objective of our project was to create a vascular surgery simulation model. The simulation model consists of a platform, artificial blood reservoir, artificial blood, inflow and outflow limbs, electric motor, battery, pulse generator, and cryopreserved vessel. Three different vascular surgery simulation stations were created: carotid endarterectomy with shunting and patch angioplasty, arterial bypass, and arteriovenous graft formation. A scientific study involving surgical residents will need to be undertaken to determine whether this simulator has intermodal transferability.
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Affiliation(s)
- Brian Fletcher
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Jaime De La Ree
- The Bradley Department of Electrical and Computer Engineering, Department of Engineering, Virginia Tech, Roanoke, Va
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Cacioppa LM, Pini R, Longhi M, Vacirca A, Gallitto E, Faggioli G, Gargiulo M, Stella A. The Value of Carotid Endarterectomy as a Learning Tool for Trainees. Ann Vasc Surg 2017; 47:195-199. [PMID: 28890063 DOI: 10.1016/j.avsg.2017.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/21/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) intervention needs a specific training and a sufficient learning curve to obtain optimal results in terms of outcome. A formative program was settled up in a single academic center to optimize training of standard CEA procedures. This study aims to evaluate the 11-year results of the teaching CEA program. METHODS The trainees CEA teaching program is carried on during the 5-year vascular surgery residency period, and it is stratified as follows: learning theory and intervention assistance (minimum 50 procedures per year) in the first and second residency year; performing CEA as second operator in the third and fourth residency year (minimum 50 procedures per year); CEA execution as first operator with attending supervision in the last residency year. All CEA procedures from 2005 to 2015 were retrospectively collected and the 30-day results were compared according to the expertise of the first operator: experienced vascular surgeons (EVSs) versus trainees. All CEA procedures were performed in general anesthesia, with routine shunting and patching. RESULTS In the study period, 1,379 (361 [26.2%] symptomatic; 1,018 [73.8%] asymptomatic) CEAs were performed. Trainees performed 199 (14.4%) CEAs as first operator. Patients submitted to CEA by trainees were similar in terms of preoperative clinical characteristics except for the patients' age (trainees 72.4 years versus EVS 70.8 years, P = 0.02) and smoking history (trainees 30.7% versus EVS 24.1%, P = 0.04). The 30-day complication rates were similar in CEA performed by trainees versus EVS: stroke 0.5% vs. 1.1%, P = 0.5; death 0.0% vs. 0.5%, P = 0.6; stroke/death 0.5% vs. 1.7%, P = 0.24; hematoma 3.0% vs. 2.2%, P = 0.48; and cranial nerve injury 9.0% vs. 7.8%, P = 0.47, respectively. The intervention time was significantly longer in CEAs performed by trainees compared with EVS: 104 ± 1.9 min versus 98 ± 1.0 min, P = 0.02. CONCLUSIONS With a defined CEA teaching program, trainees can obtain results similar to those of more experienced surgeons in terms of clinical outcome at the price of an increased intervention time.
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Affiliation(s)
- Laura Maria Cacioppa
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
| | - Matteo Longhi
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Andrea Vacirca
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Enrico Gallitto
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
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Grahem HD, Teixeira RKC, Feijó DH, Yamaki VN, Valente AL, Feitosa DJS, Dos Reis JMC, de Barros RSM. Treinamento de anastomoses vasculares de baixo custo: o cirurgião vai à feira. J Vasc Bras 2017; 16:262-266. [PMID: 29930658 PMCID: PMC5868946 DOI: 10.1590/1677-5449.000817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anastomoses vasculares são procedimentos comuns realizados por grande parte dos cirurgiões e cujo treinamento ocorre principalmente em seres humanos, contrariando os princípios éticos vigentes. Esse fato se deve, sobretudo, à carência e ao alto custo relacionados aos atuais modelos de treinamento. Assim, este estudo visa avaliar a viabilidade de três vegetais para a realização de anastomoses vasculares. Foram utilizadas cinco unidades de cebolinha, vagem e feijão-verde. Em cada uma tentou-se realizar uma anastomose término-terminal. Conseguiu-se a realização da anastomose apenas na vagem e no feijão-verde. Contudo, por apresentar uma menor espessura, o feijão-verde assemelhou-se mais aos vasos humanos.
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15
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Nayahangan L, Konge L, Schroeder T, Paltved C, Lindorff-Larsen K, Nielsen B, Eiberg J. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training. Eur J Vasc Endovasc Surg 2017; 53:591-599. [DOI: 10.1016/j.ejvs.2017.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/18/2017] [Indexed: 12/20/2022]
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16
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Eckstein H. El examen europeo de especialistas en cirugía vascular: 10 buenas razones para certificarse como Fellow of the European Board of Vascular Surgery (FEBVS). ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Belykh EG, Lei T, Oliveira MM, Almefty RO, Yagmurlu K, Elhadi AM, Sun G, Bichard WD, Spetzler RF, Preul MC, Nakaji P. Carotid Endarterectomy Surgical Simulation Model Using a Bovine Placenta Vessel. Neurosurgery 2015; 77:825-9; discussion 829-30. [DOI: 10.1227/neu.0000000000000924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
Carotid endarterectomy (CEA) is a common, well-developed surgical procedure. Although surgical simulation is gaining in importance for residency training, CEA practice opportunities for surgical residents are limited.
OBJECTIVE:
To describe a new haptic CEA model.
METHODS:
Six bovine placentas were used to create the model. Each placenta provided about 6 large arterial and venous bifurcations. In total, 36 large-vessel bifurcations were dissected and prepared for the CEA simulation. Bovine placenta vessels were arranged to simulate the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA). The diameters and wall thicknesses were measured and compared with human CCA, ICA, and ECA parameters.
RESULTS:
All bovine placentas provided vessels suitable for modeling carotid artery bifurcations and CEA training. Mean ± SD diameters of simulated CCAs, ECAs, and ICAs were 11.2 ± 1.8, 4.3 ± 0.5, and 9.8 ± 3.0 mm, respectively, from nondilated veins and 8.7 ± 1.4, 4.4 ± 1.3, and 7.2 ± 1.7 mm, respectively, from nondilated arteries. Mean vessel wall thicknesses were 2.0 ± 0.6 mm for arteries and 1.4 ± 0.5 mm for veins. Placental vessel tissue had dimensions and handling characteristics similar to those of human carotid arteries. The CEA procedure and its subtasks, including vessel-tissue preparation and surgical skills performance, could be reproduced with high fidelity.
CONCLUSION:
A bovine placenta training model for CEA is inexpensive and readily available and closely resembles human carotid arteries. The model can provide a convenient and valuable simulation and practice addition for vascular surgery training.
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Affiliation(s)
- Evgenii G. Belykh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Scientific Center of Reconstructive and Restorative Surgery, Laboratory of Neurosurgery, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia
| | - Ting Lei
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Magaldi M. Oliveira
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Department of Surgery, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Rami O. Almefty
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ali M. Elhadi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Guozhu Sun
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - William D. Bichard
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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18
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Simulation in vascular access surgery training. J Vasc Access 2015; 16 Suppl 9:S121-5. [PMID: 25751566 DOI: 10.5301/jva.5000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 11/20/2022] Open
Abstract
Rapidly growing technical developments and working time constraints call for changes in trainee formation. In reality, trainees spend fewer hours in the hospital and face more difficulties in acquiring the required qualifications in order to work independently as a specialist. Simulation-based training is a potential solution. It offers the possibility to learn basic technical skills, repeatedly perform key steps in procedures and simulate challenging scenarios in team training. Patients are not at risk and learning curves can be shortened. Advanced learners are able to train rare complications. Senior faculty member's presence is key to assess and debrief effective simulation training. In the field of vascular access surgery, simulation models are available for open as well as endovascular procedures. In this narrative review, we describe the theory of simulation, present simulation models in vascular (access) surgery, discuss the possible benefits for patient safety and the difficulties of implementing simulation in training.
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19
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What is the best training for vascular access surgery? J Vasc Access 2015; 16 Suppl 9:S16-9. [PMID: 25684580 DOI: 10.5301/jva.5000345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 11/20/2022] Open
Abstract
Questions have been raised whether there is a lack of appropriate training in access creation and maintenance, and if training juniors in arteriovenous (AV) fistulas may affect the outcome. A survey was undertaken to study "experts" opinion in access training using a closed questionnaire. The majority of "experts" consented that there is a lack of appropriate training in access creation and maintenance in a great extent, although they located the main deficit regarding access training in the preoperative planning and decision making. Regarding the second question, a literature search revealed only four studies, comparing the outcomes of AV fistulas created either by consultant surgeons or trainees. A meta-analysis performed revealed that 1-year patency rate was not statistically significant different among access procedures created either by consultants or trainees. Access surgery shares the same basic principles with vascular surgery and provides a valuable workload for the trainees and is a necessity to become a building component in all "core" vascular curricula; the required skills can be acquired with the trainees operating independently simple cases, as the latter is not leading to suboptimal outcomes.
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20
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Simulation of Dialysis Access (SoDA) – Eight Stations Hands-On Dialysis Access Simulation. J Vasc Access 2014. [DOI: 10.5301/jva.2014.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fandler M, Habersack M, Dimai HP. Have "new" methods in medical education reached German-speaking Central Europe: a survey. BMC MEDICAL EDUCATION 2014; 14:172. [PMID: 25129398 PMCID: PMC4236571 DOI: 10.1186/1472-6920-14-172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/12/2014] [Indexed: 05/11/2023]
Abstract
BACKGROUND Simulation-based-training (SBT) in the education of health professionals is discussed as an effective alternative for knowledge and skills enhancement as well as for the establishment of a secure learning environment, for learners and patients. In the Anglo-American region, SBT and simulation and training centers (STC) are numbered as standard for medical training. In German-speaking Central Europe, priority is still given to the establishment of SBT and STC. The purpose of this study was (i) to survey the status quo relating to the existence and facilities of simulation and training centers at medical universities in German-speaking Central Europe and (ii) the evaluation of training methods, especially in the area of emergency medicine skills. METHODS All public and private medical universities or medical faculties in Germany (36), Austria (4) and German-speaking Switzerland (3) were interviewed. In the survey, information regarding the existence and facilities of STCs and information with regards to the use of SBT in the area of emergency medicine was requested. The questions were partly posed in a closed-ended-, in an open-ended- and in a multiple choice format (with the possibility of selecting more than one answer). RESULTS Of a total of 43 contacted medical universities/medical faculties, 40 ultimately participated in the survey. As decisive for the establishment of a STC the potential to improve the clinical-practical training and the demand by students were listed. Obligatory training in a STC during the first and sixth academic year was confirmed only by 12 institutions, before the first invasive procedure on patients by 17 institutions. 13 institutions confirmed the use of the STC for the further training of physicians and care-staff. Training for the acute care and emergency medicine skills in the field of pediatrics, for the most part, occurs decentralized. CONCLUSIONS New methods in medical training have reached German-speaking Central Europe, but the simulation and training centers vary in size, equipment or regarding their integration into the obligatory curriculum as much as the number and variety of the offering to be trained voluntarily or on an obligatory basis.
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Affiliation(s)
- Martin Fandler
- Department of Emergency and Critical Care Medicine, Nuremberg Hospital, Prof.-Ernst-Nathan-Str., 1, 90419 Nuremberg, Germany
| | - Marion Habersack
- Office of the Vice Rector for Teaching & Studies, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Hans P Dimai
- Department of Internal Medicine, Division of Endocrinology & Metabolism, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
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Training and Certification in Dialysis access. J Vasc Access 2014; 15 Suppl 8:S3-7. [DOI: 10.5301/jva.5000322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/20/2022] Open
Abstract
Decreasing and eliminating the gaps in knowledge, skills, and effective communication are the mainstays for a successful dialysis access training program curriculum and at the core of the human factors training philosophy. Many of these skills can be learned in the simulation environment. Education and training will reduce gaps in knowledge and technical skills, before exposing patients to procedure-related risk. For dialysis access, a reliable workplace environment depends upon a culture where safety and accountability are balanced to recognize the human contribution to success or failure in the complex care of patients with end-stage renal disease. Rigorous testing and certification adds value to the participants and validates the training program.
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