Adapted chicken model for training percutaneous arterial access

Abstract

ObjectiveEndovascular approaches within vascular surgery have grown substantially over the past two decades. As general surgery trainees gain exposure to these approaches, innovative simulation methods to train basic endovascular skills are needed. The purpose of this study was to pilot an existing low-cost model for percutaneous femoral arterial access and examine its effect on resident simulation performance and procedural interest. MethodsA percutaneous arterial access simulation was designed using an adapted chicken breast model. Exiting postgraduate year 1 and 2 general surgery residents participated in sessions with these models for ultrasound-guided arterial access simulation using 5F micropuncture kits. Vascular surgery faculty and fellows provided didactic introductions and proctoring during sessions. Residents also completed skill self-assessments before and after participating in the simulation and rated the model and simulation as a whole. Paired t tests and descriptive statistics were applied in analyses. ResultsTwenty-six residents participated in the simulation in May 2022. Mean resident confidence in overall ability to complete steps required for percutaneous femoral arterial access increased from 3.1 ± 1.0 to 4.4 ± 0.6 (P < .001) when assessed on a 5-point rating scale. Most improved individual steps were identification of arterial cannulation sites using ultrasound (mean difference, +1.4; 95% confidence interval, 1.0-1.8; P < .001) and advancement of hemostatic sheaths over the guidewire into position (mean difference, +1.5; 95% confidence interval, 1.0, 1.9; P < .001). Residents also reported increased comfort level asking to vascular surgery fellows and faculty to participate in subsequent percutaneous access procedures (mean before, 2.7 ± 1.0; mean after, 3.2 ± 0.7; P = .015). On session evaluations, the majority of residents (n = 19 [86%]) strongly agreed that the model was realistic for training purposes and could be used for future skill assessments (n = 16 [73%]). The average material cost required for creation of one chicken model was estimated at $10.32. ConclusionsGeneral surgery trainees require opportunities for low-stakes, independent practice of basic endovascular skills, particularly those with applicability beyond vascular surgery. In this study, use of a simple, a low-cost chicken model promoted increases in procedural confidence and was sufficiently realistic for further training with residents. In the future, this model will be incorporated into standardized assessments to ensure translation of simulated skills to live operative settings.