Collaborative simulation rotation with integrated cardiothoracic and vascular surgery junior residents accelerates technical skill progression

Abstract

ObjectiveIntegrated cardiothoracic surgery (CTS) and vascular surgery (VS) residents must achieve operative independence in fewer years compared with residents in traditional training paradigms. Developing a strong foundation early in training from which to build technical skills is of paramount importance. We hypothesized that intensive simulation performed by CTS and VS junior residents would accelerate technical skill progression and improve confidence. MethodsIn July 2021, 7 post-graduate year (PGY)-1 and 5 PGY-2 residents from integrated CTS and VS programs at a single institution participated in a collaborative simulation rotation. Training included low-fidelity vascular anastomoses, high-fidelity cadaver operative simulation, and core surgical tasks. Residents rated confidence levels before and after training. Performance during end-to-end and end-to-side vascular anastomoses (pre- and post-simulation) were evaluated for: respect for tissue, time and motion, needle handling, needle angles, and knot tying. ResultsEnd-to-end anastomosis scores increased from 10.4 to 19 (p < .001); completion times reduced from 10.8 to 8.7 min (p = .02). End-to-side anastomosis scores increased from 11.4 to 14.6 (p < .001); completion time was unchanged at 8.8 vs. 8.9 min. Trainee confidence level increased for these core tasks: knot tying (3.4 vs 4.1, p = .03), end-to-end anastomosis (2.1 vs 3.6, p < .01), end-to-side anastomosis (1.9 vs 3.3, p < .01), Castroviejo needle driver handling (2.7 vs 3.8, p < .01), ultrasound guided vascular access (2.4 vs 3.5, p = .01), bronchoscopy (1.8 vs 3.1, p = .01), and chest tube placement (1.9 vs 3.1, p < .01). ConclusionsDedicated collaborative simulation focusing on technical skills relevant to both CTS and VS trainees accelerates skills progression and increases resident confidence.