Humanoids for teaching and training coronary artery bypass surgery to the next generation of cardiac surgeons.

Piergiorgio Tozzi,Matthias Kirsch,Enrico Ferrari,Friedrich Eckstein,Peter Matt,Oliver Reuthebuch,Carlos A Mestres,Christoph Huber

doi:10.1093/icvts/ivab260

Abstract

OBJECTIVESTechnical skills are an essential component of cardiac surgery, and the operating room is becoming an even more challenging environment for trainees who want to acquire such skills. Simulation, which partially overcomes this limitation, represents a valid adjunct to surgical education. We describe an original simulator and provide results in terms of trainees’ evaluations and ratings.METHODSWe used a humanoid that is a silicone replica of the chest of an adult human that provides a complete anatomical platform for hands-on skin-to-skin practice of surgical techniques in arrested heart coronary artery bypass graft (CABG) surgery cases. Learners were residents in cardiac surgery. The teaching sessions included 2 full three-vessel CABG procedures using both mammary arteries and a hydrogel vein. Five board-certified cardiovascular surgeons scored the surgical activity of all trainees. The trainees were asked to complete an exit questionnaire to evaluate their course.RESULTSOverall, 16 residents participated in the simulation, including 5 women and 11 men, with a mean age of 30 ± 4 years, all of whom had at least 2 years of cardiac surgery training. All participants completed the 2 CABG operations. Three mammary arteries (4.6%) were seriously damaged during harvesting. In 1 case (3.1%), an aortic tear occurred during aortic cannulation. Each trainee performed overall 6 distal and 2 proximal coronary anastomoses. All participants agreed that the ‘humanoid reproduces real-life situations, the feeling is realistic, and they are now more confident in performing coronary anastomosis’.CONCLUSIONSTrainees involved in this simulation curriculum acquired and refined technical skills that could be applied directly to human patients. In addition, we were able to foster a higher level of teamwork within the operating room team.

Highlights

Technical skills are an essential component of cardiac surgery, and the operating room is becoming an even more challenging environment for trainees who want to acquire such skills
Overall, 16 residents participated in the simulation, including 5 women and 11 men, with a mean age of 30 ± 4 years, all of whom had at least 2 years of cardiac surgery training
All participants agreed that the ‘humanoid reproduces real-life situations, the feeling is realistic, and they are more confident in performing coronary anastomosis’. Trainees involved in this simulation curriculum acquired and refined technical skills that could be applied directly to human patients

Summary

Introduction

Technical skills are an essential component of cardiac surgery. The operating room has become an even more challenging environment in which to acquire such skills. The apprentice model in humans is associated with a low tolerance for learning inefficiency, eliminates deliberate practice and does not ensure enough exposure to rare yet grave undesirable events [2]. This teaching model alone does not provide residents with adequate operating experience that would enable them to acquire the confidence and level of expertise needed to operate independently. Simulation should help partially overcome current limitations of the apprentice model while being an adjunct to cardiac surgery education It should be considered as an educational technique that allows trainees to mimic real-world experiences in an interactive manner [3]

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