RS09. The Fundamentals of Vascular Surgery: A 6-Year Review of the First U.S. Dedicated Vascular Simulation Course

Abstract

Duty-hour restrictions, changing training paradigms, and diminishing open surgical case volumes have caused dramatic shifts in vascular trainees experience over the past decade. While simulation training has been advocated as an augment to resident training, the benefits of short 3- to 4-day courses are largely unknown. The goal of this study was to perform a 6-year review of the first simulation course established for vascular trainees in the United States. A 3-day vascular simulation course was conducted at a dedicated learning center each year from 2012 to 2017. Attendees rated their confidence pre and post course on a 6-point Likert scale ranging from 1 none to 6 expert across eight different technical and cognitive categories. Participants were also asked to rate the value of each activity using a similar scale. Assessments of each trainee were completed by the course director and sent to their program director (PD). After 6 months, PDs and participants were surveyed on the lasting usefulness of the course. There were 153 attendees, after excluding medical students and general surgery residents, full data were available for 98 vascular trainees. Residents were categorized as junior (PGY1-2, n = 59) or senior (PGY 3, n = 39). Participants rated all teaching activities as useful (4) or better, with anatomic exposures (5.8) and one-on-one suturing (5.5) rated most valuable. Both groups showed significant improvement in confidence in all measures following the course (Table I) with juniors improving significantly more than seniors in anastomoses, AAA measurements, and tibial exposures (Table II). Six-month follow-up with PDs found that 100% (41 of 41) reported at least one noticeable lasting skill improvement and 85% (35 of 41) stating they modified their trainees curriculum based on the course assessment. Attendee survey response found that 100% (63 of 63) would recommend the course as a valuable activity and the majority reported incorporating at least one (97%, 61 of 63) or multiple skills (90%, 57 of 63) learned at the course into their daily activities. This study demonstrates that brief, intensive simulation courses can have a valuable and lasting impact on vascular resident education. Modifying learning activities by trainee level and focusing on high yield activities such as cadaver exposures and one-on-one instruction can add further benefit. Providing outside assessments of trainee competence may be especially useful in individualizing resident curricula.Table IPre-assessment and postassessment confidence scores by level of trainingVascular skillJunior pre assessment (n = 59)Junior post assessment (n = 59)P valueSenior pre assessment (n = 39)Senior post assessment (n = 39)P valuePerforming anastomosis2.733.88<.0014.45.13<.001Measuring abdominal aortic aneurysm stent grafts based on computed tomography angiography2.093.64<.0013.84.8<.001Knowledge base in radiation safety3.24.27<.0014.034.8<.001Knowledge base in coronary anatomy2.883.63<.0013.133.9<.001Tibial vessel exposure2.053.8<.0013.564.74<.001Thoracoabdominal exposure1.593.29<.0012.464.13<.001Thoracic aortic exposure1.423.1<.0012.494.15<.001Carotid stent1.863.34<.0012.534.11<.001 Open table in a new tab Table IIImprovement in pre and post assessment confidence scores by level of trainingVascular skillJuniors (n = 59)Seniors (n = 39)PPerforming anastomosis1.180.72.003Measuring abdominal aortic aneurysm stent grafts based on computed tomography angiography1.571.05.011Knowledge base in radiation safety1.100.77.080Knowledge base in coronary anatomy0.770.76.965Tibial vessel exposure1.751.18.001Thoracoabdominal exposure1.701.67.856Thoracic aortic exposure1.681.67.932Carotid stent1.481.58.680 Open table in a new tab