Standardization is superior to traditional methods of teaching open vascular simulation

Abstract

Standardizing surgical skills teaching has been proposed as a method to rapidly attain technical competence. This study compared acquisition of vascular skills by standardized vs traditional teaching methods. The study randomized 18 first-year surgical residents to a standardized or traditional group. Participants were taught technical aspects of vascular anastomosis using femoral anastomosis simulation (Limbs & Things, Savannah, Ga), supplemented with factual information. One expert instructor taught a standardized anastomosis technique using the same method each time to one group over four sessions, while, similar to current vascular training, four different expert instructors each taught one session to the other (traditional) group. Knowledge and technical skill were assessed at study completion by an independent vascular expert using Objective Structured Assessment of Technical Skill (OSATS) performance metrics. Participants also provided a written evaluation of the study experience. The standardized group had significantly higher mean overall technical (95.7% vs 75.8%; P = .038) and global skill scores (83.4% vs 67%; P = .006). Tissue handling, efficiency of motion, overall technical skill, and flow of operation were rated significantly higher in the standardized group (mean range, 88%-96% vs 67.6%-77.6%; P < .05). The standardized group trended to better cognitive knowledge (mean, 68.8% vs 60.7%; P = .182), creation of a secure knot at the toe of the anastomosis, fashioning an appropriate arteriotomy, better double-ended suture placement at the heel of the anastomosis (100% vs 62.7%; P = .07), and accurate suture placement (70% vs 25%; P = .153). Seventy-two percent of participant evaluations suggested a preference for a standardized approach. This study demonstrates the feasibility of open vascular simulation to assess the effect of differing teaching methods on performance outcome. Findings from this report suggest that for simulation training, standardized may be more effective than traditional methods of teaching. Transferability of simulator-acquired skills to the clinical setting will be required before open simulation can be unequivocally recommended as a major component of resident technical skill training.