Virtual Simulation of Intraoperative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis

Abstract

Study designMulticenter simulation training using an explanatory sequential mixed methods study.Key findingsA total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth.ConclusionOperative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment.CommentaryThis study examined the value of simulated intraoperative decision-making, which tackles a problem that seems more amenable to virtual training. I still wonder whether performing one arteriovenous fistula anastomosis in a real patient would be more beneficial to a trainee than performing 10 virtual simulation anastomoses using a piece of plastic tubing. I question whether performing one open aortic anastomosis to an alternately calcified and friable aorta is more beneficial than performing 10 virtual simulation anastomoses in a model that reminded me of a rubber chicken when I participated in a session. I am still not sure that mandatory virtual simulation training is necessary or even advantageous for all vascular training centers, especially if the afternoon spent in a simulation training center performing an anastomosis to a plastic tube or rubber chicken means the trainee will miss participating in a couple of real cases with real patients.Nonetheless, the Association of Program Directors in Vascular Surgery and other vascular groups have emphasized the value of virtual simulation training for several years. The reality is that the level of experience has been decreasing, often to an unacceptable level, for performing certain open vascular operations, especially aortic surgery, among our trainees. The two most likely solutions for vascular trainees are simulation training or establishing centers of excellence, at which high-volume cases are performed and to which trainees can rotate.Take-home messageIn the past, I have urged caution about adopting vascular trainee learning strategies such as virtual simulation training or centers of excellence, but the future is now. Study designMulticenter simulation training using an explanatory sequential mixed methods study. Multicenter simulation training using an explanatory sequential mixed methods study. Key findingsA total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth. A total of 17 vascular and general surgery trainees and 6 vascular surgery faculty participated in an online virtual simulation of major decision making during open abdominal aortic aneurysm repair. Of the 23 participants, 93% reported feeling they were making real intraoperative decisions, 85% stated it had added to their knowledge base, and 96% requested additional simulations. Several themes emerged from the results of a questionnaire, including the benefits of virtual learning to standardize the training experience and how managing the unexpected as a trainee is an important part of surgical education growth. ConclusionOperative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment. Operative simulation training should focus on both technical skills and intraoperative decision-making, especially when encountering the unexpected. The learners' responses indicated that this virtual platform can allow for intraoperative decision-making practice in a remote learning environment.