Simulation-Based Training in Cardiac Surgery

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• 作者：Richard H. Feins ; MD^a ; ^{rfeins@med.unc.edu} ; Harold M. Burkhart ; MD^b ; John V. Conte ; MD^c ; Daniel N. Coore ; PhD^d ; James I. Fann ; MD^e ; George L. Hicks Jr. ; MD^f ; Jonathan C. Nesbitt ; MD^g ; Paul S. Ramphal ; MD^h ; Sharon E. Schiro ; PhD^a ; K. Robert Shen ; MD^b ; Amaanti Sridhar ; BSⁱ ; Paul W. Stewart ; PhDⁱ ; Jennifer D. Walker ; MD^j ; Nahush A. Mokadam ; MD^k
• 关键词：AIAD ; acute intraoperative aortic dissection ; AVR ; aortic valve replacement ; CABG ; coronary artery bypass grafting ; CPB ; cardiopulmonary bypass ; MAE ; massive air embolism ; SDCF ; sudden deterioration in cardiac function ; UNC ; University of North Carolina at Chapel Hill
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：103
• 期：1
• 页码：312-321
• 全文大小：1012 K
• 卷排序：103

文摘

Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons.MethodsTraining modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function. Using deliberate practice, first-year cardiothoracic surgical residents at eight institutions were trained and evaluated on component tasks for each module and later on full cardiac operations. Evaluations were based on five-point Likert-scale tools indexed by module, session, task items, and repetitions. Statistical analyses relied on generalized linear model estimation and corresponding confidence intervals.ResultsThe 27 residents who participated demonstrated improvement with practice repetitions resulting in excellent final scores per module (mean ± two SEs): cardiopulmonary bypass, 4.80 ± 0.12; coronary artery bypass grafting, 4.41 ± 0.19; aortic valve replacement, 4.51 ± 0.20; massive air embolism, 0.68 ± 0.14; acute intraoperative aortic dissection, 4.52 ± 0.17; and sudden deterioration in cardiac function, 4.76 ± 0.16. The transient detrimental effect of time away from training was also evident.ConclusionsOverall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.