dimitrios stefanidis md, phd, facs, fasmbs medical director, carolinas simulation center
DESCRIPTION
Feasibility and Value of a Procedural Workshop for Surgery Residents Based on Phase-II of the APDS/ ACS National Skills Curriculum. Dimitrios Stefanidis MD, PhD, FACS, FASMBS Medical Director, Carolinas Simulation Center Carolinas HealthCare System, Charlotte, NC. Disclosure Slide. - PowerPoint PPT PresentationTRANSCRIPT
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Feasibility and Value of a Procedural Workshop for Surgery
Residents Based on Phase-II of the APDS/ ACS National Skills
Curriculum Dimitrios Stefanidis MD, PhD, FACS, FASMBS
Medical Director, Carolinas Simulation Center
Carolinas HealthCare System, Charlotte, NC
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• Funding for this study was received by industry (Ethicon)
Disclosure Slide
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Background
• Resident skills training outside the operating room has gained widespread acceptance
• Simulators proven to be valuable tools for training but have some limitations
• Animal and cadaver models are more realistic and may offer advantages for resident training 1,2
• ACS/APDS resident skills curriculum includes such models in its phase-II training modules but limited evidence exists on their ease of implementation and value
1 Jacobs LM 2003 J Trauma2 Mitchell E 2011 J Vasc Surg
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Study ObjectiveTo assess the feasibility, value, and cost required to administer a procedural workshop for general surgery residents based on phase II of the national skills curriculum
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Methods• IRB approved project• A procedural workshop for general surgery
residents (PGY I-IV) based on phase II of the ACS/ APDS national skills curriculum was administered at the end of the 2010-2011 academic year
• Surgery faculty instructed residents on a variety of level appropriate surgical procedures using 4 training models (2 cadaver torsos and 2 pigs)
• Baseline OR experience, self reported skill, prior simulator experience assessed
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Workshop Structure
• Didactic material provided to residents ahead of course
• Educational objectives and expectations clearly defined
• Duration of workshop 8 hours
• Residents divided in 2 groups (AM-PM)• Each resident participated for 4 hours• 2 residents on each model matched to an attending with
expertise in the procedures performed
• Multiple carefully chosen procedures performed on each model
• Residents and Faculty completed questionnaires
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Procedures PerformedProcedure Model PGY
Open inguinal hernia Cadaver I
Lap cholecystectomy Pig I
Thoracotomy Cadaver II
Lap Heller myotomy Pig IV
Lap colectomy (Right/ Left) Cadaver III
Bowel anastomosis Pig I
Lap ventral hernia repair with mesh Pig II
Vascular anastomosis Pig II
Thyroidectomy Cadaver III
Lap nephrectomy Pig IV
Trauma exposures Cadaver III
Lap Nissen fundoplication Pig IV
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Workshop Assessment - Residents• Participants were asked to rate the quality of the
workshop on five criteria using a 10-point Likert scale:• Course organization• Provided course material • Close interaction with faculty and feedback received• Training models used• Protected time
• Other parameters assessed (5-point scale)• Resident preparedness for the procedures • Relevance of course content to educational needs• Perceived impact on knowledge and skill
• Training model of preference, faculty assessment
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Faculty Assessments
• Workshop• Resident Performance (10-point Likert scale)
• Overall Performance during this Workshop• Knowledge of Anatomy• Understanding of Key Procedure Steps• Proper Instrument Selection and Use • Laparoscopic and Open Technical Ability • Ability to Assist • Ability to Communicate / Work as a Team • Receptiveness to Performance Feedback
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Results
• Seven faculty and 16 residents participated and provided evaluations
• 23 different procedures performed (4 per resident)
• Resident baseline• Procedures 2 (0-12)• Simulation
• Lap 22±7 hours• Open 6±2 hours
• Skill Self Rating• Lap 6 (3-8)• Open 7 (4-8)
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Results
• Overall quality and value of the workshop 8 (7-10) • 87% of residents strongly agreed or agreed that
the course content was relevant to their educational needs and that their understanding of surgical techniques improved
• Most participants (68%) felt that both cadaver and pig models were necessary for such a workshop as each model offered unique advantages and disadvantages for individual procedures
• All participants felt that such workshops should be part of the general surgery curriculum
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Workshop Assessment
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Workshop Assessment
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Resident Performance Assessment
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Costs and Resources
• Average cost per cadaver appr. $3,500• Average cost per pig appr. $1,200• Faculty time • Supporting staff salaries• Supplies• Preparation time (approx. 25 hours) by course
director/ staff
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Resident Feedback
• More of this • More attendings• Need more time • Have more of
them • More time • More often• More instruments
More
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Conclusions
• Procedural workshop based on animal and cadaver models is highly valued by surgery residents and faculty
• Provides an opportunity for close interaction between faculty and residents in a relaxed environment that promotes learning
• Resource intensive and costly but feasible
• Such workshops should be incorporated into the surgical skills curriculum
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Acknowledgments
• Participating faculty and program leadership• Industry for providing funding and supplies• Simulation Center Staff• Vivarium Staff
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Questions?
• www.carolinassimulationcenter.org