PhaseII of the APDS ACS National Skills Curriculum Dimitrios Stefanidis MD PhD FACS FASMBS Medical Director Carolinas Simulation Center Carolinas HealthCare System Charlotte NC Funding for this study was received by industry Ethicon ID: 569954
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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, FASMBSMedical Director, Carolinas Simulation CenterCarolinas HealthCare System, Charlotte, NCSlide2
Funding for this study was received by industry (Ethicon)
Disclosure SlideSlide3
BackgroundResident skills training outside the operating room has gained widespread acceptanceSimulators 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 1,2ACS/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 Trauma
2
Mitchell E 2011 J Vasc SurgSlide4
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 curriculumSlide5
MethodsIRB approved
projectA 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 assessedSlide6
Workshop StructureDidactic material provided to residents ahead of courseEducational objectives and expectations clearly definedDuration of workshop 8 hours
Residents divided in 2 groups (AM-PM)Each resident participated for 4 hours2 residents on each model matched to an attending with expertise in the procedures performedMultiple carefully chosen procedures performed on each modelResidents and Faculty completed questionnairesSlide7
Procedures PerformedProcedure
ModelPGYOpen inguinal herniaCadaverILap cholecystectomy
PigIThoracotomy Cadaver
IILap Heller myotomyPigIVLap colectomy (Right/
Left)CadaverIIIBowel anastomosisPig
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
IVSlide8
Workshop Assessment - ResidentsParticipants were asked to rate the quality of the workshop on five criteria using a 10-point Likert scale:Course organizationProvided course material
Close interaction with faculty and feedback receivedTraining models usedProtected timeOther parameters assessed (5-point scale)Resident preparedness for the procedures Relevance of course content to educational needsPerceived impact on knowledge and skillTraining model of preference, faculty assessmentSlide9
Faculty AssessmentsWorkshopResident Performance (10-point Likert scale)Overall Performance during this Workshop
Knowledge of AnatomyUnderstanding of Key Procedure StepsProper Instrument Selection and Use Laparoscopic and Open Technical Ability Ability to Assist Ability to Communicate / Work as a Team Receptiveness to Performance Feedback Slide10
ResultsSeven faculty and 16 residents participated and provided evaluations23 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)Slide11
ResultsOverall 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 improvedMost 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 curriculumSlide12
Workshop AssessmentSlide13
Workshop AssessmentSlide14
Resident Performance AssessmentSlide15
Costs and ResourcesAverage cost per cadaver appr. $3,500Average cost per pig appr. $1,200Faculty time Supporting staff salaries
SuppliesPreparation time (approx. 25 hours) by course director/ staffSlide16
Resident FeedbackMore of this More attendingsNeed
more time Have more of them More time More oftenMore instruments
MoreSlide17
ConclusionsProcedural workshop based on animal and cadaver models is highly
valued by surgery residents and facultyProvides an opportunity for close interaction between faculty and residents in a relaxed environment that promotes learningResource
intensive and costly but feasibleSuch workshops should be incorporated into the surgical skills curriculumSlide18
Acknowledgments Participating faculty and program leadershipIndustry for providing funding and suppliesSimulation Center Staff
Vivarium StaffSlide19
Questions?
www.carolinassimulationcenter.orgDimitrios.Stefanidis@carolinas.org