Abstracts
Canadian Cardiovascular Society (CCS) Oral TECHNOLOGY IN TRAINING AND PATIENT CARE DELIVERY Saturday, October 24, 2015
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improvement in stress testing interpretation with each incremental year of Cardiology training. Trainees are more proficient in the identification of abnormalities than recognizing the significance of these abnormalities.
189 STRESS ELECTROCARDIOGRAPHIC INTERPRETATION SKILLS OF CARDIOLOGY TRAINEES: ARE THEY COMPETENT? AY Chan, J Janevski, DS Lee, P Dorian, EH Yu Toronto, Ontario BACKGROUND:
Exercise stress testing provides essential diagnostic and prognostic information. Accurate interpretation of stress electrocardiogram (ECG) tests is important for patient care. The stress ECG interpretation skills of Cardiology trainees are not well understood. The purpose of this study was to document the proficiency of Cardiology trainees at stress ECG interpretation. METHODS: Twenty-eight trainees (100% of trainees in the training program) representing all 3 training years (11 first (C1), 9 second (C2), and 8 third-year (C3) trainees) volunteered for testing after providing informed consent. Trainees were given 16 exercise stress tests with important findings in the following categories: ST segment deviation (n¼7); arrhythmias (n¼5); conduction system disorders (n¼3); and normal (n¼1) for interpretation. Trainees were instructed to: (1) identify abnormalities (if any) present on the stress tests, and (2) provide an interpretation of the abnormalities that they found. A marking scheme for each stress ECG was derived by two experienced stress ECG readers, who listed 16 pre-defined important abnormalities present on the stress ECGs, and 9 important interpretations of such abnormalities by consensus. Stress ECGs were then scored using the pre-defined scoring system, blinded to trainee identity and year of training. RESULTS: The percentage of trainees who correctly recognized the abnormalities in each category are listed in the Table. The percentages of trainees who correctly interpreted the significance of the abnormalities present for: (1) ST segment deviation were 42% (overall), 57% (C1), 28% (C2), 41% (C3); (2) arrhythmias were 38% (overall), 40% (C1), 36% (C2), 38% (C3); (3) conduction system changes were 5% (overall), 5% (C1), 11% (C2), 0% (C3); and (4) normal were 68% (overall), 73% (C1), 56% (C2), 75% (C3). As an example of the identification of an abnormality versus the interpretation of its significance; the stress ECG demonstrating 2:1 AV block at rest and improvement of AV conduction with exercise stress to 1:1, then reversion to 3:1 AV block in recovery period, was correctly diagnosed in 63.1% overall [66.6% (C1), 70.4% (C2), 50% (C3)]. The interpretation of the significance of this finding was stated in 10.7% overall [9.1% (C1), 22.2% (C2), 0% (C3)]. CONCLUSION: The identification and interpretation of important abnormalities on stress ECG by Cardiology trainees may be suboptimal. There appears to be no significant
190 PHYSICAL PATIENT SPECIFIC SIMULATION FOR ASCENDING AORTIC ANEURYSMS SURGERY PRE-PROCEDURAL TRAINING J Garcia, Z Yang, K Lachapelle, R Mongrain, R Leask Montréal, Québec BACKGROUND:
Simulators of ascending thoracic aorta (ATA) and ascending thoracic aortic aneurysm (ATAA) lack patient pathologies and the living human tissue characteristics essential for realistic pre-procedural practice. The objective of this study was to develop a series of anatomically correct ascending aorta pathological training phantoms composed of materials bio-mechanically similar to ATA and ATAA. METHOD/RESULTS: The in vivo anatomy of patients were acquired from CT scans. Files were segmented and 3D models were printed. We also created several composites made of photopolymers. To identify suitable materials for the physical models, we evaluated candidate materials by mechanical testing with an equibiaxial tensile tissue tester (Electroforce ELF 3200, Bose) at a 0.1mm/s strain rate: -ATA/ATAA, -Companies 1, 2, 3: Commercial elastomers for mimicking human tissues, -Composites 1, 2, 3: 3-D printed composites. Unique stress-strain curves were created during loading cycles for each material. To compare the samples we used the stiffness computed by calculating the slope values of the hyperelastic model fit (Mooney-Rivlin) of the loading stress-strain curves over physiological strains (d:15-25%). CONCLUSION: As a proof of concept, five rigid physical models of human aortas were printed with a 2mm wall thickness (Figure). Full and root models were fabricated to demonstrate differences in aneurysm geometry and root pathologies. All groups were significantly different to the human tissue at physiological strains, in terms of stiffness (E) and stress (p<0.05, One-way ANOVA). Currently there is no commercially available 3D printing material that can replicate the manipulation and mechanical properties of human aortic tissue. We are now evaluating the addition of softer materials
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to better match the ATA and ATAA tissues characteristics prior to printing flexible 3D models.
Canadian Journal of Cardiology Volume 31 2015
required to perform specific tasks improved through use of the simulator. Residents who used the simulator more frequently showed a greater improvement in measured times. Although the voluntary use was relatively low, the residents believed it was helpful in improving their technical skills and would translate to improved skill in the operating room. The use of this simulator may be a helpful adjunct in the training of surgical residents. 192 APPLICATION OF HIGH FIDELITY SIMULATION IN TEACHING MITRAL VALVE ANNULOPLASTY TO CARDIAC SURGERY RESIDENTS
191 CARDIAC SURGICAL TRAINING THROUGH LOW-FIDELITY SIMULATION D Holloway, B Kidd, M Quantz, A Maitland Calgary, Alberta BACKGROUND:
Cardiac surgery is a technically demanding specialty where precise placement of sutures is essential for success. Due to restrictions in duty hours, decreased operative time, and increased public scrutiny; there is a growing trend for increased utilization of simulation to augment training of surgical residents. METHODS: A novel suture simulation device was designed and distributed to 8 cardiac surgery residents. The simulator was a 3D printed hemisphere inside a box; mimicking a heart in the chest. The hemisphere had 12 regions which contained polymer inserts for suturing. A website was developed with a unique login for each resident. The website would randomly select a series of specific suture throws at specific regions to create surgical tasks. Each resident received a simulator for 30 days. The frequency of participation was voluntary at the preference of the resident. The time to complete each task was recorded using the website. All residents were filmed completing a task on the first and last day of the 30 day trial. At the conclusion, each resident’s opinion on the usefulness of the simulator was assessed through a survey. RESULTS: Use of the simulator ranged from 2 to 26 tasks; with a median of 7.5 tasks. The time required to complete a task was significantly shorter after the 30 day period with a mean of 312 and 202 seconds for the initial and final tasks, respectively (p ¼ 0.005). Increased use of the simulator was associated with a decreased time required to complete a task (p < 0.001). More experienced residents performed tasks significantly faster than junior residents with a mean of 169 and 252 seconds for the senior and junior residents, respectively (p < 0.001). All the residents stated the simulator was beneficial, would recommend it for other residents, and felt the skills learned would translate to the operating room. CONCLUSION: A low fidelity simulator was created to help cardiac surgery residents practice suturing skills. The time
V Chan, T Malas, M Ruel, F Rubens Ottawa, Ontario BACKGROUND:
Integrated 6-year cardiothoracic residency programs are currently a common stream for training cardiac surgery residents. Cardiothoracic surgery residents accepted directly from medical school have less surgical exposure than residents accepted following completion of a general surgery residency. Therefore, use of simulation models in training integrated 6-year cardiothoracic surgery residents may be useful especially in teaching less frequently performed surgical procedures with potential great morbidity and mortality such as mitral valve surgery. METHODS: Seven cardiac surgery residents performed mitral valve annuloplasty on bovine hearts over 3 sessions in 2013. This cohort was comprised of 2 first year, one second year, one third year, 2 fourth year, and one fifth year resident. Objective structured assessment of technical skills (OSATS) scale was used to assess resident performance and recorded by 2 attending staff. RESULTS: Inter-assessor variability was favorable (kappa ¼0.9). Overall, the global OSATS score increased over the course of the teaching sessions and was significantly different in the latest session compared to the first session (24.72.4 versus 17.92.0, p¼0.04). Global OSATS scores tended to increase to a greater degree in residents in their final two years compared to more junior level residents (p¼0.1). CONCLUSION: High fidelity teaching models simulating mitral valve repair are a useful component of an integrated cardiothoracic surgery residency. 193 USING ECONSULTS TO INFORM CARDIOLOGY CONTINUING MEDICAL EDUCATION NEEDS OF PRIMARY CARE PROVIDERS A Shoki, CB Johnson, C Liddy, N Gauthier, E Keely Ottawa, Ontario BACKGROUND:
Cardiology knowledge transfer for primary care providers (PCPs) has traditionally been delivered through continuing medical education (CME) events. Ideally, CME for PCPs should align with clinical questions