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Simulation based training improves medical student performance on an endovascular simulator
SURGICAL EDUCATION I scopy; number of attempts to cannulate the papilla, pancreatic duct, and common bile duct; number of contrast injections; use of endoscopic tools, and complications. Subjects assessed the graphics, procedural accuracy, difficulty, and haptics, plus overall realism and training potential of the simulator using Likert-type scales.
Simulation based training improves medical student performance on an endovascular simulator Maureen M Tedesco MD, David A Peterson MD, Tae K Song MD, Rich Parent MD, Mary Qiu BS, Jason T Lee MD Stanford University Medical Center, Stanford, CA
RESULTS: Age, post-graduate year, and prior endoscopy and ERCP experience positively correlate with skill level (all p⬍0.001). For both cases combined, total procedure time differed across novices, intermediates, and experts (p⫽0.009). For the same measure, Case 1 differentiated all skill levels (p⫽0.024) while Case 2 distinguished only novice from expert (p⫽0.043). Across all skill levels, opinions were similar regarding graphics (moderately realistic), accuracy (similar to real procedure), difficulty (somewhat less difficult), overall realism (moderately realistic), and haptics. Subjects (67%) believe the simulator has definite training potential.
INTRODUCTION: The American College of Surgeons recently established a program to accredit simulation-based learning centers for the education of surgical trainees. Surgical simulators have been shown to enrich the educational environment as well as distinguish procedural competency between novice and experts. The purpose of this study is to assess the technical performance of medical students in a simulation-based vascular surgery curriculum. METHODS: Twelve preclinical medical students enrolled in a vascular surgery elective course performed a renal angioplasty/stent procedure on the Simbionix endovascular simulator (pre-test). The subjects¿ performance was evaluated utilizing a structured global assessment scale based on angiography setup, target vessel catheterization, and the intervention. Objective measures determined by the simulator were collected for each subject. At the conclusion of the eight-week course that included didactic teaching and weekly supervised simulator sessions, the subjects repeated the renal angioplasty/stent procedure (post-test).
CONCLUSIONS: The two simulated ERCP cases differentiate novice, intermediate, and expert skill levels based on total procedure time. The majority of subjects felt the simulated graphics, procedural accuracy, and overall realism exhibit face validity. Subjects believe the simulator is a useful training tool.
RESULTS: The average pre-test score on the structured global assessment scale was 1.97⫾0.25 (out of a possible 5). All students showed significant improvement on the post-test, with the mean post-test score rising to 3.56⫾0.47 (p⬍0.01). Objective measures including total procedure time (0:23:52 vs. 0:18:11, p⫽0.03), time until diagnostic aortogram (0:08:05 vs. 0:03:43, p⬍0.01), time until stent deployment (0: 16:20 vs. 0:11:02, p⫽0.01), and correctly starting anticoagulation (p⬍0.01) significantly improved after completion of the course.
High fidelity, simulation-based training at the pointof-care improves teamwork in the operating room John T Paige MD, Valeriy Kozmenko MD, Tong Yang MD, Ramnarayan Paragi Gururaja MD, Charles W Hilton MD, Isidore Cohn Jr MD, FACS, Sheila W Chauvin M Ed, PhD Louisiana State University Health Sciences Center, New Orleans, LA INTRODUCTION: Effective teamwork influences patient safety in the operating room (OR). Simulation-based training can provide an authentic, low risk learning environment for OR teams. We implemented an innovative OR team training program using high fidelity simulation and evaluated whether teamwork competencies taught in training transferred to actual OR cases.
CONCLUSIONS: A didactic teaching course accompanied by a structured endovascular skill simulation training program improved the subjective and objective technical performance of novices on a high fidelity endovascular simulator. Medical student training can benefit significantly from simulator-based courses.
METHODS: Every member of the general surgery OR teams at an academic affiliated medical center participated in a half-day teamwork training module over a one-month period. Each session occurred in the actual OR using an innovative mobile mock OR configuration with a high fidelity human patient simulator. Training required the OR team to respond to standardized patient scenarios.Teamwork competencies were taught through debriefing after each scenario. A 37-item instrument divided into 5 subscales targeting teamwork competencies was used to assess participants’ transfer of learning from training to practice in actual OR cases. Prior to and after the month long training intervention, participants completed the instrument based on their five most recently completed general surgery cases. Pre- and post-intervention mean scores were analyzed using T-test.
Face and construct validity of a computer-based virtual reality simulator for endoscopic retrograde cholangiopancreatography James G Bittner IV MD, Obinna Ezeamuzie BS, Toufic Imam MD, Bruce V MacFadyen MD, FACS, Robert R Schade MD, FACG, John D Mellinger MD, FACS Medical College of Georgia School of Medicine, Augusta, GA INTRODUCTION: A gastrointestinal endoscopy society encourages curriculum-based computerized simulator use for endoscopic retrograde cholangiopancreatography (ERCP) training, though little data substantiate this recommendation. The study aim was to determine face and construct validity of a high-fidelity ERCP simulator and to assess its perceived utility as a training tool.
RESULTS: Twenty-seven pre-assessments and 33 post-assessments provided usable data. Statistically significant improvements in mean scores were observed in four subscales: ‘Planning and Verification,’ ‘Individual Performance,’ ‘Shared Mental Model,’ and ‘Adaptive Communication and Response’ (p⬍0.001 for all four). The magnitude of the training on these gains was large (effect size ⬎ 1 for all four).
METHODS: Twelve subjects were grouped into novice, intermediate, and expert skill levels. Subjects completed two consecutive simulator-based cases then an online survey. Performance measures include times to complete procedure, reach papilla, and apply flouro-
© 2008 by the American College of Surgeons Published by Elsevier Inc.
ISSN 1072-7515/08/$34.00
S87
Simulation based training improves medical student performance on an endovascular simulator Maureen M Tedesco MD, David A Peterson MD, Tae K Song MD, Rich Parent MD, Mary Qiu BS, Jason T Lee MD Stanford University Medical Center, Stanford, CA
RESULTS: Age, post-graduate year, and prior endoscopy and ERCP experience positively correlate with skill level (all p⬍0.001). For both cases combined, total procedure time differed across novices, intermediates, and experts (p⫽0.009). For the same measure, Case 1 differentiated all skill levels (p⫽0.024) while Case 2 distinguished only novice from expert (p⫽0.043). Across all skill levels, opinions were similar regarding graphics (moderately realistic), accuracy (similar to real procedure), difficulty (somewhat less difficult), overall realism (moderately realistic), and haptics. Subjects (67%) believe the simulator has definite training potential.
INTRODUCTION: The American College of Surgeons recently established a program to accredit simulation-based learning centers for the education of surgical trainees. Surgical simulators have been shown to enrich the educational environment as well as distinguish procedural competency between novice and experts. The purpose of this study is to assess the technical performance of medical students in a simulation-based vascular surgery curriculum. METHODS: Twelve preclinical medical students enrolled in a vascular surgery elective course performed a renal angioplasty/stent procedure on the Simbionix endovascular simulator (pre-test). The subjects¿ performance was evaluated utilizing a structured global assessment scale based on angiography setup, target vessel catheterization, and the intervention. Objective measures determined by the simulator were collected for each subject. At the conclusion of the eight-week course that included didactic teaching and weekly supervised simulator sessions, the subjects repeated the renal angioplasty/stent procedure (post-test).
CONCLUSIONS: The two simulated ERCP cases differentiate novice, intermediate, and expert skill levels based on total procedure time. The majority of subjects felt the simulated graphics, procedural accuracy, and overall realism exhibit face validity. Subjects believe the simulator is a useful training tool.
RESULTS: The average pre-test score on the structured global assessment scale was 1.97⫾0.25 (out of a possible 5). All students showed significant improvement on the post-test, with the mean post-test score rising to 3.56⫾0.47 (p⬍0.01). Objective measures including total procedure time (0:23:52 vs. 0:18:11, p⫽0.03), time until diagnostic aortogram (0:08:05 vs. 0:03:43, p⬍0.01), time until stent deployment (0: 16:20 vs. 0:11:02, p⫽0.01), and correctly starting anticoagulation (p⬍0.01) significantly improved after completion of the course.
High fidelity, simulation-based training at the pointof-care improves teamwork in the operating room John T Paige MD, Valeriy Kozmenko MD, Tong Yang MD, Ramnarayan Paragi Gururaja MD, Charles W Hilton MD, Isidore Cohn Jr MD, FACS, Sheila W Chauvin M Ed, PhD Louisiana State University Health Sciences Center, New Orleans, LA INTRODUCTION: Effective teamwork influences patient safety in the operating room (OR). Simulation-based training can provide an authentic, low risk learning environment for OR teams. We implemented an innovative OR team training program using high fidelity simulation and evaluated whether teamwork competencies taught in training transferred to actual OR cases.
CONCLUSIONS: A didactic teaching course accompanied by a structured endovascular skill simulation training program improved the subjective and objective technical performance of novices on a high fidelity endovascular simulator. Medical student training can benefit significantly from simulator-based courses.
METHODS: Every member of the general surgery OR teams at an academic affiliated medical center participated in a half-day teamwork training module over a one-month period. Each session occurred in the actual OR using an innovative mobile mock OR configuration with a high fidelity human patient simulator. Training required the OR team to respond to standardized patient scenarios.Teamwork competencies were taught through debriefing after each scenario. A 37-item instrument divided into 5 subscales targeting teamwork competencies was used to assess participants’ transfer of learning from training to practice in actual OR cases. Prior to and after the month long training intervention, participants completed the instrument based on their five most recently completed general surgery cases. Pre- and post-intervention mean scores were analyzed using T-test.
Face and construct validity of a computer-based virtual reality simulator for endoscopic retrograde cholangiopancreatography James G Bittner IV MD, Obinna Ezeamuzie BS, Toufic Imam MD, Bruce V MacFadyen MD, FACS, Robert R Schade MD, FACG, John D Mellinger MD, FACS Medical College of Georgia School of Medicine, Augusta, GA INTRODUCTION: A gastrointestinal endoscopy society encourages curriculum-based computerized simulator use for endoscopic retrograde cholangiopancreatography (ERCP) training, though little data substantiate this recommendation. The study aim was to determine face and construct validity of a high-fidelity ERCP simulator and to assess its perceived utility as a training tool.
RESULTS: Twenty-seven pre-assessments and 33 post-assessments provided usable data. Statistically significant improvements in mean scores were observed in four subscales: ‘Planning and Verification,’ ‘Individual Performance,’ ‘Shared Mental Model,’ and ‘Adaptive Communication and Response’ (p⬍0.001 for all four). The magnitude of the training on these gains was large (effect size ⬎ 1 for all four).
METHODS: Twelve subjects were grouped into novice, intermediate, and expert skill levels. Subjects completed two consecutive simulator-based cases then an online survey. Performance measures include times to complete procedure, reach papilla, and apply flouro-
© 2008 by the American College of Surgeons Published by Elsevier Inc.
ISSN 1072-7515/08/$34.00
S87