Stanford Study Measures Value of Endovascular Simulation Training for Surgical Residents

June 8, 2012—The results of a study of endovascular skills training provided to surgical residents at Stanford University's Goodman Simulation Center were presented at the Society for Vascular Surgery's (SVS) 2012 Vascular Annual Meeting in National Harbor, Maryland.

In an SVS press release, study investigator Jason T. Lee, MD, who is the vascular surgery residency/fellowship Program Director at Stanford Hospital and Clinics, explained that implementation of an intensive simulation-based endovascular curriculum during the vascular surgery core rotation improved the technical skills of general surgical residents on a high-fidelity simulator. This translated to improved performance in the actual operating room. The experimental group was compared to a control cohort of surgical residents receiving the usual teaching obtained from standard clinical rotations.

“Surgical simulation has emerged as a potentially important adjunct to residency training in the era of duty-hour work restrictions,” commented Dr. Lee. “We conducted a prospective randomized trial to determine whether an endovascular simulation-based curriculum improved the technical performance of our surgical residents.”

In the SVS announcement, Dr. Lee explained that third-year residents rotating on vascular surgery were randomized to “simulation” consisting of weekly faculty-mentored simulation-based sessions and compared to “control” without simulation assignments and teaching sessions. Endovascular skills were assessed pre- and postrotation on a high-fidelity simulator utilizing a previously validated checklist, structured endovascular global assessment scale (score 1–5), and a live operating room patient evaluation at the end of the rotation.

From 2008 to 2011, 25 consecutive surgical residents (13 simulation vs 12 control) rotating on Stanford's vascular surgery service were enrolled. Pretest assessment was not different between groups documenting similar baseline skills (1.6 vs 1.4), and operative exposure during their 8-week rotation was similar for open and endovascular cases. The amount of time reading, didactic teaching, and conference attendance was also similar between cohorts.

As quoted in the SVS press release, Dr. Lee summarized the findings. “There was significant improvement on the posttest global assessment score (3.6 vs 1.5) performed on the simulator for the entire group, with the residents assigned to the simulation group outperforming the control group (4 vs 3.3) on the simulator. The novel finding in this study was the translation in performance on a live operating room patient with the simulation group performing better than the control group (3.5 vs 2.5).”

Dr. Lee concluded, “We hope in the future, the vascular skills lab provides a safe training environment for trainees to augment their education in both open surgical and endovascular skills and that some benchmarks for assessment and competency determination can be provided to vascular surgery educators.”