Immersive Video Modeling Versus Traditional Video Modeling for Teaching Central Venous Catheter Insertion to Medical Residents.

Background  Central Venous Catheter (CVC) placement is a common critical care procedure. Simulated practice has been shown to reduce its iatrogenic complications. Video modeling (VM) is an instructional adjunct that improves the quality and success of CVC insertion. Immersive VM can improve recall and skill translation, but its role in teaching medical procedures is not established. Research question/hypothesis We hypothesized that, relative to traditional VM, immersive VM would decrease cognitive load and enhance ultrasound-guided CVC insertion skill acquisition. Methods Thirty-two resident physicians from four specialties were randomized into traditional (control) or immersive VM (intervention) groups for three CVC training sessions. Cognitive load was quantified via NASA Task Load Index (TLX). Mean (± standard deviations) values were compared using two-tailed t-tests. Skill acquisition was quantified by procedural time and the average 5-point [EM1] [TB2] entrustment score of three expert raters. Results Overall entrustment scores improved from the first (3.44±0.98) to the third (4.06±1.23; p<0.002) session but were not significantly different between the control and intervention groups. There were no significant differences between NASA TLX scores or procedural time. Conclusion We found no significant difference in entrustment, cognitive load, or procedural time. Immersive VM was not found to be superior to traditional VM for teaching CVC insertion.

Patient and observer scar assessment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergoing carotid endarterectomy for stroke risk reduction.

BACKGROUND: Carotid endarterectomy (CEA) is a very common operation, but there is no agreement on the appropriate orientation of the surgical incision. METHODS: We retrospectively reviewed the charts of patients who had undergone CEA between Jul. 1, 2010, and Dec. 31, 2013. We contacted patients identified in the review to solicit participation in a clinical follow-up examination, during which the esthetic outcome of the scar was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: During the study period 237 CEAs were performed. Nine patients refused the use of their personal health information in this study. There were no significant differences in the neurologic outcomes of patients based on the incision orientation (perioperative stroke and death 1.4% with transverse incision v. 0% with a vertical incision, p = 0.44). Fifty-two patients presented for follow-up examination. Thirty-three had a transverse incision and 19 had a vertical incision. Results of the POSAS significantly favoured the transverse incision (p = 0.03). Vertical incisions were more often associated with persistent, mild marginal mandibular nerve dysfunction (p = 0.04). CONCLUSION: Carotid endarterectomy performed through a transverse skin incision compared with a vertically oriented skin incision is associated with improved esthetic outcome, as measured by the POSAS, without an observed statistically significant difference in the risk of perioperative stroke or death between the 2 techniques.

CONTEXTE: L'endartériectomie de la carotide est une intervention chirurgicale très courante. Toutefois, il n'existe aucun consensus sur l'orientation de l'incision. MÉTHODES: Nous avons analysé rétrospectivement les dossiers de patients ayant subi une endartériectomie de la carotide entre le 1er juillet 2010 et le 31 décembre 2013. Nous avions communiqué au préalable avec les patients concernés pour solliciter leur participation à un examen de suivi clinique au cours duquel le résultat esthétique de leur cicatrice serait évalué au moyen de l'échelle d'évaluation des cicatrices par les patients et les observateurs (POSAS). RÉSULTATS: Au cours de la période visée, 237 endartériectomies de la carotide ont été pratiquées. Neuf patients ont refusé qu'on utilise leurs renseignements médicaux personnels dans le cadre de l'étude. Aucune différence significative n'a été observée quant aux capacités neurologiques des patients selon l'orientation de leur incision chirurgicale (décès et accident vasculaire cérébral périopératoires : 1,4 % avec incision transversale contre 0 % avec incision verticale, p = 0,44). Au total, 52 patients se sont présentés pour un examen de suivi : 33 avaient eu une incision transversale et 19, une incision verticale. Les résultats à la POSAS étaient nettement meilleurs pour les incisions transversales (p = 0,03). Les incisions verticales étaient plus souvent associées à un dysfonctionnement léger, mais persistant de la branche marginale de la mandibule du nerf facial (p = 0,04). CONCLUSION: Notre étude indique que d'après la POSAS, l'endartériectomie de la carotide est associée à un meilleur résultat esthétique lorsqu'elle est pratiquée au moyen d'une incision cutanée transversale qu'au moyen d'une incision verticale. Par ailleurs, aucune différence statistiquement significative n'a été observée quant aux risques de décès et d'accident vasculaire cérébral périopératoires associés à l'une ou l'autre de ces 2 techniques.