Feasibility and Evaluation of Surgical Simulation with Developed Crisis Scenarios: A Comparison of Performance by Vascular Surgery Training Paradigms.

ABSTRACT

OBJECTIVES: Surgical simulation is an integral component of training and has become increasingly vital in the evaluation and assessment of surgical trainees. Simulation proficiency determination has been traditionally based on accuracy and time to completion of various simulated tasks, but we were interested in assessing clinical judgment during a simulated crisis scenario. This study assessed the feasibility of creating a crisis simulator station for vascular surgery and evaluated the performance of vascular surgery integrated residents (0+5) and vascular surgery fellows (5+2) during a technical testing with an integrated crisis scenario. METHODS: A Modified Delphi method was used to create vascular surgery crisis simulation stations containing a clinical scenario in conjunction with either an open or endovascular simulator. Senior level vascular surgery trainees from both integrated residencies (0+5) and traditional vascular surgery fellowships (5+2) were then evaluated on two simulation stations 1) Elective carotid endarterectomy (CEA) where the crisis is a postoperative stroke and 2) Endovascular aneurysm repair (EVAR) for a ruptured abdominal aortic aneurysm (rAAA). Each simulation had a crisis scenario incorporated into the procedure. Assessment was completed using a performance assessment tool containing a Likert scale. Total score was calculated as a percentage. Scores were also sub-divided in the following four categories Situation Recognition and Decision-making, Procedural Flow, Technical Skills, and Interpretation and Use of Imaging Skills. Student's t-test was used for analysis. RESULTS: 40 senior-level trainees were evaluated (27 fellows and 13 integrated residents) completing 80 simulations. The CEA crisis simulation yielded similar results between both groups (0+5 vs. 5+2, p = 1.00). The 0+5 residents in vascular surgery were graded to be more proficient in the EVAR for rAAA crisis simulation and demonstrated significant differences in Total Score (p = 0.04), Procedural Flow (p=0.03), and Interpretation and Use of Imaging Skills (p = 0.02). CONCLUSIONS: The creation of crisis-based simulation for trainees in vascular surgery is feasible and actionable. Integrated 0+5 residents performed similarly to 5+2 fellows on an open carotid endarterectomy (CEA) crisis simulation, but 0+5 residents scored significantly higher compared to traditional 5+2 fellows in an endovascular rAAA crisis simulation. Crisis simulation may offer better educational experiences and improved value compared to routine simulation. Further studies using different procedural models and clinical scenarios are needed to assess the validity of crisis simulation in vascular surgery and to better understand the performance disparities found between these training paradigms.