Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment.

ABSTRACT

BACKGROUND: A high-fidelity simulator that uses a perfused porcine heart, cannulae, and tubing has been demonstrated to be a useful training adjunct. We hypothesized that multimodal assessment of cardiopulmonary bypass (CPB) skills within this high-fidelity simulated environment could discern expert from trainee performance. METHODS: Three traditional fellows (postgraduate year 6-8) and 3 attending surgeons each performed 3 aortic cannulations. The third sequence included venous cannulation, commencement of CPB, and placement of a cardioplegia catheter and aortic cross-clamp. Performance across 20 cognitive and 21 technical domains was evaluated. Surgeon and assistant hand movements and economy of motion were assessed by electromagnetic motion sensors worn under sterile gloves. RESULTS: Analysis showed a significant difference in cognitive (6.7 ± 2.3 vs 4.6 ± 2.7, P = .03) but not technical (6.2 ± 2.5 vs 5.8 ± 2.2, P = .7) scores favoring the experts. In addition, experts showed higher efficiency by spending 64 ± 14 seconds to construct a nonpledgeted aortic purse-string suture and secure it with a Rummel, while trainees spent 82 ± 30 seconds to complete this task (P = .03). Motion analysis revealed similar path lengths between experts and trainees for cannulation and CPB but significantly shorter path lengths for experts in cross-clamp (47.5 ± 15.5 m vs 91.9 ± 20.3 m, P = .04). CONCLUSIONS: Multimodal assessment using cognitive, technical, and motion analysis of basic CPB tasks using a high-fidelity simulation environment is a valid system to measure performance and discriminate experts from trainees. This construct may allow for development of "competence thresholds" with important implications for training and certification in cardiothoracic surgery.