Cadaver Simulation Is Associated With Increased Comfort Performing Open Vascular Surgery Amongst Integrated Vascular Surgery (0+5) Residents And Recent Graduates
Joel L. Ramirez, MD1, Mark R. Nehler, MD2, Jahan Mohebali, MD3, Eric J. T. Smith, BS1, Mohammad H. Al-Musawi, MD2, Daniel McDevitt, MD4, Matthew R. Smeds, MD5, Devin S. Zarkowsky, MD2.
1University of California, San Francisco, San Francisco, CA, USA, 2University of Colorado, Aurora, CO, USA, 3Massachusetts General Hospital, Boston, MA, USA, 4Peachtree Vascular Specialists, Atlanta, GA, USA, 5Saint Louis University, Saint Louis, MO, USA.
OBJECTIVES: With the evolution in vascular surgery towards increased endovascular therapy and decreased open surgical training, comfort with open procedures by current trainees is declining. A proposed method to improve this discomfort is simulator training. We hypothesized that open, cadaver, and endovascular surgery simulation would be associated with increased self-perceived comfort performing corresponding procedures.
METHODS: Integrated (0+5) vascular surgery residents and recent graduates in the US were asked to complete a survey quantifying comfort via a Likert scale with procedures and experience with simulation training. Simulation groups were then matched using coarsened exact matching. Ordinal logistic regression assessed the association between simulation experience and comfort performing procedures.
RESULTS: Surveys were completed by 68 (12%, 68/565) trainees and 20 (1%, 20/3,177) attending surgeons in their first five years of practice. On unmatched analyses, there were no significant differences in comfort performing any open or endovascular aorto-mesenteric or peripheral vascular procedures between respondents who reported experience with open or endovascular simulation, respectively. However, respondents who reported cadaver simulation experience had a significantly higher reported comfort score performing open juxtarenal aortic repair (2.4 vs 1.7), SMA thrombectomy or bypass (2.5 vs 1.9), IVC or iliac vein repair (2.2 vs 1.7), axillary-femoral artery bypass (3.4 vs 2.5), femoral-popliteal artery bypass (3.7 vs 2.8), and inframalleolar artery bypass (2.8 vs 2.1; all P <0.05). After matching on training level, number of abdominal cases completed, and number of open vascular cases completed, ordinal logistic regression demonstrated that previous cadaver simulation was significantly associated with increased comfort performing open aortic repairs, venous repair, visceral revascularization, and peripheral bypasses (Table). CONCLUSIONS: In this nationally representative sample, cadaver, but not open or endovascular, simulation was associated with increased comfort performing open vascular surgery. Providing cadaver simulation to trainees may help to improve comfort levels performing open surgery. Integrated vascular surgery training programs should consider implementing these experiences in their curriculum.
| Procedure | Odds Ratio | 95% CI | P Value |
| Thoracoabdominal Aortic Repair | 3.90 | 0.98-15.53 | 0.05 |
| Paravisceral Aortic Repair | 3.25 | 1.14-9.25 | 0.03 |
| Juxtarenal Aortic Repair | 3.92 | 1.38-11.13 | 0.01 |
| Superior Mesenteric Artery Thrombectomy or Bypass | 4.03 | 1.46-11.13 | 0.01 |
| Carotid-Subclavian Bypass | 3.07 | 1.18-8.01 | 0.02 |
| Axillary-Femoral Artery Bypass | 3.23 | 1.27-8.20 | 0.01 |
| Femoral-Popliteal Bypass | 3.04 | 1.21-7.59 | 0.02 |
| Inframalleolar Artery Bypass | 3.69 | 1.36-10.06 | 0.01 |
| Calculated using ordinal logistic regression based on a Likert scale of 1 (Not comfortable performing independently) to 5 (Comfortable performing independently) with cadaver simulation as the primary predictor. | |||
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