Use of Simulation-Based Surgical Education and Training Within the Context of the Core Competencies, Milestones, Patient Safety, and the New ACGME Accreditation System Cardiothoracic Surgery Prospective 6th Annual Meeting of the Consortium of ACS-Accredited Education Institutes (ACS AEI Consortium Meeting) March 15, 2013 Richard H. Feins, MD Division of Cardiothoracic Surgery University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Disclosures Equity interest in KindHeart, Inc., a UNC spin-off company producing simulators Teleflex, Inc., supplemental instrument and suture support for the AHRQ grant

Use of Simulation-Based Surgical Education and Training Within the Context of the Core Competencies, Milestones, Patient Safety, and the New ACGME Accreditation System Cardiothoracic Surgery Prospective 6th Annual Meeting of the Consortium of ACS-Accredited Education Institutes (ACS AEI Consortium Meeting) March 15, 2013 Richard H. Feins, MD Division of Cardiothoracic Surgery University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Goals of the TSDA Cardiothoracic Resident Boot Camp To introduce skill sets to CT residents that will make their subsequent education more effective To evaluate the use of simulation and a controlled educational environment on CT resident education To explore new teaching methods for cardiothoracic surgery To demonstrate the commitment of the specialty to the education of the CT resident To standardize the content, quality, and methodology of CT resident simulation-based education To begin the networking process for new CT residents with their future colleagues

Cardiac Surgery Simulation Consortium University of North Carolina at Chapel Hill (PI) Massachusetts General Hospital Johns Hopkins University Vanderbilt University University of Rochester Mayo Clinic Stanford University University of Washington

Improved Patient Safety by Simulator Based Training in Cardiac Surgery AHRQ Grant # 1R18HS Residents participating Over 120 individual simulation hours per resident Over 4000 total simulation hours 290 page comprehensive curriculum syllabus written Extensive video library recorded Over 22,000 data points recorded

Critical Components Necessary for Excellence in Training Core Competencies –Patient care, Medical Knowledge, Practice-Based Learning, Interpersonal and Communication Skills, Professionalism, and Systems-Based practice. Milestones Patient Safety The ACGME’s Next Accreditation System

Cardiac Surgery Simulation Consortium University of North Carolina at Chapel Hill (PI) Massachusetts General Hospital Johns Hopkins University Vanderbilt University University of Rochester Mayo Clinic Stanford University University of Washington

AHRQ Grant Simulation Modules BASIC PROCEDURES 1.Cardiopulmonary Bypass (CPB) 2.Coronary Artery Bypass Grafting (CABG) 3.Aortic Valve Replacement (AVR)

AHRQ Grant Simulation Modules Significant Adverse Events 4.Air Embolism (AE) 5.Acute Intra-operative Aortic Dissection (AIAD) 6.Sudden Deterioration of Cardiac Function (SDCF)

Schema for Simulation Based Training in Cardiac Surgery Component Task Component Task Component Task Procedure or Adverse Event Procedure or Adverse Event

Improved Patient Safety by Simulator Based Training in Cardiac Surgery AHRQ Grant # 1R18HS Simulation Syllabus for Each Week of Training Overview Goals and Objectives Teaching Plan Simulator(s) Set-up Conduct of Simulation Assessment Tools

Aortic Cannula Placement

Acute Intra-operative Aortic Dissection (AIAD)

Improved Patient Safety by Simulator Based Training in Cardiac Surgery AHRQ Grant # 1R18HS Resident time is a major problem Eventually the aspects of deliberate practice come into play Faculty commitment very important Adverse events A comprehensive syllabus is essential

Improved Patient Safety by Simulator Based Training in Cardiac Surgery AHRQ Grant # 1R18HS Complete the study Role out the syllabus to all programs Develop syllabi and simulators for other aspects of cardiothoracic surgery

The Future of Cardiothoracic Surgery Simulation-Based Training Simulation proficiency will be required for resident participation in the OR Simulation based education will be required as part of resident case logs especially for adverse events Methodology of milestone training using simulation will be further developed Simulation for competency testing will be required Simulation will become an important tool for remediation