A Novel Cadaver-Based Educational Program in General Surgery Training Catherine E. Lewis, MD Warwick J. Peacock, MD, Areti Tillou, MD, O. Joe Hines, MD.

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Presentation transcript:

A Novel Cadaver-Based Educational Program in General Surgery Training Catherine E. Lewis, MD Warwick J. Peacock, MD, Areti Tillou, MD, O. Joe Hines, MD Jonathan R. Hiatt, MD Department of Surgery David Geffen School of Medicine at UCLA

Anatomy in Surgical Education Knowledge of anatomy/exposure essential Time devoted to anatomy decreasing Interns lack adequate knowledge Cadaveric dissection is irreplaceable

Ideal model for surgical skills training Support basic and complex operations Superior to other models / simulators - Realistic - Provides haptic feedback - Representative surgical anatomy Cadaver-Based Education

Specific Aims Describe UCLA Surgery anatomy program Assess resident attitudes toward program

UCLA Surgery Anatomy Program Conceived by emeritus faculty member

UCLA Surgery Anatomy Program Conceived by emeritus faculty member Rembrandt Harmenszoon van Rijn, The Anatomy Lesson, c 1632

UCLA Surgery Anatomy Program Conceived by emeritus faculty member Utilizes fresh-frozen cadavers Provides education, skills and research for undergraduates, graduates & postgraduates Implemented for general surgery residents as component of core education conferences

Anatomy Theater

Anatomy Lab

Cadavers Fresh frozen at -17  C to -20  C Stored in special facility Defrosted prior to use Ethically donated per patient’s bequest

Anatomy Program Costs Each body approximately $2,500 Donated / without charge: Instruments Faculty time Facilities

UCLA Anatomy Curriculum Core general surgery procedures Junior resident skills sessions Senior resident skills sessions PGY1 dissection program

UCLA Anatomy Curriculum Core general surgery procedures Junior resident skills sessions Senior resident skills sessions PGY1 dissection program

Core General Surgery Procedures Lecture on relevant surgical anatomy Demonstration on fresh cadaver Resident performance of procedures: Groin herniorrhaphyThoracic outlet Liver harvestPancreatectomy ThyroidectomyGastrectomy Abdominal aortic aneurysmectomy

Resident Skills Sessions JuniorSenior Group size InstructorsFaculty & Sr residentsFaculty ProceduresWound repair Intestinal anastomosis Chest tubes Abdominal incisions Trauma exposures Neck exposures Percutaneous trach

Resident Skills Sessions JuniorSenior Group size InstructorsFaculty & Sr residentsFaculty ProceduresWound repair Intestinal anastomosis Chest tubes Abdominal incisions Trauma exposures Neck exposures Percutaneous trach

Resident Skills Sessions JuniorSenior Group size InstructorsFaculty & Sr residentsFaculty ProceduresWound repair Intestinal anastomosis Chest tubes Abdominal incisions Trauma exposures Neck exposures Percutaneous trach

TypeN DemographicsSelect from list2 Attitudes toward program 5-Point Likert Scale6 Compare to other modalities Rank-order3 Preferred formatRank-order1 Cadaver Education Survey Response Rate 89% (n = 40)

Cadaver Sessions are a Good Way to Learn Anatomy

Cadaver Sessions are a Good Way to Learn Steps of an Operation

Cadaver Sessions Increase my Confidence in Doing an Operation

I Would Like to Have More Cadaver Sessions

I Would Spend Free Time in the Cadaver Lab

Trainees Should do an Operation on a Cadaver Before Real Patient

Comparison of Learning Modalities Learn Anatomy Cadaver Textbooks Simulators Websites Animate labs Lectures Increase Confidence Cadaver Simulators Textbooks Websites Animate labs Lectures Learn Steps of Operation Cadaver Simulators Animate labs Websites Textbooks Lectures

Comparison of Learning Modalities Learn Anatomy Cadaver Textbooks Simulators Websites Animate labs Lectures Increase Confidence Cadaver Simulators Textbooks Websites Animate labs Lectures Learn Steps of Operation Cadaver Simulators Animate labs Websites Textbooks Lectures

Comparison of Learning Modalities Learn Anatomy Cadaver Textbooks Simulators Websites Animate labs Lectures Increase Confidence Cadaver Simulators Textbooks Websites Animate labs Lectures Learn Steps of Operation Cadaver Simulators Animate labs Websites Textbooks Lectures

Preferred Session Format Perform dissection under direct supervision Self-guided dissection and review of findings with instructor Watch instructor perform a dissection

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

AuthorsProcedures/skills FacFellResStudent Anastakis, Are, Holland Open GSXX Cundiff, Katz, Supe, Udomsawaengsup, Giger, LeBlanc Lap GSXX Gunst, AboudTraumaXXX Reed, MitchellVascularX CastleUrologicX Lewis (current)Lap, open GSX XX Fresh Cadavers in Surgical Training

Comparison of Cadaver Types Fresh frozenEmbalmed Duration of useDays to wksMonths to yrs Cost$$$ Basic skills trainingExcellentGood Operative simulationExcellentPoor Tissue consistencyPliableRigid Tissue colorGoodPoor Tissue plane preservationExcellentPoor ID of small structuresExcellentPoor Flexibility for positioningExcellentPoor Infection riskLowNone

Future Directions Continue to expand curriculum Dedicated facility nearing completion Program validation using surgical skills assessment and demonstration of improved operative performance

Summary: Cadaver-Based Education Efficient and effective educational tool Useful in teaching anatomy, surgical skills, complex open & laparoscopic procedures Increase confidence in performing operations Positive perception by residents More effective than other learning modalities