Feasibility and Value of a Procedural Workshop for Surgery Residents Based on Phase-II of the APDS/ ACS National Skills Curriculum Dimitrios Stefanidis MD, PhD, FACS, FASMBS Medical Director, Carolinas Simulation Center Carolinas HealthCare System, Charlotte, NC

Funding for this study was received by industry (Ethicon) Disclosure Slide

Background Resident skills training outside the operating room has gained widespread acceptance Simulators proven to be valuable tools for training but have some limitations Animal and cadaver models are more realistic and may offer advantages for resident training 1,2 ACS/APDS resident skills curriculum includes such models in its phase-II training modules but limited evidence exists on their ease of implementation and value 1 Jacobs LM 2003 J Trauma 2 Mitchell E 2011 J Vasc Surg

Study Objective To assess the feasibility, value, and cost required to administer a procedural workshop for general surgery residents based on phase II of the national skills curriculum

Methods IRB approved project A procedural workshop for general surgery residents (PGY I-IV) based on phase II of the ACS/ APDS national skills curriculum was administered at the end of the academic year Surgery faculty instructed residents on a variety of level appropriate surgical procedures using 4 training models (2 cadaver torsos and 2 pigs) Baseline OR experience, self reported skill, prior simulator experience assessed

Workshop Structure Didactic material provided to residents ahead of course Educational objectives and expectations clearly defined Duration of workshop 8 hours Residents divided in 2 groups (AM-PM) Each resident participated for 4 hours 2 residents on each model matched to an attending with expertise in the procedures performed Multiple carefully chosen procedures performed on each model Residents and Faculty completed questionnaires

Procedures Performed ProcedureModelPGY Open inguinal herniaCadaverI Lap cholecystectomyPigI ThoracotomyCadaverII Lap Heller myotomyPigIV Lap colectomy (Right/ Left)CadaverIII Bowel anastomosisPigI Lap ventral hernia repair with meshPigII Vascular anastomosisPigII ThyroidectomyCadaverIII Lap nephrectomyPigIV Trauma exposuresCadaverIII Lap Nissen fundoplicationPigIV

Workshop Assessment - Residents Participants were asked to rate the quality of the workshop on five criteria using a 10-point Likert scale: Course organization Provided course material Close interaction with faculty and feedback received Training models used Protected time Other parameters assessed (5-point scale) Resident preparedness for the procedures Relevance of course content to educational needs Perceived impact on knowledge and skill Training model of preference, faculty assessment

Faculty Assessments Workshop Resident Performance (10-point Likert scale) Overall Performance during this Workshop Knowledge of Anatomy Understanding of Key Procedure Steps Proper Instrument Selection and Use Laparoscopic and Open Technical Ability Ability to Assist Ability to Communicate / Work as a Team Receptiveness to Performance Feedback

Results Seven faculty and 16 residents participated and provided evaluations 23 different procedures performed (4 per resident) Resident baseline Procedures 2 (0-12) Simulation Lap 22±7 hours Open 6±2 hours Skill Self Rating Lap 6 (3-8) Open 7 (4-8)

Results Overall quality and value of the workshop 8 (7-10) 87% of residents strongly agreed or agreed that the course content was relevant to their educational needs and that their understanding of surgical techniques improved Most participants (68%) felt that both cadaver and pig models were necessary for such a workshop as each model offered unique advantages and disadvantages for individual procedures All participants felt that such workshops should be part of the general surgery curriculum

Workshop Assessment

Resident Performance Assessment

Costs and Resources Average cost per cadaver appr. $3,500 Average cost per pig appr. $1,200 Faculty time Supporting staff salaries Supplies Preparation time (approx. 25 hours) by course director/ staff

Resident Feedback More of this More attendings Need more time Have more of them More time More often More instruments More

Conclusions Procedural workshop based on animal and cadaver models is highly valued by surgery residents and faculty Provides an opportunity for close interaction between faculty and residents in a relaxed environment that promotes learning Resource intensive and costly but feasible Such workshops should be incorporated into the surgical skills curriculum

Acknowledgments Participating faculty and program leadership Industry for providing funding and supplies Simulation Center Staff Vivarium Staff

Questions?