Vascular anastomosis model: relation between competency in a laboratory-based model and surgical competency.
BACKGROUND
Previously, we presented a new, laboratory-based, vascular anastomosis model as a tool to objectively quantify surgical skill. The purpose of the present study was to determine the relation between the outcomes of vascular anastomosis in the laboratory and technical competency, when performing similar vascular anastomoses, in the operating room.


METHODS
Twenty-nine resident surgeons-in-training participated in the present study. All residents had at least one previous laboratory training session using the vascular anastomosis model. Then residents had to create a forearm arterio-venous bridge graft in the operating room (OR). Three measures were used to assess technical competency in the OR: completion time of the graft to vein anatomosis, leakage grade across the anastomosis, and the mini-objective structured assessment of technical skills (MOSAT) score. Similar outcomes obtained in the laboratory were used as predictors of OR outcomes. Significant predictors were identified using multiple linear regression and multiple ordinal logistic regression modelling.


RESULTS
Worse leakage in the laboratory predicted worse leakage in the OR, longer completion time and worse MOSAT score in the OR. Longer completion time in the laboratory was associated with longer OR completion time, but less leakage. Higher year of training and greater laboratory exposure were related to higher MOSAT score and shorter completion time in the OR, respectively.


CONCLUSIONS
Completion time and grade of anastomosis leakage measured in the laboratory were predictive of technical competency in the OR. The vascular anastomosis model may be useful for training in clinical surgery.
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. racwl@mahidol.ac.th
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Wilasrusmee
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Lertsithichai
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Kittur
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000193:education; D019917:Blood Vessel Prosthesis Implantation / Q000193:education*; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D017145:Models, Educational; D013536:Suture Techniques / Q000193:education; D013997:Time Factors