Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: the Boot Camp experience.
OBJECTIVE
We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station.


METHODS
At "Boot Camp," 33 first-year cardiothoracic surgical residents participated in 4-hour coronary anastomosis sessions (6-7 attending surgeons per group of 8-9 residents). At beginning, midpoint, and session end, anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months.


RESULTS
Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 +/- 0.58 (forceps use) to 2.44 +/- 0.48 (needle angles). Midpoint scores ranged from 1.76 +/- 0.63 (forceps use) to 1.91 +/- 0.49 (needle angles). Session end scores ranged from 1.29 +/- 0.45 (needle holder use) to 1.58 +/- 0.50 (needle transfer and suture management and tension; P < .001). Video recordings confirmed improved performance (interrater reliability >0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room.


CONCLUSIONS
Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary.
Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr, Stanford, CA 94305, USA. jfann@stanford.edu
James I
JI
Fann
John H
JH
Calhoon
Andrea J
AJ
Carpenter
Walter H
WH
Merrill
John W
JW
Brown
Robert S
RS
Poston
Maziyar
M
Kalani
Gordon F
GF
Murray
George L
GL
Hicks
Richard H
RH
Feins
D000714:Anastomosis, Surgical; D000818:Animals; D002983:Clinical Competence; D003198:Computer Simulation; D001026:Coronary Artery Bypass / Q000193:education*; D003331:Coronary Vessels / Q000601:surgery*; D003479:Curriculum; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D023421:Models, Animal; D009048:Motor Skills; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000193:education; D013552:Swine; D013647:Task Performance and Analysis; D019616:Thoracic Surgical Procedures / Q000193:education*; D014741:Video Recording