title: Evaluation of simulation-based training model on vascular anastomotic skills for surgical residents.
abstract: BACKGROUND
  Reduced work hours and concerns over patient safety have encouraged surgical educators to find methods to advance resident skills more efficiently. Simulation provides the opportunity to improve technical surgical skills outside the operating room. We hypothesized that practice on surgical task simulators would improve residents' technical performance of vascular anastomotic technique.
  
  
  METHODS
  Senior general surgery residents at an academic medical center completed pretests and posttests on 3 vascular surgery simulators: femoral-popliteal bypass, carotid endarterectomy, and abdominal aortic aneurysm repair. The initial training sessions began with a 15-minute instructional video on how to perform the procedures, followed by supervised sessions in anastomotic technique with attending vascular surgeons. Initial individual sessions were videotaped as a pretest, and the final attempt was videotaped as the posttest. Each test was evaluated by a single experienced attending vascular surgeon blinded to the examinees. Anastomoses were graded using a performance rating and a modified objective structured assessment of technical skill rating. Results were analyzed using mixed model P values.
  
  
  RESULTS
  The residents showed statistically significant improvement between the pretest and the posttest in both their performance rating (1.9 vs. 2.4, P = 0.02) and the objective structured assessment of technical skill (2.6 vs. 3.1, P = 0.01), as well as in most subsets of each assessment scale.
  
  
  CONCLUSIONS
  We conclude that practice using simulated anastomotic models leads to measurable improvement in vascular anastomotic technique in senior general surgery residents.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
authors.forename: Vaia Y
authors.initials: VY
authors.lastname: Sigounas
authors.forename: Peter W
authors.initials: PW
authors.lastname: Callas
authors.forename: Cate
authors.initials: C
authors.lastname: Nicholas
authors.forename: Julie E
authors.initials: JE
authors.lastname: Adams
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bertges
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stanley
authors.forename: Georg
authors.initials: G
authors.lastname: Steinthorsson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ricci
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation / Q000592:standards; D004521:Educational Measurement / Q000379:methods; D016894:Endarterectomy, Carotid / Q000193:education / Q000379:methods; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000639:trends; D008348:Manikins; D017145:Models, Educational; D011150:Popliteal Artery / Q000601:surgery; D015397:Program Evaluation; D014656:Vascular Surgical Procedures / Q000193:education* / Q000379:methods; D014707:Vermont