title: Assessment of a mitral valve replacement skills trainer: a simplified, low-cost approach.
abstract: OBJECTIVE
  Simulated mitral valve replacement may aid in the assessment of technical skills required for adequate performance in the operating room. We sought to design and assess a mitral valve replacement training station that is low-cost, nonperishable, portable, and reproducible as a first step in developing a mitral valve surgical skills curriculum.
  
  
  METHODS
  Nineteen physicians (7 general surgery residents, 8 cardiothoracic surgery residents, and 4 attending cardiothoracic surgeons) underwent simulated mitral valve replacement testing. Simulated mitral valve replacement was performed on a training station consisting of a replaceable "mitral annulus" inside a restrictive "left atrium." Eight components of performance were graded on a 5-point scale. A composite score (100 point maximum) was calculated by weighting the grades by procedural time. The effect of training level was evaluated using analysis of variance and post hoc Tukey honestly significant difference.
  
  
  RESULTS
  The speed of simulated mitral valve replacement varied among general surgery residents, cardiothoracic surgery residents, and attending cardiothoracic surgeons (52.9 ± 9.0 vs 32.8 ± 4.7 vs 28.0 ± 3.5 minutes, respectively; F = 25.3; P < .001). Level of training significantly affected all 8 evaluation components (P < .001). Composite scores increased with level of training (general surgery residents 32.9 ± 11.4, cardiothoracic surgery residents 65.1 ± 11.5, and attending cardiothoracic surgeons 88.3 ± 7.8 of a possible 100 points; F = 35.7; P < .001). Cardiothoracic surgery residents who reported having performed 10 to 50 mitral valve replacements as the primary surgeon had a composite score of 65.0 ± 2.8 (P < .01 compared with attending cardiothoracic surgeons).
  
  
  CONCLUSIONS
  Simulated mitral valve replacement can be performed using this simple, affordable, portable setup. Performance scores correlate with level of training and experience, but residents who performed 10 to 50 mitral valve replacements still failed to reach attending-level proficiency. This training simulator may facilitate skills practice and evaluation of competency in cardiac surgery trainees.
authors.affiliation: Department of Cardiothoracic Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Greenhouse
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.forename: Sophia
authors.initials: S
authors.lastname: Dellis
authors.forename: Joy
authors.initials: J
authors.lastname: Park
authors.forename: David W
authors.initials: DW
authors.lastname: Yaffee
authors.forename: Abe
authors.initials: A
authors.lastname: DeAnda
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Leora B
authors.initials: LB
authors.lastname: Balsam
mesh_terms: D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000191:economics / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D008943:Mitral Valve / Q000601:surgery*; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D009048:Motor Skills; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000193:education; D013647:Task Performance and Analysis; D013663:Teaching / Q000191:economics / Q000379:methods*; D013997:Time Factors