title: A randomized comparison of a 3-week and 6-week vascular surgery simulation course on junior surgical residents' performance of an end-to-side anastomosis.
abstract: OBJECTIVE
  We assessed the effect of an open vascular simulation course on the surgical skill of junior surgical residents in performing a vascular end-to-side anastomosis and determined the course length required for effectiveness. We hypothesized that a 6-week course would significantly increase the surgical skill of junior residents in performing an end-to-side anastomosis, while a 3-week course would not.
  
  
  METHODS
  We randomized 37 junior residents (postgraduate year 1 to 3) to a course consisting of three (short course, n = 18) or six (long course, n = 19) consecutive weekly 1-hour teaching sessions. Content focused on instrument recognition and performance of an end-to-side vascular anastomosis using a simulation model. A standardized 50-point vascular skills assessment (SVSA) measured knowledge and technical proficiency. Senior residents (postgraduate year 4 to 5) were tested at baseline. Junior residents were tested at baseline and at 1 and 16 weeks after course completion, and their scores were compared with baseline and senior resident scores. Residents and faculty completed a standardized anonymous evaluation of the course.
  
  
  RESULTS
  Baseline scores between short-course and long-course participants were not different. At baseline, junior residents had significantly lower SVSA scores than senior residents (36±7 vs 41.4±2.5; P=.002). One week after course completion, SVSA scores for short-course (43.5±2.9 vs 34.2±7.5; P=.008) and long-course (43.9±5.6 vs 38.3±5.9; P=.006) participants were significantly improved from baseline. SVSA scores decreased slightly at 16 weeks but remained above baseline in short-course (39±6.2 vs 34.2±7.5; P=.03) and long-course (40±4.5 vs 38.3±5.9; P=.08) participants. Long vs short course length did not affect improvement in SVSA scores at 1 or 16 weeks. In short-course and long-course participants, SVSA scores at 1 and 16 weeks were not significantly different from senior resident scores. Course ratings were high, and 95% of residents indicated the course "made them a better surgeon." Residents and faculty felt the educational benefit of the course merited the investment of resources.
  
  
  CONCLUSIONS
  An open vascular simulation course consisting of three weekly 1-hour sessions increased the surgical skill of junior residents in performing a vascular end-to-side anastomosis to that of senior residents on a standardized assessment. A 6-week course provided no additional benefit. This study supports the use of an open vascular simulation course to teach vascular surgical skills to junior residents. A course consisting of three 1-hour sessions is an effective and efficient component of a simulation program for junior surgical residents in a busy surgical center.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA 01655, USA. william.robinson@umassmemorial.org
authors.forename: William P
authors.initials: WP
authors.lastname: Robinson
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Cutler
authors.forename: Donald T
authors.initials: DT
authors.lastname: Baril
authors.forename: Anne C
authors.initials: AC
authors.lastname: Larkin
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Eslami
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Arous
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000193:education*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008953:Models, Anatomic; D018794:Problem-Based Learning; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000193:education*