title: A prospective randomized study assessing optimal method for teaching vascular anastomoses.
abstract: BACKGROUND
  Laboratory skills training is now required for general surgery residents. The optimal method of teaching vascular anastomosis (VA) is not well defined. Teaching VA skills one-on-one with a faculty instructor will result in a more rapid accumulation of skills than teaching in a large group setting.
  
  
  METHODS
  Residents were shown an instructional video on how to perform a VA using a standardized model (cadaver saphenous vein and porcine aorta). Each resident then performed a baseline VA. Sixteen first- and second-year surgical residents were then randomized to 2 VA teaching sessions that consisted of either 1) group teaching (GT, 8 residents in a room with 1 faculty instructor circulating) or 2) one-on-one teaching (1-on-1, faculty member focused on individual resident). After each of these sessions, residents performed a standardized VA. The anastomoses were video recorded. Performance was evaluated using a standardized scoring system by a separate expert who viewed the video recordings in a blinded fashion. Outcome measures included total errors, total time, global rating scale, and an anastomosis-specific end-product evaluation (leak and passage of coronary dilator).
  
  
  RESULTS
  Overall, significant decreases in total errors (21 to 15, P=0.001) and time to complete anastomoses (42 to 38 min, P=0.02) and an increase in global rating scales (7 to 11, P=0.003) were noted in both groups from baseline after 2 VA teaching session. The 1-on-1 group demonstrated significantly greater improvement in terms of reduced anastomotic time (30 vs. 42 min, P=0.007) and in reduction of errors (13 vs. 19 errors, P=0.09) than the GT group.
  
  
  CONCLUSIONS
  The high-fidelity VA model is a useful tool for junior general surgery residents. Both GT and 1-on-1 groups demonstrated significant improvement in total errors and time after only 2 sessions. Greater improvement was noted using the 1-on-1 model.
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Schwartz
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: de Virgilio
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chisum
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Heslin
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Alyssar
authors.initials: A
authors.lastname: Zein
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Meilu
authors.initials: M
authors.lastname: McDermott
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Amy
authors.initials: A
authors.lastname: Kaji
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Arezou
authors.initials: A
authors.lastname: Yaghoubian
authors.affiliation: Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA. Electronic address: cdevirgilio@labiomed.org.
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education; D000818:Animals; D001011:Aorta / Q000601:surgery*; D004501:Education, Medical / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D013552:Swine; D013663:Teaching / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000193:education*