title: "Top Gun" competition: motivation and practice narrows the technical skill gap among new cardiothoracic surgery residents.
abstract: BACKGROUND
  Adoption of simulation skills training in cardiothoracic (CT) surgery remains a challenge. This study sought to determine whether a "Top Gun" competition would encourage simulator use and improve technical skills among first-year CT residents.
  
  
  METHODS
  A coronary anastomosis simulation module with instructional video was sent to 96 first-year CT residents in traditional programs who were then invited to participate in a Top Gun competition. Residents uploaded a video recording of their baseline anastomosis using the simulator. After 6 weeks of practice under faculty supervision, each trainee uploaded a final video. All submissions were rated in blinded fashion by three CT surgeons. Twelve components were scored on a 5-point Likert scale (1 = poor; 5 = excellent); also, an overall pass-fail grade was given. Five trainees with the highest final scores were invited to compete at a live Top Gun competition.
  
  
  RESULTS
  Seventeen trainees submitted a baseline anastomosis video for evaluation; 15 submitted a final video. Overall average scores improved from 3.24 ± 0.61 to 4.01 ± 0.33 (p < 0.001). Performance of the bottom 50% increased (1.11 ± 0.57) relative to the top 50% (0.43 ± 0.31), resulting in no detectable score difference after training (p = 0.14). Overall average time (minutes:seconds) decreased from 11:10 (range, 5:56 to 18:58) to 9:04 (range, 5:52 to 16:23; p < 0.01). Residents achieving a pass from all three raters increased from 13% (2 of 15) to 73% (11 of 15; p < 0.002). Thirteen of 15 residents completed a survey. Residents performed an average of 23 anastomoses (range, 10 to 40). The majority (10 of 13) agreed or strongly agreed that practicing on simulators will improve a trainee's technical skill acquisition.
  
  
  CONCLUSIONS
  Focused training results in improved technical skills in vessel anastomosis, especially for residents with lower baseline skills. Simulation, as with any educational endeavor, requires the motivation of the trainee, commitment of the faculty educator, and a defined training curriculum.
authors.affiliation: Division of Cardiac Surgery, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois. Electronic address: denter@md.northwestern.edu.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Enter
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University, St. Louis, Missouri.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Fann
authors.affiliation: Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: George L
authors.initials: GL
authors.lastname: Hicks
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Verrier
authors.affiliation: Joint Council on Thoracic Surgery Education, Chicago, Illinois.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mark
authors.affiliation: Division of Cardiac Surgery, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Lou
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
mesh_terms: D000714:Anastomosis, Surgical / Q000193:education; D002983:Clinical Competence; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008953:Models, Anatomic; D009042:Motivation; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000193:education*; D014741:Video Recording