title: Vessel ligation training via an adaptive simulation curriculum.
abstract: BACKGROUND
  A cost-effective model for open vessel ligation is currently lacking. We hypothesized that a novel, inexpensive vessel ligation simulator can efficiently impart transferrable surgical skills to novice trainees.
  
  
  METHODS
  VesselBox was designed to simulate vessel ligation using surgical gloves as surrogate vessels. Fourth-year medical students performed ligations using VesselBox and were evaluated by surgical faculty using the Objective Structured Assessments of Technical Skills global rating scale and a task-specific checklist. Subsequently, each student was trained using VesselBox in an adaptive practice session guided by cumulative sum. Posttesting was performed on fresh human cadavers by evaluators blinded to pretest results.
  
  
  RESULTS
  Sixteen students completed the study. VesselBox practice sessions averaged 21.8 min per participant (interquartile range 19.5-27.7). Blinded posttests demonstrated increased proficiency, as measured by both Objective Structured Assessments of Technical Skills (3.23 versus 2.29, P < 0.001) and checklist metrics (7.33 versus 4.83, P < 0.001). Median speed improved from 128.2 s to 97.5 s per vessel ligated (P = 0.001). After this adaptive training protocol, practice volume was not associated with posttest performance.
  
  
  CONCLUSIONS
  VesselBox is a cost-effective, low-fidelity vessel ligation model suitable for graduating medical students and junior residents. Cumulative sum can facilitate an adaptive, individualized curriculum for simulation training.
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Yinin
authors: Y
authors: Hu
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Robyn N
authors: RN
authors: Goodrich
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Ivy A
authors: IA
authors: Le
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Kendall D
authors: KD
authors: Brooks
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Robert G
authors: RG
authors: Sawyer
authors: Division of General Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Philip W
authors: PW
authors: Smith
authors: Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors: Anneke T
authors: AT
authors: Schroen
authors: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia. Electronic address: skr3f@virginia.edu.
authors: Sara K
authors: SK
authors: Rasmussen
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D014656:Vascular Surgical Procedures / Q000193:education*
keywords: Medical; Proficiency metrics; Simulation; Student; Surgical education; Surgical training; Vascular surgery techniques