Development of a PROficiency-Based StePwise Endovascular Curricular Training (PROSPECT) Program.
OBJECTIVE
Focus on patient safety, work-hour limitations, and cost-effective education is putting pressure to improve curricula to acquire minimally invasive techniques during surgical training. This study aimed to design a structured training program for endovascular skills and validate its assessment methods.


METHODS
A PROficiency-based StePwise Endovascular Curricular Training (PROSPECT) program was developed, consisting of e-learning and hands-on simulation modules, focusing on iliac and superficial femoral artery atherosclerotic disease. Construct validity was investigated. Performances were assessed using multiple-choice questionnaires, valid simulation parameters, global rating scorings, and examiner checklists. Feasibility was assessed by passage of 2 final-year medical students through this PROSPECT program.


METHODS
Ghent University Hospital, a tertiary clinical care and academic center in Belgium with general surgery residency program.


METHODS
Senior-year medical students were recruited at Ghent University Hospital. Vascular surgeons were invited to participate during conferences and meetings if they had performed at least 100 endovascular procedures as the primary operator during the last 2 years.


RESULTS
Overall, 29 medical students and 20 vascular surgeons participated. Vascular surgeons obtained higher multiple-choice questionnaire scores (median: 24.5-22.0 vs. 15.0-12.0; p < 0.001). Students took significantly longer to treat any iliac or femoral artery stenosis (3.3-14.8 vs. 5.8-30.1min; p = 0.001-0.04), whereas in more complex cases, fluoroscopy time was significantly higher in students (8.3 vs. 21.3min; p = 0.002; 7.3 vs. 13.1min; p = 0.03). In all cases, vascular surgeons scored higher on global rating scorings (51.0-42.0 vs. 29.5-18.0; p < 0.001) and examiner checklist (81.5-75.0 vs. 54.5-43.0; p < 0.001). Hence, proficiency levels based on median expert scores could be determined. There were 2 students who completed the program and passed for each step within a 3-month period during their internships.


CONCLUSIONS
A feasible and construct validated surgical program to train cognitive, technical, and nontechnical endovascular skills was developed. A structured, stepwise, proficiency-based valid endovascular program to train cognitive, technical, and human factor skills has been developed and proven to be feasible. A randomized controlled trial has been initiated to investigate its effect on performances in real life, patient outcomes, and cost-effectiveness.
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: heidi.maertens@ugent.be.
Heidi
H
Maertens
Department of Surgery, McGill University, Montreal, Canada; Arnold & Blema Steinberg Medical Simulation Centre, McGill University, Montreal, Canada.
Rajesh
R
Aggarwal
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Liesbeth
L
Desender
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Frank
F
Vermassen
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Isabelle
I
Van Herzeele
D000328:Adult; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003479:Curriculum; D057510:Endovascular Procedures / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000066908:Simulation Training; D055815:Young Adult
Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; assessment; endovascular intervention; interpersonal and communication skills; medical knowledge; practice-based learning; proficiency based; surgical training