title: Simulation-Based Training in Cardiac Surgery.
abstract: BACKGROUND
  Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons.
  
  
  METHODS
  Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function. Using deliberate practice, first-year cardiothoracic surgical residents at eight institutions were trained and evaluated on component tasks for each module and later on full cardiac operations. Evaluations were based on five-point Likert-scale tools indexed by module, session, task items, and repetitions. Statistical analyses relied on generalized linear model estimation and corresponding confidence intervals.
  
  
  RESULTS
  The 27 residents who participated demonstrated improvement with practice repetitions resulting in excellent final scores per module (mean ± two SEs): cardiopulmonary bypass, 4.80 ± 0.12; coronary artery bypass grafting, 4.41 ± 0.19; aortic valve replacement, 4.51 ± 0.20; massive air embolism, 0.68 ± 0.14; acute intraoperative aortic dissection, 4.52 ± 0.17; and sudden deterioration in cardiac function, 4.76 ± 0.16. The transient detrimental effect of time away from training was also evident.
  
  
  CONCLUSIONS
  Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.
authors: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: rfeins@med.unc.edu.
authors: Richard H
authors: RH
authors: Feins
authors: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Harold M
authors: HM
authors: Burkhart
authors: Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: John V
authors: JV
authors: Conte
authors: Department of Computing, University of West Indies (Mona), Kingston, Jamaica.
authors: Daniel N
authors: DN
authors: Coore
authors: Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
authors: James I
authors: JI
authors: Fann
authors: Division of Cardiac Surgery, University of Rochester, Rochester, New York.
authors: George L
authors: GL
authors: Hicks
authors: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Jonathan C
authors: JC
authors: Nesbitt
authors: Department of Surgery, School of Clinical Medicine and Research, University of the West Indies, Nassau, Bahamas.
authors: Paul S
authors: PS
authors: Ramphal
authors: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Sharon E
authors: SE
authors: Schiro
authors: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors: K Robert
authors: KR
authors: Shen
authors: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Amaanti
authors: A
authors: Sridhar
authors: Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: Paul W
authors: PW
authors: Stewart
authors: Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors: Jennifer D
authors: JD
authors: Walker
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors: Nahush A
authors: NA
authors: Mokadam
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D013903:Thoracic Surgery / Q000193:education*