title: Role of Simulation in Endovascular Aneurysm Repair (EVAR) Training: A Preliminary Study.
abstract: Endovascular aneurysm repair (EVAR) requires a high-level of technical-competency to avoid device-related complications. Virtual reality simulation-based training (SBT) may offer an alternative method of psychomotor skill acquisition; however, its role in EVAR training is undefined. This study aimed to: a) benchmark competency levels using EVAR SBT, and b) investigate the impact of supervised SBT on trainee performance.
  
  
  
  EVAR procedure-related metrics were benchmarked by six experienced consultants using a Simbionix Angiomentor EVAR simulator. Sixteen vascular surgical trainees performing a comparable EVAR before and after structured SBT (>4 teaching sessions) were assessed utilising a modified Likert-scale score. These were benchmarked for comparison against the standard set by the consultant body.
  
  
  
  Median procedural-time for consultants was 43.5 min (IQR 7.5). A significant improvement in trainee procedural-time following SBT was observed (median procedural time 77 min [IQR 20.75] vs. 56 min [IQR: 7.00], p < .0001). The mean (SD) trainee Likert score pre- and post-SBT improved (16.6 [SD 1.455] vs. 28.63 [SD 2.986], p < .0001). Fewer endoleaks were observed (p = .0063) and trainees chose an appropriately sized device more often after SBT.
  
  
  
  This study suggests that EVAR-SBT should be considered as an adjunct to standard psychomotor skill teaching techniques for EVAR within the vascular surgery training curricula.
authors.affiliation: Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK. Electronic address: as875@le.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Department of Medical and Social Care Education, University of Leicester, Leicester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Calderbank
authors.affiliation: Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sidloff
authors.affiliation: Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bown
authors.affiliation: Department of Medical and Social Care Education, University of Leicester, Leicester, UK.
authors.forename: R S
authors.initials: RS
authors.lastname: Davies
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education* / Q000295:instrumentation; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education* / Q000295:instrumentation; D000070856:High Fidelity Simulation Training; D006801:Humans; D059032:Learning Curve; D061646:Operative Time; D010865:Pilot Projects; D011474:Prosthesis Design; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; Endovascular; Simulation