title: Can hyper-realistic physical models of peripheral vessel exposure and fasciotomy replace cadavers for performance assessment?
abstract: Work-hour restrictions have reduced operative experience for residents. The Advanced Surgical Skills for Exposure in Trauma (ASSET) course fills this training gap. Cadaver use has limitations including cost and availability. Hyper-realistic synthetic models may provide an alternative to cadavers. We compared same surgeon performance between synthetic and cadaveric models to determine interchangeability for formative evaluation.
  
  
  
  Forty residents (<4 weeks after ASSET) and 35 faculty (mean, 2.5 ± 1.3 years after ASSET) exposed axillary, brachial, and femoral arteries, and performed lower extremity fasciotomy. Separate evaluators and random starting order between models were used for participants. Individual procedure scores and aggregate procedure scores, a trauma readiness index, evaluated participants. Student's t and χ tests were used where appropriate. p Values less than 0.05 were considered significant.
  
  
  
  For same surgeons, faculty, but not residents, had higher trauma readiness index on the synthetic model (0.63 vs. 0.70, p < 0.01; 0.63 vs. 0.67, p = 0.06, respectively). Scores were not significantly different between models for residents except for the brachial artery exposure (0.68 vs. 0.75, p < 0.01), which was the least realistic of all procedures. Faculty did significantly better on the synthetic model in all procedures. All participants completed procedures nearly twice as quickly (5.61 ± 3.21 vs. 10.08 ± 4.66 minutes) and performed fewer errors on the synthetic model (113 vs. 53, p < 0.01; 118 vs. 76, p = 0.03, respectively).
  
  
  
  Same surgeons performed procedures quicker and with fewer errors on the synthetic model. Residents performed similarly on both model types, this likely represents the unfamiliarity neophytes bring to new procedures. This suggests that the synthetic model, with easily discernible and standardized anatomy, may be useful in the early stages of training to understand critical procedural steps. The difficulty of the cadaver is more apt to assess and evaluate the experienced surgeon and identify opportunities for improvement.
  
  
  
  Prognostic, level III.
authors.affiliation: From the George Washington University, Washington DC (J.H., B.S.); Shock Trauma Anesthesiology Research Center, Departments of Anatomy, Anesthesiology, Surgery, University of Maryland, Baltimore, Maryland (C.F.M. T.S., S.S., A.P. V.S., K.P., G.G., W.T.); Institute Surgical Research, San Antonio, TX.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Holzmacher
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
authors.forename: Adam
authors.initials: A
authors.lastname: Puche
authors.forename: Guinevere
authors.initials: G
authors.lastname: Granite
authors.forename: Valerie
authors.initials: V
authors.lastname: Shalin
authors.forename: Kristy
authors.initials: K
authors.lastname: Pugh
authors.forename: William
authors.initials: W
authors.lastname: Teeter
authors.forename: Samuel
authors.initials: S
authors.lastname: Tisherman
authors.forename: Stacy
authors.initials: S
authors.lastname: Shackelford
authors.forename: Colin F
authors.initials: CF
authors.lastname: Mackenzie
mesh_terms: D000328:Adult; D002102:Cadaver; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D000071938:Fasciotomy / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D014194:Traumatology / Q000193:education*; D014656:Vascular Surgical Procedures / Q000193:education*