Integration of simulation components enhances team training in cardiac surgery

Objectives: Simulation in resident medical education has traditionally focused on isolated components of a surgical procedure. We hypothesized that incorporating an interdisciplinary team into a high-fidelity simulation laboratory would enhance the modeling of real-world challenges during cardiac surgery. Methods: Simulation exercises were performed with staffing by surgeons, anesthesiologists, perfusionists, surgical assistants, and operating room technicians. Twelve accredited cardiothoracic surgical residents were divided into 3 teams. Each team competed in the stations coronary artery bypass grafting, aortic valve replacement, and mitral valve repair. Evaluations were performed on each resident according to the resident's role in the exercise (primary surgeon, first assistant, perfusionist, or anesthesiologist). The relation between scores and years of experience was assessed with the Pearson correlation, and the comparison of scores across the 3 stations was evaluated through analysis of variance. Results: Individual scores varied considerably on the basis of simulation role and years of experience. Mean surgical scores were significantly greater for the mitral repair station (score, 4.4) than aortic valve replacement (3.6) and coronary artery bypass grafting (3.6) stations (overall difference, P =.049) and were highly correlated with years of experience. Two thirds of the residents completed the anesthesia portion of the exercise without prompting and demonstrated competence in the perfusion skill sets. Conclusions: This simulation strategy integrates components from each discipline involved in successful completion of a cardiac surgical procedure. Our findings highlight the importance of team training as a valuable component in the residency curriculum.