Simulation and skills training in mitral valve surgery

David L. Joyce, Tanvir S. Dhillon, Anthony D. Caffarelli, Daniel D. Joyce, Dimitrios N. Tsirigotis, Thomas A. Burdon, James I. Fann

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. Methods: After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score. Results: Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency. Conclusions: Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement.

Original languageEnglish (US)
Pages (from-to)107-112
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume141
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Mitral Valve Annuloplasty
Mitral Valve
Video Recording
Swine
Plastics
Learning
Sensory Feedback
Bites and Stings
Sutures
Needles
Simulation Training
Practice (Psychology)

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Joyce, D. L., Dhillon, T. S., Caffarelli, A. D., Joyce, D. D., Tsirigotis, D. N., Burdon, T. A., & Fann, J. I. (2011). Simulation and skills training in mitral valve surgery. Journal of Thoracic and Cardiovascular Surgery, 141(1), 107-112. https://doi.org/10.1016/j.jtcvs.2010.08.059

Simulation and skills training in mitral valve surgery. / Joyce, David L.; Dhillon, Tanvir S.; Caffarelli, Anthony D.; Joyce, Daniel D.; Tsirigotis, Dimitrios N.; Burdon, Thomas A.; Fann, James I.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 141, No. 1, 01.2011, p. 107-112.

Research output: Contribution to journalArticle

Joyce, DL, Dhillon, TS, Caffarelli, AD, Joyce, DD, Tsirigotis, DN, Burdon, TA & Fann, JI 2011, 'Simulation and skills training in mitral valve surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 141, no. 1, pp. 107-112. https://doi.org/10.1016/j.jtcvs.2010.08.059
Joyce DL, Dhillon TS, Caffarelli AD, Joyce DD, Tsirigotis DN, Burdon TA et al. Simulation and skills training in mitral valve surgery. Journal of Thoracic and Cardiovascular Surgery. 2011 Jan;141(1):107-112. https://doi.org/10.1016/j.jtcvs.2010.08.059
Joyce, David L. ; Dhillon, Tanvir S. ; Caffarelli, Anthony D. ; Joyce, Daniel D. ; Tsirigotis, Dimitrios N. ; Burdon, Thomas A. ; Fann, James I. / Simulation and skills training in mitral valve surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 141, No. 1. pp. 107-112.
@article{4b93d971cf1043fc8f2ec97317de8fb8,
title = "Simulation and skills training in mitral valve surgery",
abstract = "Objective: Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. Methods: After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score. Results: Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency. Conclusions: Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a {"}passing{"} grade can be established for proficiency-based advancement.",
author = "Joyce, {David L.} and Dhillon, {Tanvir S.} and Caffarelli, {Anthony D.} and Joyce, {Daniel D.} and Tsirigotis, {Dimitrios N.} and Burdon, {Thomas A.} and Fann, {James I.}",
year = "2011",
month = "1",
doi = "10.1016/j.jtcvs.2010.08.059",
language = "English (US)",
volume = "141",
pages = "107--112",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Simulation and skills training in mitral valve surgery

AU - Joyce, David L.

AU - Dhillon, Tanvir S.

AU - Caffarelli, Anthony D.

AU - Joyce, Daniel D.

AU - Tsirigotis, Dimitrios N.

AU - Burdon, Thomas A.

AU - Fann, James I.

PY - 2011/1

Y1 - 2011/1

N2 - Objective: Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. Methods: After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score. Results: Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency. Conclusions: Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement.

AB - Objective: Limited exposure and visualization and technical complexity have affected resident training in mitral valve surgery. We propose simulation-based learning to improve skill acquisition in mitral valve surgery. Methods: After reviewing instructional video recordings of mitral annuloplasty in porcine and plastic models, 11 residents (6 integrated and 5 traditional) performed porcine model mitral annuloplasty. Video-recorded performance was reviewed by attending surgeon providing audio formative feedback superimposed on video recordings; recordings were returned to residents for review. After 3-week practice with plastic model, residents repeated porcine model mitral annuloplasty. Performance assessments initially (prefeedback) and at 3 weeks (postfeedback) were based on review of video recordings on 5-point rating scale (5, good; 3, average; 1, poor) of 11 components. Ratings were averaged for composite score. Results: Time to completion improved from mean 31 ± 9 minutes to 25 ± 6 minutes after 3-week practice (P = .03). At 3 weeks, improvement in technical components was achieved by all residents, with prefeedback scores varying from 2.4 ± 0.6 for needle angles to 3.0 ± 0.5 for depth of bites and postfeedback scores of 3.1 ± 0.8 for tissue handling to 3.6 ± 0.8 for suture management and tension (P ≤ .001). Interrater reliability was greater than 0.8. In this sample, composite scores of first-year integrated and traditional residents were lower than those of senior level residents; comparatively, third-year integrated residents demonstrated good technical proficiency. Conclusions: Simulation-based learning with formative feedback results in overall improved performance of simulated mitral annuloplasty. In complex surgical procedures, simulation may provide necessary early graduated training and practice. Importantly, a "passing" grade can be established for proficiency-based advancement.

UR - http://www.scopus.com/inward/record.url?scp=78650266921&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650266921&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2010.08.059

DO - 10.1016/j.jtcvs.2010.08.059

M3 - Article

VL - 141

SP - 107

EP - 112

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -