Dimitrios Stefanidis MD, PhD, FACS, FASMBS Medical Director, Carolinas Simulation Center

1. Feasibility and Value of a Procedural Workshop for Surgery Residents Based on Phase-II of the APDS/ ACS National Skills Curriculum Dimitrios Stefanidis MD, PhD, FACS, FASMBS Medical Director, Carolinas Simulation Center Carolinas HealthCare System, Charlotte, NC

2. Disclosure Slide • Funding for this study was received by industry (Ethicon)

3. Background • Resident skills training outside the operating room has gained widespread acceptance • Simulators proven to be valuable tools for training but have some limitations • Animal and cadaver models are more realistic and may offer advantages for resident training 1,2 • ACS/APDS resident skills curriculum includes such models in its phase-II training modules but limited evidence exists on their ease of implementation and value 1 Jacobs LM 2003 J Trauma 2 Mitchell E 2011 J Vasc Surg

4. Study Objective To assess the feasibility, value, and cost required to administer a procedural workshop for general surgery residents based on phase II of the national skills curriculum

5. Methods • IRB approved project • A procedural workshop for general surgery residents (PGY I-IV) based on phase II of the ACS/ APDS national skills curriculum was administered at the end of the 2010-2011 academic year • Surgery faculty instructed residents on a variety of level appropriate surgical procedures using 4 training models (2 cadaver torsos and 2 pigs) • Baseline OR experience, self reported skill, prior simulator experience assessed

6. Workshop Structure • Didactic material provided to residents ahead of course • Educational objectives and expectations clearly defined • Duration of workshop 8 hours • Residents divided in 2 groups (AM-PM) • Each resident participated for 4 hours • 2 residents on each model matched to an attending with expertise in the procedures performed • Multiple carefully chosen procedures performed on each model • Residents and Faculty completed questionnaires

7. Procedures Performed

8. Workshop Assessment - Residents • Participants were asked to rate the quality of the workshop on five criteria using a 10-point Likert scale: • Course organization • Provided course material • Close interaction with faculty and feedback received • Training models used • Protected time • Other parameters assessed (5-point scale) • Resident preparedness for the procedures • Relevance of course content to educational needs • Perceived impact on knowledge and skill • Training model of preference, faculty assessment

9. Faculty Assessments • Workshop • Resident Performance (10-point Likert scale) • Overall Performance during this Workshop • Knowledge of Anatomy • Understanding of Key Procedure Steps • Proper Instrument Selection and Use • Laparoscopic and Open Technical Ability • Ability to Assist • Ability to Communicate / Work as a Team • Receptiveness to Performance Feedback

10. Results • Seven faculty and 16 residents participated and provided evaluations • 23 different procedures performed (4 per resident) • Resident baseline • Procedures 2 (0-12) • Simulation • Lap 22±7 hours • Open 6±2 hours • Skill Self Rating • Lap 6 (3-8) • Open 7 (4-8)

11. Results • Overall quality and value of the workshop 8 (7-10) • 87% of residents strongly agreed or agreed that the course content was relevant to their educational needs and that their understanding of surgical techniques improved • Most participants (68%) felt that both cadaver and pig models were necessary for such a workshop as each model offered unique advantages and disadvantages for individual procedures • All participants felt that such workshops should be part of the general surgery curriculum

12. Workshop Assessment

13. Workshop Assessment

14. Resident Performance Assessment

15. Costs and Resources • Average cost per cadaver appr. $3,500 • Average cost per pig appr. $1,200 • Faculty time • Supporting staff salaries • Supplies • Preparation time (approx. 25 hours) by course director/ staff

16. Resident Feedback • More of this • More attendings • Need more time • Have more of them • More time • More often • More instruments More

17. Conclusions • Procedural workshop based on animal and cadaver models is highly valued by surgery residents and faculty • Provides an opportunity for close interaction between faculty and residents in a relaxed environment that promotes learning • Resource intensive and costly but feasible • Such workshops should be incorporated into the surgical skills curriculum

18. Acknowledgments • Participating faculty and program leadership • Industry for providing funding and supplies • Simulation Center Staff • Vivarium Staff

19. Questions? • www.carolinassimulationcenter.org • Dimitrios.Stefanidis@carolinas.org