Citation

Carden A, Salcedo E, Leshikar D, Utter G, Wilson M, Galante J. J. Trauma Acute Care Surg. 2016; 80(5): 748-754.

Affiliation

Department of Trauma and Acute Care Surgery UC Davis Medical Center Sacramento, California.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001012

PMID

26891156

Abstract

INTRODUCTION: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy, but lacks practicality when hemorrhage control is the life-saving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVS).

METHODS: Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a non-inferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n= 28) versus a cadaver arm (n= 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances.

RESULTS: Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver [584s vs. 751s; difference +167 (90% C.I. +52 to +282) s faster], with a trend towards faster time to hemorrhage control [110s vs. 148s; difference +38 (-8 to +84) s faster]. There was no significant difference in Objective Structured Assessment of Technical Skills scores [3.72 vs. 3.44; difference +0.27 (90% C.I. -0.04 to +0.59) units better].

CONCLUSION: Training on a dynamic simulator resulted in non-inferior time to completion of vascular shunt placement compared to training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.

Language: en