Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment
| Autor: | Joshua L. Hermsen, Hossein Mohamadipanah, Paul D. DiMusto, Su Yang, Brett Wise, Amy G. Fiedler, Carla M. Pugh |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty media_common.quotation_subject Fidelity 030204 cardiovascular system & hematology Hand movements law.invention 03 medical and health sciences 0302 clinical medicine law medicine Cardiopulmonary bypass Humans Porcine heart Computer Simulation media_common Surgeons Cardiopulmonary Bypass business.industry Significant difference Internship and Residency High Fidelity Simulation Training Catheter 030228 respiratory system Education Medical Graduate Cardiothoracic surgery Physical therapy Surgery Clinical Competence Cardiology and Cardiovascular Medicine business Venous cannulation |
| Zdroj: | The Annals of Thoracic Surgery. 112:652-660 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.07.022 |
| Popis: | Background A high-fidelity simulator that uses a perfused porcine heart, cannulae, and tubing has been demonstrated to be a useful training adjunct. We hypothesized that multimodal assessment of cardiopulmonary bypass (CPB) skills within this high-fidelity simulated environment could discern expert from trainee performance. Methods Three traditional fellows (postgraduate year 6-8) and 3 attending surgeons each performed 3 aortic cannulations. The third sequence included venous cannulation, commencement of CPB, and placement of a cardioplegia catheter and aortic cross-clamp. Performance across 20 cognitive and 21 technical domains was evaluated. Surgeon and assistant hand movements and economy of motion were assessed by electromagnetic motion sensors worn under sterile gloves. Results Analysis showed a significant difference in cognitive (6.7 ± 2.3 vs 4.6 ± 2.7, P = .03) but not technical (6.2 ± 2.5 vs 5.8 ± 2.2, P = .7) scores favoring the experts. In addition, experts showed higher efficiency by spending 64 ± 14 seconds to construct a nonpledgeted aortic purse-string suture and secure it with a Rummel, while trainees spent 82 ± 30 seconds to complete this task (P = .03). Motion analysis revealed similar path lengths between experts and trainees for cannulation and CPB but significantly shorter path lengths for experts in cross-clamp (47.5 ± 15.5 m vs 91.9 ± 20.3 m, P = .04). Conclusions Multimodal assessment using cognitive, technical, and motion analysis of basic CPB tasks using a high-fidelity simulation environment is a valid system to measure performance and discriminate experts from trainees. This construct may allow for development of “competence thresholds” with important implications for training and certification in cardiothoracic surgery. |
| Databáze: | OpenAIRE |
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