Developing and Implementing a Cardiothoracic Surgery Simulation Curriculum

M. Imran¹, D. Ahmad², A. Kinnunen¹, I. Sultan², M. Schuchert², D. Kaczorowski³, N. Baker⁴, P. Yoon⁵, R. Levesque^2
1UPMC, Pittsburgh, Pennsylvania ²University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania ³University of Pittsburgh, Venetia, Pennsylvania ⁴UPMC, Mount Clare, West Virginia ⁵University of Pittsburgh Medical Center, Wexford, Pennsylvania

Purpose: Cardiothoracic surgery residency programs face the challenge of providing quality training with adequate autonomy given the high acuity environment of an operating room. Surgical simulation is a means to bridge the gap by providing low stress environments for deliberate practice. Our goal was to develop a structured Cardiothoracic simulation curriculum.

Methods: A portfolio of 9 simulation courses were designed for cardiothoracic surgical trainees. These were implemented as monthly modules, each with specific learning objectives. The simulations were delivered using a variety of educational tools including cadaveric facilities, porcine models, and high and low fidelity simulation models. Resident satisfaction was evaluated using quantitative (5-point Likert-scale) and qualitative assessments. Perceived pre-/post- self-confidence and competency were evaluated using a 5-point Likert-scale (1 = poor, 5 = excellent) and analyzed using cumulative mean values and a paired t-test.

Results: The simulation curriculum was categorized into 9 monthly modules and implemented using the optimal simulation tool available. Quantitative analysis of the resident’s feedback demonstrated high satisfaction scores for course content, material, instructors, and skills stations (Table). Courses that incorporated cadaveric simulation models and porcine models rated highly, scoring greater than 4 in overall satisfaction. An overwhelming majority of residents stated that the courses should be taught again (91.6% [47/60]). Statistically significant improvements were observed in residents' perceived self-confidence scores after simulations for surgical management of atrial fibrillation (2.49 vs 3.62), mitral valve repair (2.67 vs 4), aortic valve and root replacement (2.23 vs 3.5), aortic valve neocuspidization (1.86 vs 4.5), and robotic heller myotomy (3.4 vs 4.62) (p < 0.05). Qualitative assessment of the strength of each course demonstrated how hands-on practice in a simulated environment with knowledgeable and engaged instructors lead to a positive learning experience.

Conclusion: Incorporating simulation into cardiothoracic surgery residency educational curriculums is both feasible and necessary. A structured simulation curriculum is reproducible and complements clinical training in cardiothoracic surgery.

Identify the source of the funding for this research project: Department of Cardiothoracic Surgery at the University of Pittsburgh Medical Center