01.08 Novel Approach to Training Residents in Breast Surgery Using Human Donors

S. Keshwani1, A. Madrigrano1, C. Ferrigno1, J. M. Velasco1  1Rush University Medical Center, General Surgery, Chicago, IL, USA

Introduction:  Breast cancer is the leading cause of cancer in women. Management of breast cancer often includes image guided lumpectomy and SLNB (sentinel lymph node biopsy). Given the high incidence rate of breast cancer and shortage of fellowship trained specialists, general surgeons are frequently responsible for these patients. Although these procedures are part of the core curriculum of general surgery residency, residents have less operative exposure to breast surgery due to duty hour restrictions and decreased resident autonomy. This study's purpose was to create a simulation-based, novel curriculum designed to teach PGY1 and PGY2 residents how to perform breast lumpectomy and SLNB prior to their clinical experience.

Methods:  All eighteen junior general surgery residents were invited to participate. We chose fresh human donors to represent tissue planes more accurately. We inserted Savi Scout reflectors (Merit Oncology, Inc) in each breast for tumor localization. An olive pit plus 1mL of Methylene blue was inserted in the axilla for SLN identification. For the first session, two attending surgeons discussed proper surgical technique for lumpectomy and SLNB. Residents performed the procedures and received real-time feedback. Trainees returned for a second session two months later where they performed the same operation without any guidance. They were graded on technique by the same attendings present during both sessions. Residents were asked to fill out a voluntary, anonymous post-session Likert-scale based survey to gauge confidence.

Results: Out of 18 total residents, seven PGY1 and six PGY2 residents participated (response rate: 72.2%). 57% of PGY1 and 50% of PGY2 respondents strongly felt that this session improved their understanding of lumpectomies, SLNB, and axillary anatomy. Most residents also felt strongly that their skills improved when compared to the training session, and that these skills were transferable to the operating room. In attending evaluations, PGY1 residents significantly improved in all aspects of the procedures; PGY2 residents showed non-statistically significant improvement in their technique. 

Conclusion: This study aimed to implement a simulation-based program designed to teach the fundamentals of breast surgery by using available instruments. Utilization of fresh cadavers creates ideal conditions for identification of tissue planes and visualization of landmark structures. Our results indicate that residents find these sessions helpful in learning anatomy, improving their confidence and efficiency, and facilitating skill acquisition that is transferable to the operating room. Although long term objective evaluations are needed, we believe this approach should be considered in general surgery training programs.