A. Radhakrishna1, M.S. Naparst1, K. Keeling1, G. Syrnioti1, G. Guntur1, H. Nasr1, A. Radhakrishna1, A. Musunuru1, C. Hadeed1, J. Eisdorfer1, C. Lapunzina1, R. Kothuru1, P. Haser1, R. Abdel-Naby1, I. Shuman1, N.J. Gargiulo1 1One Brooklyn Health, Vascular/Trauma/Surgery, Brooklyn, NY, USA
Introduction: Surgical residents have 5 to 7 years to learn and perform surgical procedures. There is a significant variability of endovascular exposure amongst surgical residents in the United States. Endovascular skills are applicable to traumatic injuries of the arterial and venous systems and require minimal exposure and training to master the skills. The goal of this research study was to evaluate the performance of a basic endovascular skill prior to balloon aortic occlusion. Successful completion and time to complete the endovascular skill was evaluated. The basic endovascular skill was evaluated at the medical student level (MS III), and compared to post-graduate year 1 (PGY-1) and post-graduate year 5 (PGY-5) general surgical residents at a level II trauma safety-net hospital system.
Methods: Three groups of trainees were convened and assessed at a Level II Trauma Center Hospital System in a simulation laboratory. The partcipants included 6 medical students in their 3rd Year Surgery Core Rotation (GROUP I), 4 surgical PGY-1 residents (GROUP II), and 3 surgical PGY-4/PGY-5 surgical residents (GROUP III). The three groups were isolated in private simulation rest areas and then individually transitioned into the simulation laboratory. The three components of the endovascular skill included: 1. An 8 French sheath 2. A 7mm polytetrafluoroethylene (PTFE) graft 3. A 0.035 inch glidewire with a sheath introducer device. Timing of the endovascular skill began with sheath insertion into the PTFE graft, introduction of the 0.035 inch wire into the sheath, and concluded when the wire exited both the sheath and PTFE graft. Each individual of the 3 GROUPS was evaluated on the completion and the time to complete the endovascular skill. A 30 minute didactic session was implemented with a follow up skill assessment measuring time.
Results: There were no individuals in GROUP I that could complete the endovascular skill initially, however, after completion of the 30 minute didactic session all 6 individuals could complete the skill within 23.67 seconds. All 4 individuals in GROUP II completed the endovascular skill within 29.25 seconds which significanty improved to 9.13 seconds following the didactic session. GROUP III individuals completed the endovascular skill in 11.33 seconds. A significant completion time reduction disparity was observed between the PGY-1 (20.12 seconds) and PGY-4/5 (0 seconds) residents following the 30 minute didactic session.
Conclusion: The endovascular skill evaluated in this study could not be successfully completed by third year medical students until a 30 minute didactic session was implemented. This relatively brief hands-on endovascular didactic session, however, significantly improved performance at the medical student level which matched the skill level of PGY-1 and PGY 4/5 surgical residents. The significant completion time reduction disparity between the PGY-1 and PGY-4/5 surgical residents may be related to prior experience and mastery of the tecnique.