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S128 Surgical Forum Abstracts J Am Coll Surg

CONCLUSIONS: Colonoscopic skill training on a low-fidelitymodel appears to be as effective as high-fidelity model training forbasic endoscopic skill acquisition for novice learners.

A randomized control study of the effectiveness of videoinstruction for the acquisition of basic laparoscopicsurgical skillSarah Elizabeth Peyre EdD, Amy West, Luise Pernar MD,Gloria Hicks RN, Douglas Smink MD, MPH, FACSBrigham and Women’s Hospital, Boston, MA

INTRODUCTION: Instructional videos can improve performance,retention, and maintenance of skills. We sought to measure the ef-fectiveness of video instruction in laparoscopy by comparing tradi-tional simulation teaching to an instructional video module.

METHODS: Twenty-eight surgical interns were randomized to re-ceive either traditional teaching of a brief lecture, modeling andguided skills practice or video instruction using an electronic distrib-utive model paired with individual practice. Content for both armsfocused on navigation skills with a 30 degree laparoscope. A profilesurvey was collected as well as baseline and post-testing using a virtualreality camera navigation skill module. Results were analyzed using aMann Whitney U test.

RESULTS: There were 14 subjects in each study arm. The tworoups were similar in age (28.2, 27.7), video game experience (0.23,.5 average hours per week), and laparoscopic experience duringnternship (7.6, 1.8 cases). At baseline, the video and control groupsid not differ by time to completion in seconds (261 vs. 253,�0.77), percent of time horizon maintained (72.6 vs. 65.1,�0.34), or number of targets missed (3.14 vs. 2.92, p�0.66). Afterhe intervention, both the video (261 vs. 188, p�0.001) and control

(253 vs. 193, p�0.01) groups improved in time to completion, butneither improved significantly in horizon maintenance.

CONCLUSIONS: Video instruction of basic laparoscopic cameranavigation provides similar improvement in surgical trainees perfor-mance as compared with traditional simulation teaching. Utilizingvideo instruction to augment simulation skill acquisition instructioncould reduce faculty time for teaching and has important implica-tions for simulation curricula.

“Where simulation ends and training begins” The effectand durability of a pre-graduation prep course for medicalstudents entering surgical trainingOlugbenga T Okusanya MD, Zev N Kornfield MD,Caroline E Reinke MD, MSPH, Jon B Morris MD,Babak Sarani MD, FACS,Noel N Williams MB BCh, FRCSI, FRCS,Rachel R Kelz MD, MSCEHospital of the University of Pennsylvannia, Philadelphia, PA

INTRODUCTION: Medical school does not specifically prepare stu-dents for internship. Pre-internship courses are known to increaseconfidence in multiple key areas. Several prior studies have looked at

courses given at the beginning of internship when anxiety is high. We

examined the immediate effect and durability of effect of a pre-graduation prep course (PGPC) on provider confidence in medicalmanagement and technical skills.

METHODS: A four day simulation PGPC (refer to Table) was of-fered to medical students (MS) entering surgical programs (n�18;2009-2010). MS were anonymously surveyed before, after and 6months following the course. The same survey was given 6 monthsinto internship to a control group of surgical interns who did nothave a PGPC prior to graduation. Data was compared between thetime intervals and across cases and controls using the Wilcoxon rank-sum and signed-rank tests.

Medical Management Skills Technical Skills

Respiratory Distress CricothyroidotomyPost-operative Fever Chest tubePost-operative Bleeding Central LineOliguria Arterial LineChange in Mental Status Peripheral LineElectrolyte Disturbances Urinary CatheterChest Pain Nasogastric Tube Placement

(and) ManagementAcute Deterioration Unknown

EtiologyACLS algorithms

RESULTS: MS (n�12) confidence post-PGPC compared to pre-PGPC improved significantly in all areas except placement of an IVor urinary catheter. Six months into internship there was no differ-ence in confidence levels between the MS PGPC group (n�18) andthe controls (n�9), except the MS PGPC group felt more confidentin their ability to perform a crichothyroidotomy (2.5 vs 1.4 p�0.04)or place a chest tube (3.3 vs 2.1, p�0.05).

CONCLUSIONS: PGPC can improve self-confidence in youngdoctors prior to enrolling in surgical residency in many areas ofperi-operative care. The effect is most durable in high risk, infre-quently performed technical tasks. Future studies are under design toexamine the impact of PCs on the “July Effect.”

Performance assessment of surgical residents in avascular anastomosis laboratoryZachary I Okhah, Paul Morrissey MD, FACS,David Harrington MD, FACS, William G Cioffi MD, FACS,Kevin P Charpentier MD, FACSWarren Alpert School of Medicine at Brown University,Providence, RI

INTRODUCTION: We designed a low cost workshop to teach sur-gical residents basic skills of vascular anastomosis. We studied ourability to differentiate between novice, proficient individuals andexperts using objective measures of performance.

METHODS: Ten PGY-2 residents without prior vascular surgeryexperience (novice) and four attending surgeons (expert) performedend-to-side anastomosis using synthetic graft. Residents were taught

basic skills of vascular anastomosis during three didactic workshops.

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S129Vol. 213, No. 3S, September 2011 Surgical Forum Abstracts

Objective metrics included volume leaked after saline perfusion(leak) and time to complete the anastomosis. Penalty points wereassigned for broken sutures, air knots, locking sutures and failure tomaintain an outside-in to inside-out technique. Leak, time and pen-alties before and after training were compared.

RESULTS: Mean leak for the novice group was 70.4mL �13.7 andean completion time was 18.7 �3 minutes versus 45.3mL �10.6

(p�.01) and 8.5�1 minutes (p�.001) respectively for the expertgroup. Post-training (proficient group), there was significant im-provement in resident leak (46.7mL�6.8; p�.001) and time(14.4�3; p�.01). Leak was similar between the proficient and ex-pert groups (46.7 mL �6.8 vs. 45.3 mL �10.6 respectively; p�.77);

owever, there remained a significant difference for time (14.4�3.0s 8.5�1 minutes respectively; p�0.01). Mean total penalties for theovice group was (84.5�19.7) compared to zero penalties for theroficient and expert groups.

ONCLUSIONS: We report a low cost workshop for teaching sur-ical residents the basic skills of performing vascular anastomosis. Aimple, objective scoring system is described that can differentiateetween a novice, a person who is proficient and an expert at per-orming vascular anastomosis.

irkpatrick evaluation of interprofessionalimulation-based education for peroperative crisisesource managementharat Sharma BSc, MD, Sylvain Boet MD, MEd,ylan Bould MB, ChB, MEd, Ariza Birze MSc, PhD,iren Naik MD, MEd, FRCPC, Scott Reeves PhD,eodor Grantcharov MD, PhDniversity of Toronto, Toronto, ON

NTRODUCTION: Crisis management is acknowledged as key tonsuring patient safety in operating room (OR) practice. Interpro-essional education aims to teach different professions how to workffectively together. In interprofessional simulation-based educationIPSE), debriefing can be challenging, as participants may feel shynd intimidated about reflecting upon their performance in front ofeers from other professions. This study aims to evaluate IPSE crisisesource management training according to the Kirkpatrick model.

ETHODS: Teams consisting of one anesthesia resident/fellow, oneurgical resident/fellow and one circulating OR nurse, underwent

different simulated scenarios with one video-assisted, expertnstructor-lead team debriefing in between. The crisis scenarios usedhybrid simulation, combining a virtual reality laparoscopic trainernd a high-fidelity computer enhanced mannikin in a realistic oper-ting room environment. Immediately after the session participantsvaluated the program using an anonymous questionnaire, ratingheir experience. The questionnaire approached level 1 (Learners’iews on the learning experience) and 2a (modification of attitudesnd perceptions) according to the modified Kirkpatrick model.

ESULTS: Eighteen teams (54 individuals) each participated inwo scenarios and one expert instructor-lead debriefing for a total of6 scenarios and 18 debriefings. All participants, but one nurse,

valuated the training session. d

ONCLUSIONS: IPSE for peroperative crisis resource manage-ent training was feasible and very well received by the 3 professions.xpert instructor-lead team debriefing didn’t appear to be a barrier to

he implementation of routine IPSE crisis resource managementraining. Further studies should investigate the impact of such pro-rams on higher Kirkpatrick levels.

esign and validation of a model for assessment ofrocedural skills in open surgeryeil Rittenhouse MHSc, BASc, Bharat Sharma MD,anil Sonnadara PhD, Alex Mihailidis PhD, PEng,eodor Grantcharov MD, PhDniversity of Toronto, Toronto, ON

NTRODUCTION: Laparoscopy is currently the gold standard forholecystectomy. Recent literature suggests surgical trainees haveimited exposure to open cholecystectomy which may result in sub-ptimal performance in the event of conversion. Furthermore, mostraining and assessment models are designed for laparoscopic chole-ystectomy with limited opportunities for open simulator training.he present study’s purpose was to design an inexpensive model forpen cholecystectomy and validate a performance assessment tool.

ETHODS: The simulator is comprised of a porcine liver and gall-ladder in a mock human abdomen with silicon skin. The assessmentool utilizes inexpensive IR cameras to provide tracking of participantand motions. Ten novice general surgery trainees (�20 cholecystec-omies) and five expert surgeons (> 100 cholecystectomies) com-leted an open cholecystectomy using the simulator. Procedures wereecorded and assessed by a blinded evaluator using a global ratingcale. Tracking data analysis was based on number of movements andotal path length.

ESULTS: Novices (t�36.18 min) completed the procedure sig-ificantly slower than experts (t�19.53 min) (Mann-Whitney’s test�20, p�0.05) and had significantly more hand movements

Mann-Whitney’s test U�20, p�0.05). Analysis of the total globalating scale scores showed a significant difference between novice14/35) and expert (24/35) performance in all categories (Mann-

hitney’s test U�58, p�0.05).

ONCLUSIONS: The present model presents a realistic, low-costool for training and assessment of procedural skills in open chole-ystectomy. The study demonstrated the validity of the IR trackingevice as an objective assessment tool for open surgical skills training.uture training should incorporate this low-cost, highly effectiveraining device into surgical curricula.

ntraoperative resident education for robotic laparoscopicastric banding surgeryaniel A Hashimoto, Ernest Gomez, Paula K Edelson,nrico Danzer MD, Jon B Morris MD, FACS,oel N Williams MD, FRCSI, Kristoffel R Dumon MD, FACSniversity of Pennsylvania School of Medicine, Philadelphia, PA

NTRODUCTION: The incorporation of robotic surgery into resi-

ent education poses questions regarding the impact on intra-