Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention
Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention
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DOI：
10.3171/2020.9.jns202672
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发表时间：
2021-11-01
影响因子：
4.1
通讯作者：
Zada, Gabriel
中科院分区：
文献类型：
--
作者：
Donoho, Daniel A.;Pangal, Dhiraj J.;Zada, Gabriel
颈内动脉损伤（ICAI）是一种罕见的，危及生命的并发症内窥镜鼻内途径，将遇到大多数颅底神经外科医生和耳鼻喉科医生。管理ICAI的手术熟练度尚不清楚，并且尚未在全国范围内研究模拟在提高性能方面的作用。方法：从多中心区域和国家培训课程中招募了神经外科和耳鼻喉科主治和住院外科医生（n = 177），以评估前瞻性教育干预的培训结果和有效性，从而使用先前验证的灌注人体尸体模拟器提高外科医生的技术技能。参与者尝试使用他们首选的技术进行模拟ICAI控制的初始试验（T1）。进行了包括个性化指导在内的教育干预。参与者尝试第二次试验（T2）。测量任务成功率（二分）、止血时间（TTH）、估计失血量（EBL）和外科医生心率。结果参与者评分量表证实，模拟保留了8个教学设置的面孔和结构效度。试验成功率（ICAI对照）从T1的56%提高到T2的90%（p < 0.0001）。EBL和TTH分别降低了37%和38%（p < 0.0001）。介入后住院医生的表现（TTH、EBL和成功率）上级介入前主治医生的表现。改善最多的四分位数参与者TTH改善62%，EBL改善73%，试验成功率从T1的25.6%提高到T2的100%（p < 0.0001）。基线外科医生信心与T1成功无关，而培训后信心与T2成功相关。在57%的外科医生参与者中测量到心动过速，但在T2期间减弱，与弹性的发展一致。结论：在培训之前，许多主治医师和大多数住院医师不能处理ICAI罕见的、危及生命的术中并发症。模拟教育干预显著改善了外科医生的表现，并在大规模部署时保持有效。模拟还促进了有利的认知技能（技能和弹性的准确感知）的发展。罕见的、危及生命的术中并发症可能是使用手术模拟进行教育干预的最佳目标。
OBJECTIVE Internal carotid artery injury (ICAI) is a rare, life-threatening complication of endoscopic endonasal approaches that will be encountered by most skull base neurosurgeons and otolaryngologists. Rates of surgical proficiency for managing ICAI are not known, and the role of simulation to improve performance has not been studied on a nationwide scale. METHODS Attending and resident neurosurgery and otorhinolaryngology surgeons (n = 177) were recruited from multicenter regional and national training courses to assess training outcomes and validity at scale of a prospective educational intervention to improve surgeon technical skills using a previously validated, perfused human cadaveric simulator. Participants attempted an initial trial (T1) of simulated ICAI control using their preferred technique. An educational intervention including personalized instruction was performed. Participants attempted a second trial (T2). Task success (dichotomous), time to hemostasis (TTH), estimated blood loss (EBL), and surgeon heart rate were measured. RESULTS Participant rating scales confirmed that the simulation retained face and construct validity across eight instructional settings. Trial success (ICAI control) improved from 56% in T1 to 90% in T2 (p < 0.0001). EBL and TTH decreased by 37% and 38%, respectively (p < 0.0001). Postintervention resident surgeon performance (TTH, EBL, and success rate) was superior to preintervention attending surgeon performance. The most improved quartile of participants achieved 62% improvement in TTH and 73% improvement in EBL, with trial success improvement from 25.6% in T1 to 100% in T2 (p < 0.0001). Baseline surgeon confidence was uncorrelated with T1 success, while posttraining confidence correlated with T2 success. Tachycardia was measured in 57% of surgeon participants, but was attenuated during T2, consistent with development of resiliency. CONCLUSIONS Prior to training, many attending and most resident surgeons could not manage the rare, life -threatening intraoperative complication of ICAI. A simulated educational intervention significantly improved surgeon performance and remained valid when deployed at scale. Simulation also promoted the development of favorable cognitive skills (accurate perception of skill and resiliency). Rare, life-threatening intraoperative complications may be optimal targets for educational interventions using surgical simulation.