Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment
Multimodal Cardiopulmonary Bypass Skills Assessment Within a High-Fidelity Simulation Environment
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DOI：
10.1016/j.athoracsur.2020.07.022
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发表时间：
2021-07-20
影响因子：
4.6
通讯作者：
Pugh, Carla
中科院分区：
文献类型：
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作者：
Hermsen, Joshua L.;Mohamadipanah, Hossein;Pugh, Carla
背景资料。使用灌流的猪心、导管和管子的高保真模拟器已被证明是一种有用的训练辅助工具。我们假设，在这种高保真的模拟环境中，对体外循环(CPB)技能的多模式评估可以区分专家和实习生的表现。3名传统研究员(研究生6-8年级)和3名主治外科医生每人进行了3次主动脉插管。第三个步骤包括静脉插管，开始体外循环，放置心脏停搏液导管和主动脉阻断。评估了20个认知领域和21个技术领域的表现。通过戴在无菌手套下的电磁运动传感器评估外科医生和助手的手部活动和活动的经济性。分析显示，认知(6.7+/-2.3比4.6+/-2.7，P=0.03)得分有显著差异，但技术得分(6.2+/-2.5比5.8+/-2.2，P=0.7)对专家有利。此外，专家们显示出更高的效率，用+/-14秒来构建无质押的主动脉荷包缝合线，并用Rummel固定它，而受训者需要82+/-30秒来完成这项任务(P=0.03)。运动分析显示，插管和体外循环专家和实习生之间的路径长度相似，而交叉夹专家的路径长度显著缩短(47.5+/-15.5m比91.9+/-20.3m，P=0.04)。使用高保真模拟环境对CPB基本任务进行认知、技术和动作分析的多模式评估是衡量绩效和区分专家和受训者的有效系统。这一结构可能允许开发“能力阈值”，对心胸外科的培训和认证具有重要意义。(C)2021年，由胸外科医生学会主办
Background. A high-fidelity simulator that uses a perfused porcine heart, cannulae, and tubing has been demonstrated to be a useful training adjunct. We hypothesized that multimodal assessment of cardiopulmonary bypass (CPB) skills within this high-fidelity simulated environment could discern expert from trainee performance.Methods. Three traditional fellows (postgraduate year 6-8) and 3 attending surgeons each performed 3 aortic cannulations. The third sequence included venous cannulation, commencement of CPB, and placement of a cardioplegia catheter and aortic cross-clamp. Performance across 20 cognitive and 21 technical domains was evaluated. Surgeon and assistant hand movements and economy of motion were assessed by electromagnetic motion sensors worn under sterile gloves.Results. Analysis showed a significant difference in cognitive (6.7 +/- 2.3 vs 4.6 +/- 2.7, P = .03) but not technical (6.2 +/- 2.5 vs 5.8 +/- 2.2, P = .7) scores favoring the experts. In addition, experts showed higher efficiency by spending 64 +/- 14 seconds to construct a nonpledgeted aortic purse-string suture and secure it with a Rummel, while trainees spent 82 +/- 30 seconds to complete this task (P = .03). Motion analysis revealed similar path lengths between experts and trainees for cannulation and CPB but significantly shorter path lengths for experts in cross-clamp (47.5 +/- 15.5 m vs 91.9 +/- 20.3 m, P = .04).Conclusions. Multimodal assessment using cognitive, technical, and motion analysis of basic CPB tasks using a high-fidelity simulation environment is a valid system to measure performance and discriminate experts from trainees. This construct may allow for development of "competence thresholds" with important implications for training and certification in cardiothoracic surgery. (C) 2021 by The Society of Thoracic Surgeons