Improved Patient Safety by Simulator Based Training in Cardiac Surgery

描述(申请人提供)：外科病人的安全与外科医生培训的质量密切相关。对于正在接受心脏手术的患者来说尤其如此，因为手术风险很高，技术技能要求很高。在大多数外科培训中，技术技能都是通过学徒的方式传授的：住院医生在手术室学习手术，在真实的病人身上做部分或全部真实的手术。不幸的是，今天的手术室没有足够的时间教授外科手术，不容忍教育固有的低效，没有提供刻意练习技能的机会，也不能提供如何处理不良事件的精心策划的培训。但所有这些对于培训一名安全的外科医生都是必不可少的。这项研究旨在表明，通过使用现代心脏手术模拟技术，结合严格的、基于模拟的课程，心脏外科技术培训可以得到改善。这应该会培养出拥有更好技能的外科医生，从而确保患者的安全。这个为期三年的项目将根据六个模块确定在组成部分任务和整体程序中使用基于模拟器的培训的有效性：三种类型的心脏外科手术和三种在心脏手术期间可能发生的重大不良事件。这些程序将使用计算机控制的、基于组织的心脏手术模拟器进行教学，该模拟器已被证明真实地复制了正在接受心脏手术的实际患者。八个机构(北卡罗来纳大学教堂山分校、马萨诸塞州总医院、约翰霍普金斯大学、范德比尔特大学、罗切斯特大学、梅奥诊所、斯坦福大学和华盛顿大学)将参与这项研究，包括连续两个学年每年16名心胸外科第一年住院医生。该项目的第一阶段(六个月)将包括开发模拟器和全面的课程，以及教师教育。第二阶段(24个月)将涉及基于模拟器的培训和心脏手术住院医师的绩效评估。教师将使用经批准的评估工具对基于模拟的培训的每个部分进行评估。在培训结束时，两名独立的心胸外科医生将对每个经过模拟器培训的住院医生进行的录像手术以及16名参考住院医生进行的手术进行评分。每个地点的评估数据将被输入一个研究数据库，该数据库将由北卡罗来纳大学开发和管理。在最后阶段(六个月)，将用标准分析方法分析数据。虽然这项提议将检验这样一个假设，即通过使用适当的基于模拟器的培训，心脏外科住院医师可以被培训成更安全的外科医生，但结果应该同样适用于广泛的外科实践。 公共卫生相关性：该项目将研究正在学习心胸外科手术的住院医生是否可以通过使用手术模拟器在对人进行手术之前获得技能来成为更安全的外科医生。患者的安全与医生培训的质量密切相关--对于正在接受心脏手术的患者来说尤其如此。手术模拟器使用的是猪心，它与人类的心脏非常相似。在计算机的控制下，心脏泵送人造血液，因此它们看起来像是活的心脏。他们被放置在人体模型中，给受训者一种在人体胸部进行手术的感觉。八个医疗中心的住院医生将有机会在模拟器上反复练习程序，并练习对手术过程中可能发生的意外事件的反应。他们的能力将与一组没有在培训中使用模拟器的住院医生进行比较。

DESCRIPTION (provided by applicant): The safety of a surgical patient is closely related to the quality of the surgeon's training. This is particularly true of patients undergoing cardiac surgery, where stakes are high and technical skills are demanding. In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Unfortunately, today's operating room provides insufficient time in which to teach surgery, has no tolerance for the inefficiency inherent in education, offers no chance for deliberate practice of skills, and cannot provide for orchestrated training in how to deal with adverse events. But all of these are essential to the training of a safe surgeon. This study intends to show that training in cardiac surgical techniques can be improved by using modern cardiac surgery simulation technology combined with a rigorous, simulation-based curriculum. This should produce surgeons with better skills and thus ensure safety for patients. This three-year project will determine the effectiveness of using simulator-based training in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. Eight institutions (University of North Carolina at Chapel Hill, Massachusetts General Hospital, Johns Hopkins University, Vanderbilt University, University of Rochester, Mayo Clinic, Stanford University, and University of Washington) will participate in the study, which will include 16 first-year cardiothoracic residents in each of two consecutive academic years. The first phase of the project (six months) will include development of the simulators and a comprehensive curriculum, and faculty education. The second phase (24 months) will involve simulator-based training and performance assessment of cardiac surgery residents. Each part of the simulation-based training will be evaluated by the instructor, using approved assessment tools. At the end of the training, two independent cardiothoracic surgeons will grade videotaped surgery performed by each simulator-trained resident plus surgery by 16 reference residents. Assessment data from each site will be entered into a study database which will be developed and managed at the University of North Carolina. In the last phase (six months), data will be analyzed by standard methods of analysis. While this proposal will test the hypothesis that cardiac surgery residents can be trained to be safer surgeons by using appropriate simulator-based training, the results should apply equally well across a broad spectrum of surgical practice. PUBLIC HEALTH RELEVANCE: This project will study whether resident physicians who are learning cardiothoracic surgery can become safer surgeons by using surgery simulators to acquire skills before they operate on people. A patient's safety is closely related to the quality of the doctor's training - this is particularly true of patients undergoing heart surgery. The surgical simulators use pig hearts, which closely resemble human hearts. Controlled by a computer, the hearts pump artificial blood, so they seem like living hearts. They are placed in a mannequin to give trainees the feeling that they are operating on a human chest. Residents at eight medical centers will have the opportunity to practice procedures repeatedly on simulators, and to practice responding to unexpected events that might occur during surgery. Their abilities will be compared with those of a group of residents who haven't used the simulator in training.