Improved Patient Safety by Simulator Based Training in Cardiac Surgery

描述（由申请人提供）：手术患者的安全与外科医生的培训质量密切相关。这对于接受心脏手术的患者尤其如此，因为风险很高，技术技能要求很高。在大多数外科培训中，技术技能是通过学徒制传授的：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，今天的手术室提供了足够的时间来教授手术，不能容忍教育中固有的低效率，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。但所有这些都是训练一个安全的外科医生所必需的。本研究旨在表明，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，可以提高心脏手术技术的培训。这将培养出技能更好的外科医生，从而确保患者的安全。这个为期三年的项目将确定在六个模块的基础上，在组件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心脏外科手术期间可能发生的三种重大不良事件。该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，该模拟器已被证明可以真实地复制接受心脏手术的实际患者。八所机构（北卡罗来纳州大学查佩尔山分校、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、马约诊所、斯坦福大学和华盛顿大学）将参与这项研究，其中将包括16名第一年的心胸外科住院医师连续两个学年。该项目的第一阶段（六个月）将包括开发模拟器和综合课程，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外科住院医师的绩效评估。基于模拟的培训的每个部分将由讲师使用批准的评估工具进行评估。在培训结束时，两名独立的心胸外科医生将对每个模拟器培训的住院医师进行的录像手术以及16名参考住院医师进行的手术进行评分。每个研究中心的评估数据将输入研究数据库，该数据库将在北卡罗来纳州大学开发和管理。在最后阶段（6个月），将通过标准分析方法分析数据。虽然这项建议将测试假设，心脏外科住院医生可以通过使用适当的模拟器为基础的培训，培训成为更安全的外科医生，结果应该同样适用于广泛的外科实践。

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.