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Assessment tool validation and technical skill improvement in the simulation of the Norwood operation using three-dimensional printed heart models

Nabil Hussein, Osami Honjo, David J Barron, Christoph Haller, John G Coles, Glen Van Arsdell, Andrew Lim, Shi-Joon Yoo

European Journal of Cardio-Thoracic Surgery, Volume 59, Issue 2, February 2021, Pages 316–324, https://doi.org/10.1093/ejcts/ezaa321

Abstract

http://philadelphiarealestatelistings.net/2020/11/29/congressional-reps-delay-that-is-rebuke-of-loan/ Objectives: The hands-on surgical training course utilizes 3-dimensional (3D)-printed heart models to simulate complex congenital heart operations. This study aimed to validate a model and assessment tool in the simulation of 2 techniques of the Norwood operation and investigate whether technical performance improves following rehearsal with or without proctor presence.

Arcata Methods: Five ‘experienced’ and 5 ‘junior’ surgeons performed 2 techniques of the Norwood operation on 3D-printed models of hypoplastic left heart syndrome. Performances were retrospectively assessed by 10 raters with varying experience in congenital heart surgery (CHS) (Medical Doctorate versus non-Medical Doctorate). Assessments were made with the procedure-specific Hands-On Surgical Training-CHS tool. Results were analysed for technical performance and rater consistency. Following validation, 30 surgeons (24 with proctor guidance and 6 with training videos and objective feedback only) simulated the Norwood operation twice.

buy prednisone 5 mg online Results: Performance scores were consistently higher for experienced surgeons and raters discriminated clearly between the experienced and junior surgeons (P ≤ 0.001). The hands-on surgical training-CHS tool showed high inter-rater (0.86) and intra-rater (0.80) reliability among all raters. Scores for both experienced and junior surgeons were highly consistent across all raters, with no statistically significant difference (P = 0.50). All surgeons successfully performed the Norwood operation. Sixty attempts were scored in total. Eighty-seven percentage (26/30) of surgeons’ scores (mean: attempt 1 = 92, attempt 2 = 104) and times [mean: attempt 1 = 1:22:00, attempt 2 = 1:08:00 (h:mm:ss)] improved between the 2 attempts by 9% and 15% respectively (P ≤ 0.001). Total scores of all surgeons in the non-proctored subgroup (6) improved by 15% on average (mean: attempt 1 = 86, attempt 2 = 105, P = 0.002).

http://classic-carpets.co.uk/wp-includes/certificates/pharmacie/quibron-en-ligne-pinto-caron-sa.html Conclusions: Procedure-specific assessment tools can be developed to evaluate technical performance for complex CHS simulation and be performed reliably by non-expert raters. Rehearsal both under supervision and independently leads to technical skill improvement further supporting its value in CHS training.

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Commentary

Education in congenital heart surgery (CHS) is a demanding field. On the one hand, to keep the standard high, the most experienced surgeon of a center is asked to perform the operation. On the other hand, trainees should be educated. Thereof, the Norwood operation is one of the most challenging procedures on the spectrum of CHS. Three-dimensional (3D) – printed models found their entry to CHS as models for counselling parents, operation planning or teaching tools. In regard to that topic, Hussein et al published an interesting article “Assessment tool validation and technical skill improvement in the simulation of the Norwood operation using three-dimensional printed heart models” recently in the European Journal of Cardio-Thoracic Surgery. Hands-on surgical training on 3D-printed heart models showed to be a reliable surgical simulation tool and useful as procedure specific assessment tool. They observed that 87 % of attendees scores and time improved between two attempts. Accordingly, attendees improved in knowledge of the procedure, respect for tissue and fluency. A subgroup performed both attempts without any proctor guidance or feedback, an access to training videos were given instead. The analysis showed no difference in improvement of scores in the proctored versus the non-proctored group. Although, not the purpose of this paper, a secret tip is Table 1 which includes a precise description of the fundamentals, of two possible techniques, on how to perform a Norwood operation.

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