Matthew C Tufts, Myron S Powell, MD, Jim Johnson, PhD, Jim Jordan, PhD, Jeffery Carter, MD. Wake Forest Baptist Health
INTRODUCTION: Surgical graduate medical education (SGME) has undergone dramatic changes from the apprenticeship model with increased emphasis on work hour restrictions. As a result, SGME has expanded the role of simulation training (ST) with the development of new standards such as FLS and FES. Unfortunately, these courses lack the fidelity of a live animal lab nor do they allow endemic data to guide additional ST to improve management of rare events. We identified uncontrolled laparoscopic bleeding (ULB) as a rare event with a discrete knowledge and skill set that could be improved through an innovative industry partnership (IIP) in an advanced porcine laparoscopic hemostasis simulation (APLHS). Our goal was to improve general surgery residents (GSR) understanding of laparoscopic techniques (LT) for surgical hemostasis using an APLHS.
METHODS AND PROCEDURES: Two SAGES surgeons with backgrounds in surgical education reviewed 4 years of endemic serious safety events and designed an APLHS similar to the Advanced Trauma Operative Management (ATOM) course. IIPs were identified with priorities aligned to address LT of ULB. IIPs provided funding for the porcine lab, instruments, and hemostatic agents. IRB and IACUC approval was obtained. Medical education experts aided in survey development and animal use. GSR participated in anonymous surveys assessing knowledge, skills, and attitude before and after the lab with a 4-month follow-up using a 5-point Likert scale. The lab was conducted with heparinzed female adult pigs placed under general anesthesia with a structured series of mentored injuries and management including: trocar injury to the liver, splenic capsular tear, kidney laceration, and IVC injury.
RESULTS: 11 GSR completed APLHS with 100% survey completion and 72% at the 4-month interval. The post-survey results demonstrated reduced heterogeneity in management technique and improved understanding of the techniques and products. This correlated with results demonstrating increased confidence managing ULB and increased confidence using LT and/or products. At 4-months, surveys demonstrated continued improvement in technique homogeneity and 100% of the participants recommending the lab to peers.
CONCLUSION(S): We demonstrated that an APLHS may prove as a valuable tool educating and managing ULB. Our partnership demonstrated an alignment with industry, education, and patient care resulting in a “win-win” situation. Residents referred to the laparoscopic ATOM course as the most educational experience of the year. Researchers should remain cognizant of potential biases which were assessed with a concurrent IRB-approved study. Additional research is needed to further characterize value and patient outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85440
Program Number: S068
Presentation Session: Acute Care Session
Presentation Type: Podium