Randomized controlled trial comparing dynamic simulation to static simulation in trauma

Anthony J. Carden, Edgardo Salcedo, David Leshikar, Garth H Utter, MacHelle D. Wilson, Joseph M Galante

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

INTRODUCTION: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy, but lacks practicality when hemorrhage control is the life-saving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVS). METHODS: Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a non-inferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n= 28) versus a cadaver arm (n= 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances. RESULTS: Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver [584s vs. 751s; difference +167 (90% C.I. +52 to +282) s faster], with a trend towards faster time to hemorrhage control [110s vs. 148s; difference +38 (-8 to +84) s faster]. There was no significant difference in Objective Structured Assessment of Technical Skills scores [3.72 vs. 3.44; difference +0.27 (90% C.I. -0.04 to +0.59) units better]. CONCLUSION: Training on a dynamic simulator resulted in non-inferior time to completion of vascular shunt placement compared to training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Feb 17 2016

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Blood Vessels
Randomized Controlled Trials
Cadaver
Wounds and Injuries
Hemorrhage
Anatomic Models
Femoral Artery
Swine
Research

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

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title = "Randomized controlled trial comparing dynamic simulation to static simulation in trauma",
abstract = "INTRODUCTION: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy, but lacks practicality when hemorrhage control is the life-saving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVS). METHODS: Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a non-inferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n= 28) versus a cadaver arm (n= 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances. RESULTS: Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver [584s vs. 751s; difference +167 (90{\%} C.I. +52 to +282) s faster], with a trend towards faster time to hemorrhage control [110s vs. 148s; difference +38 (-8 to +84) s faster]. There was no significant difference in Objective Structured Assessment of Technical Skills scores [3.72 vs. 3.44; difference +0.27 (90{\%} C.I. -0.04 to +0.59) units better]. CONCLUSION: Training on a dynamic simulator resulted in non-inferior time to completion of vascular shunt placement compared to training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.",
author = "Carden, {Anthony J.} and Edgardo Salcedo and David Leshikar and Utter, {Garth H} and Wilson, {MacHelle D.} and Galante, {Joseph M}",
year = "2016",
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AU - Carden, Anthony J.

AU - Salcedo, Edgardo

AU - Leshikar, David

AU - Utter, Garth H

AU - Wilson, MacHelle D.

AU - Galante, Joseph M

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N2 - INTRODUCTION: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy, but lacks practicality when hemorrhage control is the life-saving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVS). METHODS: Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a non-inferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n= 28) versus a cadaver arm (n= 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances. RESULTS: Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver [584s vs. 751s; difference +167 (90% C.I. +52 to +282) s faster], with a trend towards faster time to hemorrhage control [110s vs. 148s; difference +38 (-8 to +84) s faster]. There was no significant difference in Objective Structured Assessment of Technical Skills scores [3.72 vs. 3.44; difference +0.27 (90% C.I. -0.04 to +0.59) units better]. CONCLUSION: Training on a dynamic simulator resulted in non-inferior time to completion of vascular shunt placement compared to training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.

AB - INTRODUCTION: Current general surgery residents have limited exposure to open trauma operative cases. Simulation supplements variable rotation volume and provides experience with critical but rarely performed procedures. Open simulation classically focuses on static models with anatomic accuracy, but lacks practicality when hemorrhage control is the life-saving maneuver. We sought to evaluate whether training on a dynamic simulator, while much less expensive than training on a static cadaver, might be at least as effective in training surgery residents to expeditiously place temporary vascular shunts (TVS). METHODS: Our research team developed an inexpensive, reusable dynamic simulator with ongoing hemorrhage to instruct trainees in the steps of TVS placement. We enrolled 54 general surgery residents in a non-inferiority randomized controlled trial comparing training of TVS placement on the dynamic simulator (n= 28) versus a cadaver arm (n= 26). After standardized video didactics, trainees practiced on either the simulator or cadaver arm. After trainees achieved competency, they were tested on placing a TVS for a live swine femoral artery injury. Two blinded trauma surgeons evaluated the recorded performances. RESULTS: Residents did not differ in baseline characteristics between groups, and all residents in both groups successfully completed the TVS placement test. Subjects trained on the simulator placed the TVS faster than those trained on a cadaver [584s vs. 751s; difference +167 (90% C.I. +52 to +282) s faster], with a trend towards faster time to hemorrhage control [110s vs. 148s; difference +38 (-8 to +84) s faster]. There was no significant difference in Objective Structured Assessment of Technical Skills scores [3.72 vs. 3.44; difference +0.27 (90% C.I. -0.04 to +0.59) units better]. CONCLUSION: Training on a dynamic simulator resulted in non-inferior time to completion of vascular shunt placement compared to training on a cadaver. The addition of dynamic hemorrhage to simulators might inexpensively augment trauma skills training.

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