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Simulation-Based Learning In Mitral Valve Surgery David L Joyce1, Tanvir S Dhillon2, Anthony D Caffarelli1, Daniel D Joyce3, Dimitrios N Tsirigotis4, *Thomas A Burdon1, *James I Fann11Stanford University, Palo Alto, CA;2University of California, San Diego, San Diego, CA;3New York University, New York, NY;4Yale University School of Medicine, New Haven, CT OBJECTIVES: The complexity and inherent limitations of exposure and visualization have impacted resident training in mitral valve surgery. We propose that implementation of simulation-based learning in the curriculum would improve residents’ acquisition of skills for mitral valve surgery. METHODS: Eleven residents underwent simulation training in mitral valve annuloplasty. Six were part of the integrated six-year cardiothoracic surgery training program, and five had completed a general surgery program. After reviewing an instructional video-recording on mitral valve repair using the porcine model and plastic model, each resident performed a mitral ring annuloplasty using the porcine model, and their performance was video-recorded. Each video-recording was reviewed by an attending surgeon and formative feedback provided with superimposed audio narration; the narrated recordings were returned to the residents for review. After a three-week practice period using the plastic model, the residents performed mitral annuloplasty using the porcine model and were again video-recorded. Performance assessment of technical components pre- and post-feedback was done in a blinded fashion using a 5-point rating scale (5=good, 3=average, 1=poor). RESULTS: Time to completion improved from a mean of 31 (±9) min to 25 (±6) min after the three-week practice period based on the porcine model combined with formative feedback (p=0.03). Overall improvement in the technical components was achieved in all residents, although there was wide variability with the mean near or slightly above “average” (Table). Some residents demonstrated minimal improvement using this model. CONCLUSIONS: Simulation-based learning employing formative feedback results in overall improved performance in mitral annuloplasty using the porcine model. In complex surgical procedures, where optimal educational opportunities may be limited, simulation may provide necessary early training and a means for practice with formative feedback. An important implication is that had a “passing” grade (e.g., 4 or greater) been established as a prerequisite for residents to participate in clinical mitral valve surgery, many residents would require additional training and remediation, a finding that is not surprising given the complexity of this procedure.
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