Bridging the Learning Gap: Surgery Trainees Hone Vascular Trauma Skills via High-Fidelity Simulation

Introduction

Advancing developments of endovascular approaches and subspecialty vascular care have significantly diminished general surgery residents' exposure to essential vascular techniques in trauma. This has led to a deficiency in preparedness among residency graduates in handling basic vascular emergencies. The Open Surgical Simulation System (OS3) is a high-fidelity trauma surgery model that allows for skill acquisition through hands-on practice.

Methods

We evaluated the effect of a new OS3 surgical skills curriculum on residents' self-assessed knowledge, technical skills, and confidence using precourse and postcourse surveys with 5-point Likert scales. Procedures performed included resuscitative thoracotomy, exploratory laparotomy, splenectomy, liver trauma management, small bowel resection, and retroperitoneal exploration. Determinants of skill self-assessments, perceived challenges, and course utility for skill acquisition were analyzed using linear regression modeling.

Results

One hundred eighty-three trainees completed the simulation and surveys. Each increasing postgraduate year level above 2 was associated with increases in self-assessment of knowledge, skills, and experience (P < 0.001); prior Advanced Trauma Operative Management and Advanced Surgical Skills for Exposure in Trauma course participation was not. Vascular shunt insertion, aortic crossclamp, and vascular anastomosis consistently ranked among the most challenging procedures regardless of training levels. Overall, the OS3 simulation significantly increased trainees’ confidence in performing resuscitative thoracotomy, exploratory laparotomy, splenectomy, liver trauma management, retroperitoneal exploration, and small bowel resection (P < 0.02).

Conclusions

When self-assessing technical skills in trauma, almost half of surveyed general surgery trainees describe significant difficulty with essential vascular procedures such as shunting and aortic crossclamping. The OS3 may allow for consistent and readily reproducible training in these and other procedures to alleviate this confidence gap.