Development of a Technical Skills Based Curriculum for Vascular Surgery

Introduction: Simulation is an evolving and ever more important component of training for surgical trainees. The independent specialty of vascular surgery, has a rapidly expanding repertoire of procedures with the addition of endovascular techniques. The modality, approach and educational approach to simulation can vary across the world. The aims of this research were to ascertain the highest need areas for vascular simulation, and understand the optimal learning conditions for vascular surgeons-intraining.

Methods: A needs assessment was conducted according to best practices using the Delphi method. All consultant vascular surgeons/trainers in the Republic of Ireland (n=34) were approached to contribute and generate a prioritised list of procedures for training. A random selection (n=10) of surgical NCHDs (non consultant hospital doctors) who attended various existing simulation training were interviewed on an individual basis using a semi structured format. Qualitative data was extracted using inductive thematic analysis techniques, on how best they learn from simulation, and sought to gain further insight on what they valued, prioritised, and needed from their training.

Results: A list of 34 vascular procedures were identified for prioritisation by consultant trainers. Principles of arterial repair and endarterectomy/patching were considered the highest priority. Complex major interventions consistently ranked higher over rarer or more basic procedures among trainers. Participants expressed opinions and preferences based on prior training they had received. They reported simulation was an important component of surgical training, and that competence in core technical skills was extremely important. They appreciated technical skills simulation with direct consultant trainer supervision and contemporaneous verbal feedback. Summative written feedback was also appreciated. Trainees placed visual fidelity and complex/rare procedures low on their priorities, with a strong desire to optimise fundamental skills acquisition. Participants also felt strongly about the benefits of providing a detailed briefing on session content and pre-reading in advance to maximise the educational benefit of training sessions.

Conclusions: Core operative principles and common major operative cases should remain the priority for vascular technical skills training. In designing simulators the main focus should centre on specific skill acquisition rather than replicating an entire procedure. A flipped classroom model of pre-reading, low student-to-trainer ratios, and detailed feedback from consultant trainers should be encouraged. Close collaboration between trainers, trainees and training bodies will help ensure an optimal vascular skills-based simulation curriculum to bridge the gaps in training as a consequence of our evolving healthcare system.