Proficiency-based simulation training in open and endovascular surgery.

The traditional form of surgical skills training and recent changes in health care have created challenges in keeping up the standards in skills training of future surgeons. The structured development of simulation training might help tackle these challenges. The main aim of this thesis was to explore whether basic surgical skills acquired using proficiency-based simulation training in superficial femoral artery (SFA) angioplasty and saphenofemoral junction (SFJ) dissection translate to real-world performance. Four studies were performed. In the first study, a procedure-specific checklist for SFA angioplasty was developed and validated using the Vascular Intervention Simulation Trainer (VIST) simulator. In the second study, the impact of an assistant on the technical skills of the primary operator performing SFA angioplasties on the VIST simulator was assessed. The first and the second studies were essential to study the transfer of endovascular skills after proficiency-based simulation training in SFA angioplasty to the interventional suite (third study). The fourth study describes the transfer of open vascular surgical skills after proficiency-based bench model simulation training in SFJ dissection to the operating room (OR).

Simulation-trained trainees scored higher than the controls on the procedural checklist developed (86.80 ± 5.36 vs. 67.60 ± 6.02 P = 0.001) and a global rating scale (37.20 ± 4.09 vs. 24.40 ± 5.32 P = 0.003) when performing SFA angioplasty on patients. Similarly, bench model simulation-trained trainees scored higher than the controls on procedural (30.33 ± 2.07 vs. 18 ± 2.19 P < 0.001) and global (28.33 ± 1.86 vs. 18.50 ± 4.04 P < 0.001) rating scales when performing SFJ dissection on patients. Basic surgical skills acquired using proficiency-based simulation training in SFA angioplasty and SFJ dissection do translate to real world performance. Structured proficiency-based simulation training in SFA angioplasty and SFJ dissection should be incorporated into surgical training programs.