Coronary Anastomosis Simulation: Directed Interventions to Optimize Success

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Medical Simulation

Background:

• The role of simulation-based training in coronary artery bypass grafting (CABG) surgery is not well-defined.
• Barriers to simulator use include time constraints, limited resources, and lack of mentorship.
• A longitudinal, residency-wide coronary anastomosis simulation curriculum was implemented to address these gaps.

Purpose of the Study:

• To implement and evaluate a simulation-based curriculum for coronary anastomosis in thoracic surgery residents.
• To assess the impact of simulation training on resident practice, skill assessment, and procedural efficiency.

Main Methods:

• A prospective observational study involving 17 residents and 12 faculty from a Thoracic Surgery training program.
• Participants used a low-fidelity coronary anastomosis simulator with high-quality instruments and faculty mentorship.
• Residents practiced independently and with mentors, with formal assessments conducted quarterly.

Main Results:

• Independent simulator practice increased from 21% at baseline to 82% by the fourth quarter (P = .02).
• Median Thoracic Surgery Directors Association Vessel Anastomosis Assessment scores improved from 42 to 54 (P = .04).
• Mean anastomosis time decreased by 5 minutes 6 seconds (P = .02), with significant reductions for both junior and senior residents.

Conclusions:

• A low-fidelity coronary anastomosis trainer, coupled with quality instruments and mentorship, effectively improved resident practice and surgical skills.
• The curriculum demonstrated positive impacts on assessment scores and anastomosis efficiency.
• Future steps include validating the simulator curriculum's impact on actual operating room performance.