シミュレーションベースの血管吻合トレーニングと盲検ビデオ分析による技術スキル習得の向上と評価バイアスの低減
Jorge Sulca Flores1, Kenneth Lynch2, Carla C Moreira2
1School of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Objective:
To evaluate the effectiveness of video replay in simulation-based vascular anastomosis training on technical skill acquisition, alignment between resident self-assessments and faculty evaluations, and reduction of potential evaluator bias.
Methods:
Over the course of 3 years, 31 PGY-2 general surgery residents completed a 7-week structured vascular anastomosis training program at a single academic institution. Training included simulation-based practice and video-recorded pre- and post-test performances of end-to-side anastomoses. Two independent surgical attendings reviewed blinded videos; residents conducted unblinded self-assessments. Performance was evaluated using a modified Mini-Objective Structured Assessment of Technical Skills (MOSAT) and a Global Rating Scale (GRS), with a total score of 62. Paired and unpaired t-tests were used for statistical analysis.
Results:
Significant improvements were observed in both self-assessed and faculty assessed technical scores (p < 0.0001). Residents' self-assessments increased from a mean of 29.1 to 46.6 (p < 0.0001), while attending scores rose from 29.6 to 49.9 (p < 0.0001). Mean leak volume decreased by 15.3 mL (p < 0.0001), while completion time showed no significant change. At baseline, no differences were found between resident and attending scores. Post-test, attendings rated resident performance significantly higher than residents did in GRS and overall scores (p = 0.024 and p = 0.033, respectively), particularly in domains such as flow of operation and instrument handling. At pre-test, attending scores rated female residents significantly higher than male residents in anastomosis (p = 0.024) and overall score (p = 0.040). Post-test, no significant gender differences were observed in any category or in overall scores (p = 0.541).
Conclusions:
Simulation-based vascular training using blinded video replay has been shown to improve technical skills significantly and may reduce gender-based evaluation bias. Despite access to performance footage, residents tend to underestimate their abilities compared to faculty assessments.
