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Education and Training Research

Protocol Title: Improved Patient Safety by Simulator Based Training in Cardiac Surgery

Sponsor: Agency for Healthcare Research & Quality
Principal Investigator: John V. Conte, MD

The safety of a surgical patient is closely related to the quality of the surgeon’s training. This is particularly true for patients undergoing cardiac surgery, where stakes are high and technical skills are demanding. In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Unfortunately, today’s operating room provides insufficient time in which to teach surgery, has no tolerance for the inefficiency inherent in education, offers no chance for deliberate practice of skills, and cannot provide for orchestrated training in how to deal with adverse events. But all of these are essential to the training of a safe surgeon. This study intends to show that training in cardiac surgical techniques can be improved by using modern cardiac surgery simulation technology combined with a rigorous, simulation-based curriculum. This should produce surgeons with better skills and thus ensure safety for patients.

This three-year project will determine the effectiveness of using simulator-based training in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. Eight institutions (University of North Carolina at Chapel Hill, Massachusetts General Hospital, Johns Hopkins University, Vanderbilt University, University of Rochester, Mayo Clinic, Stanford University, and University of Washington) will participate in the study, which will include 16 first-year cardiothoracic residents in each of two consecutive academic years.

This simulation study is conducted in the Johns Hopkins Cardiac Surgery Research Lab and utilizes the Ramphal Cardiac Surgery Simulator (RCSS).  “The model uses a porcine heart that is prepared with an intraventricular balloon in each ventricle. The balloons are inflated by a computer controlled activator. The computer program is able to simulate the beating heart, various cardiac arrhythmias, hypo- and hypertensive states, cardiac arrest, and even placement of an intra-aortic balloon pump. The model is perfused with a washable blood substitute. When placed in a replica of the pericardial well in a mannequin, the RCSS is capable of duplicating most aspects of cardiac surgery including all aspects of cardiopulmonary bypass, coronary artery bypass grafting both on and off bypass, aortic valve replacement, heart transplantation, and aortic root reconstruction. The computer protocols also make experience with adverse events such as accidental instillation of air into the pump circuit, aortic dissection, and sudden ventricular fibrillation after discontinuation of cardiopulmonary bypass possible.”1

“The model has been used in the training of more than 140 cardiothoracic surgery residents in the United States at the Thoracic Surgery Directors Association (TSDA) Resident Boot Camps (intensive training sessions for physicians who are beginning their residency training in cardiothoracic surgery) and the Resident Technology Symposia and has been shown to be a very effective training tool.”1