Development of a median sternotomy simulation model for cardiac surgery training

Thin Xuan Vo; Nadzir Juanda; Janet Ngu; Nada Gawad; Kathy LaBelle; Fraser D Rubens

doi:10.1016/j.xjtc.2020.03.007

Development of a median sternotomy simulation model for cardiac surgery training

JTCVS Tech. 2020 Apr 5:2:109-116. doi: 10.1016/j.xjtc.2020.03.007. eCollection 2020 Jun.

Authors

Thin Xuan Vo¹, Nadzir Juanda¹, Janet Ngu¹, Nada Gawad², Kathy LaBelle³, Fraser D Rubens¹

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
² Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
³ University of Ottawa Skills and Simulation Centre, Ottawa, Ontario, Canada.

Abstract

Objective: We sought to develop a simulation model to train resident physicians in the performance of a median sternotomy.

Methods: A modified Delphi consensus process was used with cardiac surgery staff to develop a 20-point checklist for the safe performance of a median sternotomy. Thirteen junior cardiac surgery trainees from across Canada participated in this study to assess the simulation model. Trainees performed the sternotomy before and after reviewing an instructional video. Two senior cardiac surgery resident physicians assessed the participants with the checklist during each session. An entry and exit questionnaire was given to the participants to evaluate the simulation model.

Results: Participants scored higher after the training (14.3 ± 2.0) compared with before training (8.0 ± 3.1) (P < .001). The mean duration of time for participants to complete the sternotomy was shorter before training (188 ± 52 seconds vs 228 ± 58 seconds; P = .003). The checklist interrater reliability was κ = 0.47 (moderate) for before training and κ = 0.37 (fair) for after training. All study participants rated the simulation sessions as very useful or extremely useful.

Conclusions: Using the simulation model, training video, and checklist, trainees were able to improve their skill in performing a median sternotomy. This improvement was associated with longer times to complete all procedure steps. Rater training may further improve interrater reliability. Our median sternotomy checklist and simulation model can be adopted for the technical skills training of future cardiac surgery trainees.

Keywords: medical education; simulation; sternotomy; surgical education.