Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment

Rebecca A C Skov; Jonathan Lawaetz; Michael Stroem; Isabelle Van Herzeele; Timothy A Resch; Jonas P Eiberg

doi:10.1016/j.ejvs.2023.11.016

Certification of Basic Skills in Endovascular Aortic Repair Through a Modular Simulation Course With Real Time Performance Assessment

Eur J Vasc Endovasc Surg. 2024 Apr;67(4):672-680. doi: 10.1016/j.ejvs.2023.11.016. Epub 2023 Nov 17.

Authors

Rebecca A C Skov¹, Jonathan Lawaetz², Michael Stroem³, Isabelle Van Herzeele⁴, Timothy A Resch⁵, Jonas P Eiberg²

Affiliations

¹ Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark. Electronic address: rebecca.andrea.conradsen.skov@regionh.dk.
² Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
³ Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
⁴ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
⁵ Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.

PMID: 37979611
DOI: 10.1016/j.ejvs.2023.11.016

Abstract

Objective: Endovascular aortic repair (EVAR) is being used increasingly for the treatment of infrarenal abdominal aortic aneurysms. Improvement in educational strategies is required to teach future vascular surgeons EVAR skills, but a comprehensive, pre-defined e-learning and simulation curriculum remains to be developed and tested. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), an assessment tool for simulation based education (SBE) in EVAR, has previously been designed to assess EVAR skills, and a pass limit defining mastery level has been set. However, EVARATE was developed for anonymous video ratings in a research setting, and its feasibility for real time ratings in a standardised SBE programme in EVAR is unproven. This study aimed to test the effect of a newly developed simulation based modular course in EVAR. In addition, the applicability of EVARATE for real time performance assessments was investigated.

Methods: The European Society of Vascular Surgery (ESVS) and Copenhagen Certification Programme in EVAR (ENHANCE-EVAR) was tested in a prospective cohort study. ENHANCE-EVAR is a modular SBE programme in EVAR consisting of e-learning and hands-on SBE. Participants were rated with the EVARATE tool by experienced EVAR surgeons.

Results: Twenty-four physicians completed the study. The mean improvement in EVARATE score during the course was +11.8 (95% confidence interval 9.8 - 13.7) points (p < .001). Twenty-two participants (92%) passed with a mean number of 2.8 ± 0.7 test attempts to reach the pass limit. Cronbach's alpha coefficient was 0.91, corresponding to excellent reliability of the EVARATE scale. Differences between instructors' EVARATE ratings were insignificant (p = .16), with a maximum variation between instructors of ± 1.3 points.

Conclusion: ENHANCE-EVAR, a comprehensive certifying EVAR course, was proven to be effective. EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE) is a trustworthy tool for assessing performance within an authentic educational setting, enabling real time feedback.

Keywords: Assessment; Certification; Endovascular aortic repair; Feedback; Simulation based education.

MeSH terms

Aortic Aneurysm, Abdominal* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Certification
Endovascular Aneurysm Repair
Endovascular Procedures* / education
Humans
Prospective Studies
Reproducibility of Results
Risk Factors
Treatment Outcome
Vascular Surgical Procedures / education