Novel simulation model improves training experience for cardiothoracic surgeons

"The training paradigm in cardiothoracic surgery has changed over the last decade with the institution of the resident work hour restrictions and diminishing educational resources," said Christina L. Greene, MD, from the University of Southern California (USC) in Los Angeles, who led the study under the mentorship of Craig J. Baker, MD. "Residents are now spending significantly less time in the hospital operating room, so increased importance has been placed on acquisition of surgical skills outside of the OR. Our new pressurized cadaver model is a high-fidelity surgical model that allows trainees to simulate an operative procedure and become proficient in critical surgical techniques."

Fresh tissue dissection from cadavers is viewed by many surgeons as the "gold standard" for surgical simulation, but the lack of circulating blood volume limits the real-world effects for trainees. For this study, Dr. Greene and colleagues evaluated the use of a unique pressurizing system designed by USC.

"This training is performed in a controlled environment outside of the time pressures of the operating room and without consequence to the patient," said Dr. Greene. "We believe this model can increase patient safety and provide better learning environments for residents. The tissue is much closer to what a resident will encounter in the OR, and the ability to simulate surgical bleeding provides instantaneous feedback to the learner."

The researchers pressurized cadavers using red or blue liquid made by dying tap water with food coloring. This perfusate (a fluid that flows through an organ or tissue) is then pumped into the arteries and veins of the cadaver to create pressure and flow through the vessels. A line attached to a centrifugal pump is used to maintain the desired arterial pressure.

"Simulation is an amazing alternative to direct patient care and is becoming one of the most important ways that surgical trainees are taught and evaluated," said Moishe Liberman, MD, PhD, from Centre Hospitalier Universitaire de Montréal in Canada, who was not affiliated with the study. "The pressurized cadaver model developed by Greene and colleagues for cardiac surgery education is a step in the right direction and provides a near real-life situation for the training and evaluation of cardiac surgery residents. This will hopefully be the first step in increased high-fidelity models for education in cardiothoracic surgery."