Introduction
We designed a low cost workshop to teach surgical residents basic skills of vascular anastomosis. We studied our ability to differentiate between novice, proficient individuals and experts using objective measures of performance.
Methods
Ten PGY-2 residents without prior vascular surgery experience (novice) and four attending surgeons (expert) performed end-to-side anastomosis using synthetic graft. Residents were taught basic skills of vascular anastomosis during three didactic workshops. Objective metrics included volume leaked after saline perfusion (leak) and time to complete the anastomosis. Penalty points were assigned for broken sutures, air knots, locking sutures and failure to maintain an outside-in to inside-out technique. Leak, time and penalties before and after training were compared.
Results
Mean leak for the novice group was 70.4mL ¡À13.7 and mean completion time was 18.7 ¡À3 minutes versus 45.3mL ¡À10.6 (p<.01) and 8.5¡À1 minutes (p<.001) respectively for the expert group. Post-training (proficient group), there was significant improvement in resident leak (46.7mL¡À6.8; p<.001) and time (14.4¡À3; p<.01). Leak was similar between the proficient and expert groups (46.7 mL ¡À6.8 vs. 45.3 mL ¡À10.6 respectively; p=.77); however, there remained a significant difference for time (14.4¡À3.0 vs 8.5¡À1 minutes respectively; p<0.01). Mean total penalties for the novice group was (84.5¡À19.7) compared to zero penalties for the proficient and expert groups.
Conclusions
We report a low cost workshop for teaching surgical residents the basic skills of performing vascular anastomosis. A simple, objective scoring system is described that can differentiate between a novice, a person who is proficient and an expert at performing vascular anastomosis.
