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Resident Education Program in Thoracic Surgery

Simulation Program

The Vanderbilt thoracic surgery simulation program, under the direction of Dr. Jonathan Nesbitt, has become an integral part of the residency training experience.  Throughout the years of training, fundamentals of cardiac and thoracic surgery are taught in a simulated environment.  Training in specific procedures are also taught and practiced in a deliberate and distributed method. The level of complexity of the procedures increases as the resident’s level of experience advances accordingly.

Specific Goals

  • To determine the practical and logistical considerations using the various cardiac and thoracic simulation models.
  • To investigate competency assessment utilizing direct observation and video clips of simulation performance evaluated by live and independent educators.
  • To investigate the use of “deliberate practice” with simulation as a means of more efficiently teaching proficiency in cardiac and thoracic technical skills.
  • To develop new innovations in cardiothoracic surgical simulation in an effort to facilitate and further teaching methodologies.

Background

High Fidelity cardiac simulation has been utilized since 2008 and has become an integral part of the TSDA Cardiothoracic Surgery Boot Camp.  The Vanderbilt cardiothoracic surgery program as both a high Fidelity cardiac simulator as well as a high Fidelity perfusion and ECMO simulator.  The cardiac simulator provides an extremely realistic environment in which a specially prepared porcine heart is activated by computer-controlled intra-ventricular balloons.  It is perfused with blood like solution and placed in a realistic pneumatic.  This allows for simulation and heart cannulation, coronary bypass surgery was arrested or beating heart, aortic valve replacement, and aortic root replacement.  It also allows for training in adverse events.

The Califia perfusion simulator can perform adult and pediatric cardiac perfusion training as well as adult and pediatric ECMO training.  Such training is performed with both the cardiac surgery service and the perfusion service for combined training.  The VUMC Cardiac Perfusion School is very involved with these simulation efforts.

Open lobectomy as also been taught at the TSDA Cardiothoracic surgery Boot Camp since 2008.  The identical model has been utilized in the Vanderbilt simulation program for instruction of both the general surgery and thoracic residents.

The Vanderbilt University Medical Center cadaver laboratory has become a key integral part of resident education.  Specific procedures are taught in a controlled environment using real anatomic structures.  The cadaver lab is easily accessed and arranged.

Methods

A 36 week cardiac surgery curriculum is used as a guide.  6 modules comprise the curriculum.  The modules include: Fundamentals of perfusion, cardiac cannulation with cardiopulmonary bypass, coronary artery bypass grafting (on and off pump), aortic valve replacement, complications of perfusion, and sudden cardiac decompensation.

General thoracic surgery lung and esophageal porcine blocks are available for training open and thoracoscopic skills.

Periodically, training sessions in the cadaver lab are arranged with staff surgeons to teach specific operations and to review the anatomy and anatomic relationships.

The resident’s train in a deliberate and distributive fashion and are graded accordingly on their performance.  Such measures allow both the resident and the educator to gain knowledge of skill levels and advancement.

The cardiac simulation laboratory is open 24/74 training exercises by the resident with or without staff supervision.
 


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This page was last updated September 30, 2014 and is maintained by