Human cadaver endovascular training :the establishment and validation of a fresh frozen pulsatile human cadaver endovascular training model

Abstract

AIMS: The current study had the following aims: 1. Establish an effective pulsatile human cadaver pulsatile flow model (PHCM). 2. Explore the acceptability of PHCM 3. Assess the face and construct validity of PHCM. 4. Compare the effectiveness and transferability of endovascular skills taught on PHCM versus a virtual reality simulator (VRS). 5. Examine the role of video-enhanced feedback during technical skills training. METHODS: 1. Cadaveric experiments were conducted at a licensed research facility: Newcastle Surgical Training Centre (NSTC). 2. Structured questionnaires were used to explore public and professional opinion. 3. Face and construct validity were assessed in a standard manner using practitioners of varying levels of experience. 4. Novice candidates were recruited and completed the same training regime on PHCM or VRS before crossing over onto the alternate model to compare the effectiveness of PMCH and transferability of endovascular skills. All performances were recorded and scored by two blinded experts using a validated clinical scoring tool. 5. Novice candidates were assessed performing a basic suturing exercise before and after varying forms of feedback (including video enhanced feedback). RESULTS: 1. A PHCM was successfully created. 2. Patients and professionals support cadaveric endovascular training but expressed some reservations over its feasibility. 3. Expert practitioners confirmed the models face validity. PHCM has construct validity in differentiating between novice candidates and both intermediate (p=0.000)* level and expert (p=0.000) practitioners (improved overall procedure score (OPS)). 4. PHCM training improved candidate’s quantitative parameters (Time p=0.000, Fluoroscopy p=0.026, Contrast p=0.008) and clinical performance scores (p=0.000)*. Both PHCM and VRS demonstrated transferability of basic endovascular skills. 5. Video feedback is superior to a structured lecture (OPS) and individualized feedback was not superior to unsupervised video-enhanced feedback (p=1.000*). CONCLUSION: PHCM is a feasible, valid and effective model for training basic endovascular skills. The role of unsupervised video feedback could further enhance technical skills training and warrants further investigatio