Objective Many bench-top surgical simulators assess laparoscopic proficiency, yet few address core open surgical skills. The purpose of this study is to describe a cost-effective bench-top vessel-ligation simulator and provide construct validation. Design Prospective comparison of blinded proficiency assessments among participants performing a bench-top vessel-ligation simulation task. Evaluations were performed using Objective Structured Assessments of Technical Skills. Setting This study took place at the University of Virginia School of Medicine, a large academic medical institution. Participants Participants included fourth-year medical students participating in a focused surgical elective course (N = 16), post-graduate year (PGY) 2–3 surgery residents (N = 6), and surgical faculty (N = 5). Results Fixed costs of the vessel-ligation simulator totaled $30. Flexible costs of operation were less than $0.20 per attempt. Median task-specific checklist scores among medical students, residents, and faculty were 4.83, 7.33, and 7.67, respectively. Median global rating scores across the three groups were 2.29, 4.43, and 4.76, respectively. Significant proficiency differences were noted between students and residents/faculty for both metrics (p < 0.001). Conclusions A cost-effective bench-top simulator can effectively measure proficiency with basic open surgical techniques such as vessel-ligation. Among junior surgical trainees, this tool can identify learning gaps and improve operative skills in a pre-clinical setting.

Background A cost-effective model for open vessel ligation is currently lacking. We hypothesized that a novel, inexpensive vessel ligation simulator can efficiently impart transferrable surgical skills to novice trainees. Materials and Methods VesselBox was designed to simulate vessel ligation using surgical gloves as surrogate vessels. Fourth-year medical students performed ligations using VesselBox, and were evaluated by surgical faculty using the Objective Structured Assessments of Technical Skills (OSATS) global rating scale and a task-specific checklist. Subsequently, each student was trained using VesselBox in an adaptive practice session guided by cumulative sum. Post-testing was performed on fresh human cadavers by evaluators blinded to pre-test results. Results Sixteen students completed the study. VesselBox practice sessions averaged 21.8 minutes per participant (IQR 19.5 – 27.7). Blinded post-tests demonstrated increased proficiency, as measured by both OSATS (3.23 vs 2.29, p < 0.001) and checklist metrics (7.33 vs 4.83, p < 0.001). Median speed improved from 128.2 seconds to 97.5 seconds per vessel ligated (p = 0.001). Following this adaptive training protocol, practice volume was not associated with post-test performance. Conclusions VesselBox is a cost-effective, low-fidelity vessel ligation model suitable for graduating medical students and junior residents. Cumulative sum can facilitate an adaptive, individualized curriculum for simulation training.

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INTRODUCTION:Abuse of prescription opioids has reached epidemic proportions, and research demonstrates that prescription opioids used in post-cesarean-delivery pain management contribute significantly to this epidemic. Research in other surgical specialties demonstrated that patients consume about half of their initial prescription dose; however, this theory has yet to be applied to the field of obstetrics and gynecology. The objective of this research is to determine if initial prescription size influences patient consumption of opioids for post-cesarean-delivery pain management.METHODS:This randomized controlled trial involves 170 opioid-naive women ages 19–40 years undergoing scheduled cesarean deliveries at Carilion Roanoke Memorial Hospital. Patients were randomized to receive either 10 or 20 tabs of oxycodone 5 mg as an initial postoperative prescription in a double-blinded, parallel trial design. Outcome metrics regarding opioid consumption patterns and pain control were collected at three different time points postoperatively: 2–3 days, 10–14 days, and 6 weeks.RESULTS:Preliminary data (n=62) demonstrates that an average of 5 (±3.73) opioid tablets were consumed postoperatively in the 10-tablet group, compared to 8.4 (±8.87) tablets in the 20-tablet group (P=.05). Moreover, no participant requested additional refills of opioids.CONCLUSION:We observed that the average number of opioids consumed for adequate postoperative pain management was about half of the initial prescription size in both groups. Preliminary data supports the idea that initial prescription size influences patient opioid consumption. This study has direct implications to support a standard reduction of opioid prescriptions for post-cesarean pain management and the potential to directly impact millions of women every year.