Development of a median sternotomy simulation model for cardiac surgery training

Abstract

Objective: We sought to develop a simulation model to train resident physicians in the performance of a median sternotomy.Methods: A modified Delphi consensus process was used with cardiac surgery staff to develop a 20-point checklist for the safe performance of a median sternotomy. Thirteen junior cardiac surgery trainees from across Canada participated in this study to assess the simulation model. Trainees performed the sternotomy before and after reviewing an instructional video. Two senior cardiac surgery resident physicians assessed the participants with the checklist during each session. An entry and exit questionnaire was given to the participants to evaluate the simulation model. Results: Participants scored higher after the training (14.3 AE 2.0) compared with before training (8.0 AE 3.1) (P < .001). The mean duration of time for participants to complete the sternotomy was shorter before training (188 AE 52 seconds vs 228 AE 58 seconds; P ¼ .003). The checklist interrater reliability was k ¼ 0.47 (moderate) for before training and k ¼ 0.37 (fair) for after training. All study participants rated the simulation sessions as very useful or extremely useful. Conclusions: Using the simulation model, training video, and checklist, trainees were able to improve their skill in performing a median sternotomy. This improvement was associated with longer times to complete all procedure steps. Rater training may further improve interrater reliability. Our median sternotomy checklist and simulation model can be adopted for the technical skills training of future cardiac surgery trainees. (JTCVS Techniques 2020;2:109-16

Comparison of the short and medium term efficacy of ortholox UHMWPE sternal cerclage band system and figure-of-8 wire sternum closure technique in patients at risk for sternal dehiscence

“…However, because the wires pierce the sternum's cortical layers, there is a risk that the patient would move inappropriately, which could result in sternum separation (5). Figure-of-8 Wire, which were designed as an alternative to the traditional one-by-one wire, are used to reduce this risk (6). In cases when closure has failed, sternal 8-shape wires have been utilized both frequently and as a first rescue technique.…”

Commentary: Stay midline, stay steady: Median sternotomy training

“…Considered a basic skill, a poorly performed median sternotomy can result in significant complications. 1 Recognizing an opportunity for an adjunct educational tool, and spurred by significant support from educators and program directors in Canada, Vo and colleagues 2 have developed a simulation model for the practice of median sternotomy and provide preliminary validation evidence for its use in training.…”

“…Although there are excellent models for techniques such as vascular anastomosis or cannulation for cardiopulmonary bypass, the median sternotomy is often neglected. A major strength of the study by Vo and colleagues 2 is that they have developed an inexpensive, realistic model focusing on performing this important task. The model is easy to reproduce, and blinded assessments by participants indicate they found the model to be realistic and useful.…”

Commentary: The educational hole is no bigger than the sum of its parts

“…Among the innovative approaches that have been proposed to address this obvious gap, simulation of surgical procedures has emerged as a clear favorite of program directors and trainees alike. 1 In their thoughtful approach to teaching what may be the most fundamental of cardiac surgical skills, Vo and colleagues 2 demonstrate an approach to education that the members of our specialty would do well to emulate.…”

“…It is for this reason that the protocol outlined in the current study provides valuable benchmarks for those inexperienced in handling a sternal saw. The checklist Vo and colleagues 2 provide in their online-only material will become immediate mandatory reading for junior residents in my own operating room, and I suspect that codifying even this most basic of techniques will prove valuable to educators and trainees alike.…”