Strengthen vascular simulation research with modern validity frameworks, longer skill-retention follow-up, cost-effectiveness analysis, and more nontechnical-skills and cadaver models¶

Strategy · All strategies
Evidence · 3 claims (3 for) · 2 studies (2 quant-synthesis), q2 · 0 of 2 report an effect size · 3 claims rest on one study

Description¶

The review's forward-looking recommendations for integrating simulation into vascular curricula: prospective studies should use Messick's modern validity framework, include "a longer follow-up time of trainee skill retention and discussion of cost-effectiveness", and validate simulators "in large, well-designed randomized control trials with adequate follow-up time". It also calls for greater implementation of nontechnical-skills testing and of cadaver models alongside other modalities, and for novel high-fidelity simulators with greater sensory and haptic feedback for basic endovascular skills.

Design Implications¶

Context¶

Requirements¶

• Future trials must include adequate follow-up time and larger samples, since many current trials had small sample sizes.
• Training institutions and designers should implement cadaver models in combination with other simulation modalities.

Constraints¶

• Open vascular simulators face greater resistance and cost than endovascular counterparts because a three-dimensional field is harder to replicate than a two-dimensional computer system; NTS implementation carries high costs of implementation and maintenance.

Target Learners¶

• vascular surgery trainees
• surgical trainees at any stage
• medical students on vascular placements

Target Learning Goals¶

• open and endovascular procedural skill proficiency
• nontechnical skills such as teamwork and communication
• skill retention over time

Affordances¶

• Messick Validity Loe Simulator Evaluation

Claims¶

• Only seven studies of vascular surgery simulation achieved a level of effectiveness greater than 3/5, with the majority scoring LoE 1-2/5 [+W]
• Nontechnical-skills simulation of ruptured AAA with the Resusci Anne Simulator directly improved patient outcomes, reducing door-to-occlusion time, door-to-needle time, and 30-day mortality (LoE 4/5) [+W]
• High-fidelity simulation methods (simulators, 3D models, cadaver-based practice) are associated with superior Acquisition retention, though some studies report contradictory findings [+M]

Related Strategies¶

• Develop and validate a reusable, cost-effective, high-fidelity training platform and build homogeneous assessment tools for aneurysm clipping simulation
• Prioritize larger multi-center RCTs with standardized AR systems, uniform metrics, and long-term follow-up when evaluating AR surgical training
• Future research should use standardized validated outcome measures, longitudinal follow-up designs, and methods linking learner gains to patient-relevant outcomes
• Future research should include long-term RCTs with adequate sample sizes, standardized outcome measures, and cost-effectiveness analyses
• Require adequately powered studies of skill retention and transfer before recommending major investment in cadaveric simulation
• Develop portable low-cost COTS-based simulators to enable ubiquitous training and presurgical warm-up in minimally invasive surgery
• Prioritize randomized controlled trials, established validity frameworks, and protocol publication in future VRS simulation research

Examples¶

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Key Sources¶

• Haiser Alexander, Aydin Abdullatif, Kunduzi Basir, Ahmed Kamran, Dasgupta Prokar. (2022). A Systematic Review of Simulation-Based Training in Vascular Surgery. The Journal of Surgical Research. https://doi.org/10.1016/j.jss.2022.05.009