Development of a Vascular Surgery Simulation Curriculum: From Design and Implementation to Studying the Impact of Peer-Assisted Learning on Skills Acquisition

BACKGROUND: In the last few decades, increasing emphasis has been placed on moving residents' early learning curves out of the operating room into a simulated environment. In response, ample research focusing on development/validation of instructional modules, simulators and assessment methodologies has been conducted. However, evaluation of the best methods of implementing these curriculums is lagging behind, and there is currently no standardized method of disseminating surgical simulation curriculums. OBJECTIVE: The goal of this project was two-fold: to create a standardized vascular surgery simulation curriculum for junior surgical residents, and to conduct a study evaluating the effects of Peer-Assisted Learning (PAL) on surgical skills acquisition and learner confidence. METHODS: Instructional materials (video + written instructions, task trainers) for a simulated end-to-side vascular anastomosis procedure were created in collaboration with vascular surgery faculty. Using the end-to-side anastomosis as the procedure being taught, 45 PGY 1-3 general surgery residents were randomized to Solo or PAL practice. Learners in the Solo arm practiced independently, whereas learners in the PAL arm practiced with a same-level peer while employing PAL techniques such as roleplaying and providing peer feedback. Pre-test and post-test videotaped performances were recorded, and assessed by 2 experts who were blinded to group, test and learner. Survey questionnaires were used to gauge participant confidence. RESULTS: Learners showed significant improvement in their post-test checklist scores, global rating scores and self-reported confidence in comparison to their pre-test scores (all p <0.05). There were no significant differences in pre-test outcome measures (checklist, global ratings, time taken, self-reported confidence) between Solo and PAL groups. Comparing post-test outcomes between groups, PAL learners had significantly higher global ratings (p = 0.02) and significantly lower time to anastomosis completion (p = 0.01); there were no significant differences in self-reported confidence (p = 0.25). CONCLUSION: This project resulted in the development and implementation of a standardized simulated vascular surgery curriculum for junior surgical residents at UT Southwestern Medical Center. Our study shows that learners who practiced with a peer showed better skill acquisition. With no current standardization in dissemination of simulation curriculums, it is important to study methods that enhance skill acquisition, and subsequently incorporate these techniques into future simulation curriculums through curricular reform.