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Simulation in Cardiothoracic Surgery

By M. Blair Marshall, MD

Even the most talented musical virtuoso would not play a piece in public without practicing. Yet we ask residents to perform the operative equivalent of a virtuoso performance only after essentially a brief glance at the sheet music. With the persistent push to shorten work hours and training, one would think that this results in a decreased opportunity to hone skills prior to starting one’s own practice. For the routine lobectomy or cardiac procedures, there may be ample opportunity to refine one’s skill during training, but what of the more complex procedures? Certainly as the complexity of cardiothoracic procedures increases, the frequency of which they are performed decreases. The age old opportunity to “see one, do one, teach one” is now essentially non existent and no longer relevant or workable.

Until recently, the opportunity to practice cardiothoracic surgery outside of an operating room was minimal. Simulation in cardiothoracic surgery is still in its infancy. That being said, the potential is enormous, and I expect that in a relatively short  period of time, it will become a requirement. From a technological standpoint, current simulators are extremely expensive, and are, for the most part, somewhat awkward. This is analogous to computers in the 70’s. In a short time, technology will meet our needs for simulation and with reasonable cost. I have already seen evidence of this, and it is not so far away.    

Currently, for pure skills in cardiothoracic surgery, home made simulators using animal heart lung blocks and other tissues have proven to be very effective tools for teaching technical skills and spatial relationships. This has been demonstrated with our efforts at the “Cardiothoracic Resident Boot Camp” held by the TSDA and ABTS. As well, in particular for general thoracic surgery, one can mimic some of the less frequently performed procedures such as bronchial sleeve resection, pulmonary arterioplasty and even chest wall resection/reconstruction. By focusing on the purely technical aspects of these procedures in a non-threatening environment, without the pressure of time and patient outcomes, we, as educators, are allowed to fully focus on the task at hand, TEACHING. Also, once the basic technical skills have been mastered, the opportunity to learn many of the subtler aspects of cardiothoracic surgery becomes apparent.

In summary, simulation in cardiothoracic surgery will become a staple in cardiothoracic education of the future. Residents will one day be able to practice repeatedly outside of the operating room prior to being expected to produce a virtuoso performance during an operation.

Publication Date: 28-Jul-2009