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OBJECTIVES:
Troublesome knowledge and threshold concepts are those concepts difficult to conceptualize but once understood are transformative and not forgotten. Complex anatomical relationships can be troublesome and difficult to comprehend but once understood seem relatively simplistic. There are several complex anatomical relationships that are troublesome but whose understanding is critical to becoming a competent vascular surgeon. Unfortunately, due to work hour restrictions and an increase in minimally invasive procedures there are declining opportunities for residents to participate in complex operations that provide the appropriate environment to visualize these anatomical relationships. Because mannequins and computer simulation do not provide sufficient realism and clinical context to adequately substitute for operative experience we propose the use of fresh cadavers to assist resident comprehension of troublesome difficult anatomical relationships in vascular surgery.
METHODS:
Twenty-two PGY 3’s (n=12) and PGY 4’s (n=10) attended four structured 3-hour cadaver skills labs. Residents performed operative vascular exposures identified, by senior surgical residents, as conceptually difficult and infrequently encountered in the current era of residency training. Exposures included the supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, proximal and distal renal arteries, and iliac artery bifurcations. Residents were tested (oral board exam style with percent correct of pre-determined check-list) in their knowledge and understanding of the anatomical relationships prior to and after the cadaver labs. Participant’s self-reported confidence in performing these complex vascular exposures was also measured pre- and post-course using the operating score (OR score, 1 = not confident and 5 = highly confident) for each of the exposures.
RESULTS:
Participation in the course resulted in a significant increase in participant comprehension and self-reported operative confidence of the five anatomical exposures; supraclavicular subclavian and vertebral arteries, supraceliac aorta, superior mesenteric artery, renal arteries, and iliac artery bifurcation. Median oral exam scores: 5% vs. 87%, 26% vs. 94%, 19% vs. 86%, 30% vs. 88%, and 29% vs. 87% respectively, all p’s <0.001 and median OR scores: 1.1 vs. 2.9, 1.3 vs. 3.5, 1.2 vs. 3.2, 1.2 vs. 3, and 1.5 vs. 3.9 respectively, all p’s<0.001.
CONCLUSIONS:
Fresh cadaver labs can provide a learner centered and safe environment for acquiring procedural understanding and operative confidence of complex vascular exposures and allows for transformational change that is essential to becoming a competent vascular surgeon.