A Systematic Review of Simulation-Based Training in Vascular Surgery

Abstract

Introduction: Recent advancements in surgical technology, reduced working hours, and training opportunities exacerbated by the COVID-19 pandemic have led to an increase in simulation-based training. Furthermore, a rise in endovascular procedures has led to a requirement for high-fidelity simulators that offer comprehensive feedback. This review aims to identify vascular surgery simulation models and assess their validity and levels of effectiveness (LoE) for each model in order to successfully implement them into current training curricula.

Methods: PubMed and EMBASE were searched on January 1, 2021, for full-text English studies on vascular surgery simulators. Eligible articles were given validity ratings based on Messick's modern concept of validity alongside an LoE score according to McGaghie's translational outcomes.

Results: Overall 76 eligible articles validated 34 vascular surgery simulators and training courses for open and endovascular procedures. High validity ratings were achieved across studies for: content (35), response processes (12), the internal structure (5), relations to other variables (57), and consequences (2). Only seven studies achieved an LoE greater than 3/5. Overall, ANGIO Mentor was the most highly validated and effective simulator and was the only simulator to achieve an LoE of 5/5.

Conclusions: Simulation-based training in vascular surgery is a continuously developing field with exciting future prospects, demonstrated by the vast number of models and training courses. To effectively integrate simulation models into current vascular surgery curricula and assessments, there is a need for studies to look at trainee skill retention over a longer period of time. A more detailed discussion on cost-effectiveness is also needed.

Keywords: Endovascular surgery; Open vascular surgery; Simulation; Training; Vascular skills.

Fig.

Study selection process according to the PRISMA statement. Figure 1 shows that 525 articles were found after the initial search and exclusion of duplicates. After abstract and title screening, 178 articles were assessed for eligibility via full-text screening and 102 articles were excluded for various reasons. Overall, 76 eligible articles were found for 34 different simulators (See Supplementary Table I). Simulators were allocated to open vascular surgery, endovascular surgery, nontechnical skills, and simulation courses.