Certification of Basic Skills in Open Repair of Infrarenal Abdominal Aortic Aneurysms Through a Modular Simulation Course with Real Time Performance Assessment

Abstract

Objective: Training opportunities in open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) have declined in parallel with the growing use of endovascular aortic aneurysm repair. Consequently, simulation based education (SBE) in OSR is recommended in the European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. This study aimed to assess whether and how novices can reach proficiency in basic OSR skills when following a fixed duration and certifying SBE programme and to evaluate the reliability and inter-rater variability of the assessment tool in this setting.

Methods: The ESVS and Copenhagen Certification Programme in OSR (ENHANCE-OPEN) was tested prospectively among OSR novices from 2023 to 2024. The programme includes pre-course e-learning and 21 hours of hands on SBE in a realistic pulsatile AAA model supervised by an experienced OSR instructor. Participant performance was rated four to five times with the OPERATE assessment tool. A previously validated pass limit of 27.7 points defined proficiency and certification.

Results: Twenty four OSR novices were included, of whom 21 (88%) passed the programme. The median baseline performance score was 23 points (interquartile range [IQR] 12, 29), which improved to a median score of 32 points (IQR 27, 39) in the final test. Participants required a median of three test attempts (IQR 1, 5) to reach the pass limit. The internal consistency of OPERATE was excellent, with a Cronbach's α coefficient of 0.93. Instructor ratings varied significantly (range -5.4 to +4.9 points; p < .001). To minimise individual instructor bias, a system was implemented whereby instructors rotated between participants.

Conclusion: Most novices reached proficiency and certification in basic OSR when following the ENHANCE-OPEN programme. OPERATE assessment was reliable for evaluating OSR skills; however, variations between instructor ratings were high, underlining the need for instructor training.

Keywords: Assessment; Certification; Curriculum; Open aortic aneurysm repair; Simulation based education.