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Simulation-Based Training in Cardiac Surgery
Open accessAbstract
Background Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons.Methods Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function. Using deliberate practice, first-year cardiothoracic surgical residents at eight institutions were trained and evaluated on component tasks for each module and later on full cardiac operations. Evaluations were based on five-point Likert-scale tools indexed by module, session, task items, and repetitions. Statistical analyses relied on generalized linear model estimation and corresponding confidence intervals.Results The 27 residents who participated demonstrated improvement with practice repetitions resulting in excellent final scores per module (mean ± two SEs): cardiopulmonary bypass, 4.80 ± 0.12; coronary artery bypass grafting, 4.41 ± 0.19; aortic valve replacement, 4.51 ± 0.20; massive air embolism, 0.68 ± 0.14; acute intraoperative aortic dissection, 4.52 ± 0.17; and sudden deterioration in cardiac function, 4.76 ± 0.16. The transient detrimental effect of time away from training was also evident.Conclusions Overall performance in component tasks and complete cardiac surgical procedures improved during simulation-based training. Simulation-based training imparts skill sets for management of adverse events and can help produce safer surgeons.
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“| Coaching process related | Session duration | >2 h | [72,78] |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [72]
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“| Resident/fellow | Resident/fellow dedicated time for coaching | [72,96,126] | |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [72]
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“The three types of research questions most represented in the articles reviewed focused on learner skills/competencies [72], development of the coach [37], and understanding and application of coaching in medical education [125].”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [72]
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“Two key components were component task training [2] and deliberate practice [3], both of which are unavailable in the clinical operating room.”
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Metadata
- Authors
- Feins, R. H., Burkhart, H. M., Conte, J. V., Coore, D. N., Fann, J. I., Hicks, G. L., Nesbitt, J. C., Ramphal, P. S., Schiro, S. E., Shen, K. R., Sridhar, A., Stewart, P. W., Walker, J. D., & Mokadam, N. A.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Mayo Clinic (US)
- Johns Hopkins University (US)
- University of the West Indies (JM)
- Stanford Medicine (US)
- University of Rochester Medicine (US)
- Vanderbilt University Medical Center (US)
- University of the West Indies (TT)
- Massachusetts General Hospital (US)
- University of Washington (US)
- Corresponding author
- Feins, Richard H.
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 103
- Issue
- 1
- Pages
- 312-321
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2514530386
- Cited by
- 148
- References
- 13
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 10 · 2023: 17 · 2022: 15 · 2021: 19 · 2020: 17 · 2019: 21 · 2018: 14 · 2017: 12
- FWCI
- 18.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Agency for Healthcare Research and Quality (R18HS020451)
- National Center for Advancing Translational Sciences (UL1TR001111)
- Topics
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Social Sciences › Education › Simulation-Based Education in Healthcare
- Social Sciences › Education › Innovations in Medical Education
- Keywords
- simulation-based training, cardiac surgery, surgical training, deliberate practice, cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, air embolism, adverse event management, skill retention, surgical safety
- MeSH terms
- Clinical Competence, Computer Simulation, Education, Medical, Graduate, Cardiac Surgical Procedures, Humans, Internship and Residency, Thoracic Surgery
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