APGO

Objective: To improve resident competence in managing laparoscopic vascular injuries via simulation.

Methods: Residents participated in a simulated laparoscopic procedure. A mannequin containing basic vascular anatomy allowed for bleeding to occur. Residents participated in the simulation, underwent a debriefing, attended a lecture on the management of vascular injury, and then repeated the simulation. Residents took a pre-test, an immediate post-test, and a late post-test two weeks later. The tests contained survey questions, knowledge-based questions, and a free-text portion to simulate dictation.

Results: Twelve residents participated. Two (17%) had ever been involved in a vascular injury. Two (17%) had ever received prior instruction on management of vascular injury. The paired t-test was used to analyze the data. Knowledge scores improved from 48% on the pre-test to 88% on the early post-test (p<0.001) and 74% on the late post-test (p=0.002). Qualitative dictation scores improved from 11% on the pretest to 43% on the early post-test (p=0.005) and 30% on the late post-test (p=0.009). Resident confidence improved from 4% on the pre-test to 42% on the early post-test (p<0.001) and 56% on the late post-test (p<0.001). 100% felt the simulation was either quite helpful or extremely helpful. 100% wanted it repeated annually.

Conclusion: Our residents rarely see laparoscopic vascular injuries or learn about their management. This simulation showed a meaningful, statistically significant, and durable improvement in resident knowledge, confidence, and dictation quality. It was widely accepted by the residents and unanimously chosen to be part of the annual curriculum.