Prospective Trial of Low-Fidelity Deliberate Practice of Aortic and Coronary Anastomoses (TECoG 002)

John R. Spratt, Melissa Brunsvold, David Joyce, Tom Nguyen, Mara Antonoff, Gabriel Loor

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: We sought to examine the feasibility of a home practice curriculum of vascular anastomosis in cardiovascular surgery using a low-fidelity simulation platform and to examine its effectiveness in skill acquisition in senior surgical trainees. Design: We organized a multicenter prospective randomized study of senior residents and fellows, who were oriented to a low-fidelity cardiac simulator and an 8-week curriculum of independent practice of aortic and coronary anastomosis. “Treatment” trainees received a simulator and the curriculum. Control trainees received only their usual operative experience. The groups then crossed over; all were studied for 16 weeks in total. Video skill assessments were captured at 0, 8, and 16 weeks and were scored by one blinded investigator using the Joint Council on Thoracic Surgery Education Assessment tool. A post-hoc survey was distributed to invited participants following study completion. Setting: University of Minnesota Department of Surgery, Mayo Clinic Department of Cardiovascular Surgery, and the University of Texas Health Science Center at Houston. Participants used the simulator in offices, call rooms, and their homes. Participants: Program participation in the study was solicited through the Thoracic Education Cooperative Group. Four institutions expressed interest and a total of 29 trainees were invited to the study and randomized. Of these, 12 (38%) completed the curriculum and submitted the requisite 3 sets of videos (6 treatment, 6 control). All were senior residents and fellows in general and cardiothoracic surgery. Results: No significant differences were detected in assessment scores before and after the curriculum nor before or after the control period in the overall or postgraduate year-stratified populations. Participant case numbers during the study did not have a significant effect on assessment scores. Randomized participants reported strong interest in deliberate practice of technical skills but identified competing clinical and personal obligations and significant barriers to simulation. Conclusions: Considerable variability in performance existed among participants who completed the study, but overall, the curriculum alone was insufficient to improve simulator Joint Council on Thoracic Surgery Education scores compared to those not undergoing the curriculum. Among senior residents and fellows, provision of a practice curriculum and simulator for repeated practice is feasible but clinical and personal responsibilities were barriers to repetitive practice.

Original languageEnglish (US)
Pages (from-to)844-855
Number of pages12
JournalJournal of surgical education
Issue number3
StatePublished - Oct 28 2018

Bibliographical note

Funding Information:
We would like to thank the Thoracic Education Cooperative Group (TECoG) for their assistance in organizing the study and in helping to recruit participating institutions. We would also like to thank Claire Hvass for assistance with simulator photography. Funding: This work was supported by a grant from the University of Minnesota Department of Surgery.

Funding Information:
Funding: This work was supported by a grant from the University of Minnesota Department of Surgery.

Publisher Copyright:
© 2018 Association of Program Directors in Surgery


  • CVS
  • Cardiovascular Surgery
  • Cardiovascular surgery
  • Joint Council on Thoracic Surgery Education
  • LAD
  • Left anterior descending
  • OM
  • OR
  • Obtuse marginal
  • Operating room
  • PDA
  • PGY
  • Patient Care
  • Post-graduate year
  • Posterior descending artery
  • Professionalism
  • TECoG
  • TSDA
  • Thoracic Education Cooperative Group
  • Thoracic Surgery Directors Association
  • aorta
  • cardiothoracic surgery
  • coronary
  • deliberate practice
  • simulation


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