Benefits of lower limb angioplasty training using a virtual reality simulator among vascular surgical residents

Background

We assessed the skill acquisition, operative competency, and confidence of vascular surgery residents during a limb angioplasty workshop and evaluated their surgical volume and retention rate at 1 year.

Methods

For 3 years (2018-2020), all residents and fellows in their final year of vascular residency at a teaching hospital were enrolled. Five residents in 2018 were enrolled in the control group (apprenticeship model). Twelve residents and fellows from 2019 (training group) and 2020 (coronavirus disease 2019 [COVID-19] group) were trained using the ANGIO Mentor (Simbionix Ltd, Airport City, Israel) in two workshops. The residents were evaluated using the Objective Structured Assessment of Technical Skills, simulator metrics, and a confidence questionnaire. A P value of < .05 was considered statistically significant.

Results

The groups were similar in age, sex, and number of limb angioplasties performed (control group, 25.00 ± 5.52; training group, 23.16 ± 7.44; COVID-19 group, 24.50 ± 8.17; P = .91, Student t test). The residents of the training and COVID-19 groups showed significantly improved Objective Structured Assessment of Technical Skills scores after the first workshop (from 15.5 [interquartile range (IQR), 12.62-19.13] to 29.5 [IQR, 25.25-39.38]; and from 14.50 [IQR, 13.62-15.00] to 23.5 [IQR, 21.87-24]; P < .001]; respectively) and reported confidence improvement (from a median of 3 [IQR, 3-3] to 4 [IQR, 4-5]; P = .01). After 6 months, the retention rate was good. During that semester, each resident performed a median of 10.50 limb angioplasties (IQR, 7.00-13.25 limb angioplasties). The second workshop did not improve either the residents' scores or their confidence. At the end of the year, the control group scored worse than did the training and control groups (control group, 23.50 [IQR, 19.00-24.50]; training group, 37.0 [IQR, 36.50-39.37]; COVID-19 group, 34.75 [IQR, 30.75-38.75]; P = .005, Kruskal-Wallis test). The simulation metrics did not show significant differences among the groups.

Conclusions

A 3-week limb angioplasty workshop can improve residents' skills and confidence. Performing 10 angioplasties per semester is sufficient to ensure the retention rate is good after 6 months, and a second workshop is unnecessary.