Page 89 - JSOM Spring 2020

skills and the first attempt for vascular access and REBOA of all scoring results. The QRT-FF had significantly better scores
placement, with five medics performing the posttest. on using the endovascular material properly (n = 0.003), com-
municating clearly and consistently (n = 0.038), performing the
Curriculum procedure without unnecessary attempts (n = 0.032), and fol-
A formalized microteaching curriculum consisted of instruc- lowing a logical sequence for the procedure (n = 0.006). The
tion in the basic anatomy of the femoral region and knowl- baseline knowledge of surgical anatomy for QRT-FF was sig-
edge of the access materials required, including a guide wire nificantly better than that of the medics, P = .048. The QRT-FF
and introducer sheath and ultrasound utilization (30 minutes). had a significantly higher overall technical skills point score
The details and instructions for use of the ER-REBOA bal- than the medics: 51.0 (44.8–52.3) vs 44.0 (41.0–46.0), P = .030.
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loon were explained and demonstrated via an animation video The QRT-FF had a median time of 2:04 minutes compared with
covering the steps necessary for achieving vascular access and 3:59 minutes for the medics to insert the sheath. Although the
deployment of the balloon in zone I (15 minutes). Ultrasound QRT-FF were faster than the medics, this was not significant, as
13
and percutaneous access skills were practiced on moulage flow presented in Table 2. Regarding the total time from start to RE-
models. Ultrasound imaging of the femoral artery and vein BOA inflation, QRT-FF had a median time of 3:23 minutes and
was practiced on a buddy trainee. medics 5:05 minutes. Again, QRT-FF were faster than medics,
though not to a statistically significant degree.
The task training model used for this study was the REBOA
Access Task Trainer (RATT; Prytime Medical Devices ). TABLE 1 Technical Skills of Firefighters and Medics
™
Trainees were introduced to the RATT and were then indi- Firefighters Medics
vidually instructed by a vascular surgeon (Dr Borger van der (n = 6), (n = 11),
Burg) to identify anatomical landmarks and to verbalize each Technical Skill Median [IQR] Median [IQR] P Value*
step required for adequate achievement of vascular access and 01. Identifies optimal 4.0 4.0
REBOA positioning in zone 1. Key skills were as follows: (1) introduction site [4.0–4.3] [4.0–5.0] NS
preparation of the endovascular tool kit, (2) achieving vascu- CFA
lar access in the model, and, finally, (3) bleeding control with 02. Identifies 4.0 4.0 NS
REBOA. Scoring ranged from 0 to 5 for nonanatomical skills. introduction site skin [3.8–5.0] [4.0–5.0]
5.0
4.0
Identification of anatomical structures was either su0-pfficient 03. Uses endovascular [4.8–5.0] [4.0–4.0] .003
material properly
(score = 1), or insufficient (score = 0).
04. Appropriate pace 4.5 4.0
with economy of [3.8–5.0] [3.0–4.0] NS
A point-of-view GoPro camera was used in all participants movement
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(via a point-of-view camera), as well as one additional Go- 05. Effectively obtains 4.5 4.0
Pro camera that was positioned to achieve a full view of the necessary US [4.0–5.0] [4.0–5.0] NS
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model and participant. After verbalizing every step of the pro- exposure
cedure, video recording was commenced and the actual test 06. Communicates 5.0 4.0
was started with registration of procedure time. clearly and [3.8–5.0] [4.0–4.0] .038
consistently
5.0
3.0
Scoring System 07. Performs procedure [3.8–5.0] [3.0–4.0] .032
without unnecessary
Participants were evaluated using a modified checklist that attempts
was developed as part of a validation study for the Advanced
4.0
5.0
Surgical Skills Exposures for Trauma (ASSET). 14,15 This in- 08. Follows a logical [5.0–5.0] [4.0–5.0] .006
sequence for the
cluded the individual procedure scores (IPS), outcomes of procedure
these scores on five components of technical and nontechnical 09. Correctly identifies 1.0 1.0
skills, Global Rating Scale scores, errors, and time to complete CFA sagittal † [1.0–1.0] [1.0–1.0] NS
the procedure of achieving vascular access and balloon place- 10. Correctly identifies 1.0 1.0
ment. Two evaluators (Drs Borger van der Burg, van Dongen, CFV sagittal † [1.0–1.0] [1.0–1.0] NS
and/or Hoencamp) located in the same laboratory evaluated 11. Technical skills for 4.0 4.0
performance with a standardized script for data collection. imaging femoral [3.0–4.0] [3.0–4.0] NS
artery
Statistical Analysis 12. Overall 3.5 3.0
Statistical analyses were performed in collaboration with the understanding of the [3.0–4.0] [2.0–3.0] .048
surgical anatomy
help of a statistician expert (TD), using the Statistical Package
4.0
3.0
for the Social Sciences (SPSS , Version 24; IBM Corporation, 13. Ready to achieve [3.8–4.3] [3.0–4.0] .024
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percutaneous access
Armonk, NY). All baseline information of the subjects and to the CFA
subsequent follow up data were registered in an electronic Overall: technical skills 51.0 44.0
data file (Microsoft Excel and SPSS ). The t test was used to total points [44.8–52.3] [41.0–46.0] .030
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analyze the test scores and procedure times. For all statistical Abbreviations: CFA, common femoral artery; CFV, common femo-
analyses, a P value ≤.05 was considered significant. ral vein; IQR, interquartile range; NS, not significant; PFA, profundal
femoral artery; SFA, superficial femoral artery; US, ultrasound.
*Mann-Whitney U test.
Results † Score ranging from 0 to 1.
Six QRT-FF participated in this study were assessed and 11
previously trained medics functioned as a control group. The All six QRT-FF performed a second attempt of gaining vas-
differences of technical skills between the six QRT-FF and 11 cular access and REBOA placement. These results are com-
medics are presented in Table 1. Evaluators were in agreement pared with the posttest of the medics in Table 3. Five medics
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