New training paradigms in vascular surgery allow for early specialization out of medical
school. Surgical simulation has emerged as an educational tool for trainees to practice
procedures in a controlled environment allowing interested medical students to perform
procedures without compromising patient safety. The purpose of this study is to assess
the ability of a simulation-based curriculum to improve the technical performance
and interest level of medical students in vascular surgery.
Prospective observational cohort study of medical student performance.
Academic medical center.
Forty-one medical students (23 first year, 15 second year, 3 other) enrolled in a
vascular surgery elective course. Students completed a survey of their interests and
performed a renal stent procedure on an endovascular simulator (pretest). The curriculum
consisted of didactic teaching and weekly mentored simulator sessions and concluded
with a final renal stent procedure on the simulator (posttest). Objective procedural
measures were determined during the pre- and posttest by the simulator, and subjective
performance was graded by expert observers utilizing a structured global assessment
scale. After the course, the students were surveyed as to their opinions about vascular
surgery as a career option. Finally, 1 year after the course, all students were again
surveyed to determine continued interest in vascular surgery.
The objective and subjective criteria measured on the simulator and structured global
assessment scale significantly improved from pre- to posttest in terms of performer
technical skill, patient safety measures, and structured global assessments. Before
beginning the course, 8.5% of the students expressed high interest in vascular surgery,
and after completing the course 70% were seriously considering vascular surgery as
a career option (p = 0.0001). More than 95% of the students responded that endovascular
simulation increased their knowledge and interest in vascular surgery. In the 1-year
follow-up survey (n = 23 medical students), 35% had already entered their clinical
years. Seventy percent of the students were still considering vascular surgery, while
several other career options were still popular including the surgical subspecialties
(70%), interventional cardiology (57%), and interventional radiology (48%). Most respondents
indicated the major reasons for continued interest in vascular surgery were the ability
to practice endovascular procedures on the simulator (100%) and mentorship from vascular
surgery faculty (78%).
The use of high fidelity endovascular simulation within an introductory vascular surgery
course improves medical student performance with respect to technical skill, patient
safety parameters, and global performance assessment. Mentored exposure to endovascular
procedures on the simulator positively impacts long term medical student attitudes
towards vascular surgery. Simulator-based courses may have the potential to be an
important component in the assessment and recruitment of medical students for future
surgical training programs.