Development of a Curriculum to Enhance Preparedness in Managing Laparoscopic Vascular Injury
Title: Development of a Curriculum to Enhance Preparedness in Managing Laparoscopic Vascular Injury Authors: Nicole Kerner, MD; Michelle Larzelere, MD; Christina Saad, MD MS MBA; Dani Zoorob, MD MHA MBA MHI 1. Nicole Kerner, MD Assistant Professor, Duke University nicole.kerner@duke.edu 2. Michelle Larzelere, MD Assistant Professor, University of Florida m.larzelere@ufl.edu 3. Christina Saad, MD MS MBA Assistant Professor, Harbor-UCLA Medical Center csaad@dhs.lacounty.gov 4. Dani Zoorob, MD MHA MBA MHI Professor, Louisiana State University - Shreveport dani.zoroob@lsuhs.edu Purpose: Our objective was to develop a curriculum to enhance resident preparedness in managing laparoscopic vascular injuries. Background: Major vascular injury is a rare, potentially catastrophic complication of laparoscopy. Preparedness to acutely manage this complication can be difficult to achieve during residency given its rarity. Methods: We developed a curriculum involving a lecture, low-fidelity simulation, and assessments. The simulation involved managing a major vascular injury. Participants were given a pretest, immediate posttest, and 3-month delayed posttest to assess knowledge and confidence. Unpaired t-test was utilized to compare scores. Results: 76, 64, and 13 residents from five OBGYN residency programs completed the pretest, immediate posttest, and delayed posttest, respectively with 65(83%), 25(39%) and 5(38%) reporting being not at all confident or slightly confident in managing a laparoscopic vascular injury, respectively (p=0.0001). The free response score (identifying critical steps in managing vascular injury) increased from 2.72 (pretest) to 5.05 (immediate post-test, p=0.0001) and 3.77 (delayed post-test, p=0.0403). The average multiple-choice score was 63% on the pretest and 79% on the post-test (p=0.0001) but dropped to 63% on the delayed posttest (p=1.0). On the immediate posttest, 52(81%) found the simulation very or extremely helpful, 56(87.5%) found it very or extremely relevant. Discussion: Residents infrequently encounter laparoscopic major vascular injuries during training. Using our curriculum, knowledge, confidence, and preparedness for such events increased. This curriculum can be easily adopted by other residency programs to promote resident preparedness. Simulation is integral to increasing exposure to improve confidence and potential competence during these rare, life-threatening situations.
