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Three weeks after the initial simulation session, the residents repeated mitral annuloplasty with the porcine model (postfeedback) these procedures were video recorded. Instruments, sutures, and annuloplasty ring were provided. Residents were given 2 additional weeks to practice the exercise on the plastic mitral model after reviewing the video recording with feedback. Formative feedback was given as a narrated video recording (audio recording superimposed on the video recording) and returned to each resident for review within 1 week. Video recordings were submitted to a senior faculty surgeon (J.I.F.) blinded to the identity of the resident. All data were stripped of identifying information and stored on a computer hard drive.
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The procedure was timed and video recorded with a head-mounted camera and 2 peripheral cameras. Sutures were 2-0 Ethibond with RB-1 needles (Ethicon, Inc, Somerville, NJ), and the annuloplasty rings were either Sorin Annuloflow or Sorin Annuloflex (Sorin Group USA, Arvada, Colo). A few days later, each resident performed a mitral annuloplasty with the porcine model (prefeedback).
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Porcine Heart ModelĪll residents reviewed instructional video recordings demonstrating how to perform a mitral annuloplasty with both the porcine model and the plastic mitral model. Approval to conduct this study was obtained from the institutional review board. The T3 resident had performed nearly 240 cases as surgeon. The 2 T2 residents had performed 19 and 20 cases. Residents in years 2 and 3 of the traditional program (T2 and T3) had performed mitral valve procedures before this simulation exercise. Neither of the T1 residents had performed any cardiac surgical cases as surgeon, because they had just completed general surgical residency. With the exception of a single R3 resident who had performed a single cardiac surgical case, none of the integrated residents (R1–R3) had performed any cardiac surgical case as surgeon rather than assistant. Residents in years 1 to 3 of the integrated program (R1–R3) and those in year 1 of the traditional program (T1) had not previously performed mitral valve surgery in the clinical setting. At a single institution during the transition from a traditional to an integrated cardiothoracic surgical residency training program, 11 residents (5 previously trained in general surgery and 6 in the 6-year integrated program) participated in this study at the beginning of the academic year.