a novel cadaver-based educational program in general surgery training catherine e. lewis, md warwick...

A Novel Cadaver-Based Educational Program in

General Surgery TrainingCatherine E. Lewis, MD

Warwick J. Peacock, MD, Areti Tillou, MD, O. Joe Hines, MD

Jonathan R. Hiatt, MD

Department of SurgeryDavid Geffen School of Medicine at UCLA

Anatomy in Surgical Education

Knowledge of anatomy/exposure

essential

Time devoted to anatomy decreasing

Interns lack adequate knowledge

Cadaveric dissection is irreplaceable

Ideal model for surgical skills

training

Support basic and complex

operations

Superior to other models /

simulators

- Realistic

- Provides haptic feedback

- Representative surgical anatomy

Cadaver-Based Education

Specific Aims

Describe UCLA Surgery anatomy program

Assess resident attitudes toward program

UCLA Surgery Anatomy Program

Conceived by emeritus faculty member

UCLA Surgery Anatomy Program

Conceived by emeritus faculty member

Rembrandt Harmenszoon van Rijn,The Anatomy Lesson, c 1632

UCLA Surgery Anatomy Program

Conceived by emeritus faculty member

Utilizes fresh-frozen cadavers

Provides education, skills and research

for undergraduates, graduates & postgraduates

Implemented for general surgery

residents ascomponent of core education conferences

Anatomy Theater

Anatomy Theater

Anatomy Theater

Anatomy Lab

Cadavers

Fresh frozen at -17C to -20C

Stored in special facility

Defrosted prior to use

Ethically donated per patient’s

bequest

Anatomy Program Costs

Each body approximately

$2,500

Donated / without charge: Instruments Faculty time Facilities

UCLA Anatomy Curriculum

Core general surgery

procedures

Junior resident skills sessions

Senior resident skills sessions

PGY1 dissection program

UCLA Anatomy Curriculum

Core general surgery

procedures

Junior resident skills sessions

Senior resident skills sessions

PGY1 dissection program

Core General Surgery Procedures

Lecture on relevant surgical anatomy

Demonstration on fresh cadaver

Resident performance of procedures:Groin herniorrhaphy Thoracic outletLiver harvestPancreatectomyThyroidectomy GastrectomyAbdominal aortic aneurysmectomy

Resident Skills SessionsJunior Senior

Group size

4-5 3-5

Instructors

Faculty & Sr residents

Faculty

Procedures

Wound repair Intestinal anastomosis Chest tubes Abdominal incisions

Trauma exposuresNeck exposuresPercutaneous trach

Resident Skills SessionsJunior Senior

Group size

4-5 3-5

Instructors

Faculty & Sr residents

Faculty

Procedures

Wound repair Intestinal anastomosis Chest tubes Abdominal incisions

Trauma exposuresNeck exposuresPercutaneous trach

Resident Skills SessionsJunior Senior

Group size

4-5 3-5

Instructors

Faculty & Sr residents

Faculty

Procedures

Wound repair Intestinal anastomosis Chest tubes Abdominal incisions

Trauma exposuresNeck exposuresPercutaneous trach

Type N

Demographics Select from list 2

Attitudes toward program

5-Point Likert Scale 6

Compare to other modalities

Rank-order 3

Preferred format Rank-order 1

Cadaver Education Survey

Response Rate 89% (n = 40)

Cadaver Sessions are a Good Way to Learn Anatomy

0%

43%

49%

6%3%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

Cadaver Sessions are a Good Way to Learn Steps of an Operation

0%

34%

40%

23%

3%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

Cadaver Sessions Increase my Confidence in Doing an

Operation

0%

14%

37%37%

11%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

I Would Like to Have More Cadaver Sessions

0%

28%

56%

13%

3%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

I Would Spend Free Time in the Cadaver

Lab

3%

18%

49%

21%

10%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

Trainees Should do an Operation on a Cadaver Before

Real Patient

5%

23%

36%

28%

8%

StronglyDisagree

Disagree Neutral Agree StronglyAgree

Comparison of Learning Modalities

LearnAnatomy

Cadaver

Textbooks

Simulators

Websites

Animate labs

Lectures

Increase Confidence

Cadaver

Simulators

Textbooks

Websites

Animate labs

Lectures

Learn Steps of Operation

Cadaver

Simulators

Animate labs

Websites

Textbooks

Lectures

Comparison of Learning Modalities

LearnAnatomy

Cadaver

Textbooks

Simulators

Websites

Animate labs

Lectures

Increase Confidence

Cadaver

Simulators

Textbooks

Websites

Animate labs

Lectures

Learn Steps of Operation

Cadaver

Simulators

Animate labs

Websites

Textbooks

Lectures

Comparison of Learning Modalities

LearnAnatomy

Cadaver

Textbooks

Simulators

Websites

Animate labs

Lectures

Increase Confidence

Cadaver

Simulators

Textbooks

Websites

Animate labs

Lectures

Learn Steps of Operation

Cadaver

Simulators

Animate labs

Websites

Textbooks

Lectures

Preferred Session Format

Perform dissection under direct

supervision

Self-guided dissection and review of findings with instructor

Watch instructor perform a dissection

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are, Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are, Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are, Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are, Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are, Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

AuthorsProcedures/

skills Fac Fell Res Student

Anastakis, Are,Holland

Open GS X X

Cundiff, Katz, Supe, Udomsawaengsup,Giger, LeBlanc

Lap GS X X

Gunst, Aboud Trauma X X X

Reed, Mitchell Vascular X

Castle Urologic X

Lewis (current) Lap, open GS X X X

Fresh Cadavers in Surgical Training

Comparison of Cadaver TypesFresh frozen Embalmed

Duration of use Days to wks Months to yrs

Cost $$ $Basic skills training Excellent GoodOperative simulation Excellent PoorTissue consistency Pliable RigidTissue color Good PoorTissue plane preservation

Excellent Poor

ID of small structures Excellent PoorFlexibility for positioning

Excellent Poor

Infection risk Low None

Future Directions

Continue to expand curriculum

Dedicated facility nearing

completion

Program validation using surgical

skillsassessment and demonstration of improved operative performance

Summary: Cadaver-Based Education

Efficient and effective educational tool

Useful in teaching anatomy, surgical

skills,complex open & laparoscopic procedures

Increase confidence in performing

operations

Positive perception by residents

More effective than other learning

modalities