Virtual Simulation of Intra-operative Decision-Making for Open Abdominal Aortic Aneurysm Repair: A Mixed Methods Analysis

OBJECTIVE: To create and pilot test a novel open abdominal aortic aneurysm (AAA) repair virtual simulation focused on intraoperative decision-making. To identify if the simulation replicated real-time intra-operative decision-making and discover how learners' respond to this type of simulation. DESIGN: An explanatory sequential mixed methods study. We developed a step-by-step outline of major intra-operative decision points within a standard open AAA repair. Perioperative and intraoperative decision making trees were developed and coded into an online virtual simulation. The simulation was piloted. Quantitative data was collected from the simulation platform. We then performed a qualitative thematic analysis on feedback from interviewed participants. SETTING: Four academic general and vascular surgical training programs across the US. PARTICIPANTS: Seventeen vascular and general surgery trainees and 6 vascular surgery faculty. RESULTS: Participants spent on average 27 minutes (range: 8-45 minutes) interacting with the interface. 93% of participants reported feeling they were making real intraoperative decisions. 85% said it added to their knowledge base. 96% requested additional simulations. 22 interviews were completed: 241 primary codes were collapsed into 21 parent codes, and 6 emerging themes identified. Themes included the benefit of how (1) Virtual Learning Could Standardize the Training Experience ; how (2) Dealing with the Unexpected as a trainee is an important part of surgical education growth, and that this (3) Choose Your Own Adventure virtual format simulates this intraoperative growth experience. Participants requested a (4) Looping Feature Feedback Diagram for future simulation iterations and highlighted that (5) Fancier is Not Necessarily More Educational. Finally, many trainees wondered about (6) The Attending Impact from the simulation: if faculty would notice a difference between trainees who did vs did not utilize the simulation for case preparation. CONCLUSIONS: Operative simulation training should focus on both technical skills and intra-operative decision-making, particularly dealing with the unexpected. The learners' responses indicate that a low-fidelity, scalable, virtual platform can effectively deliver knowledge and allow for intra-operative decision-making practice in a remote learning environment. (C) 2022 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.