A PROficiency-based StePwise Endovascular Curricular Training (PROSPECT) program enhances performances in real life : a randomized controlled trial

Background: Evolution in surgery requires optimization of skills training to provide optimal patient care. This randomized controlled trial evaluated the impact of a PROiciency-based StePwise Endovascular Curricular Training program (PROSPECT) on skill acquisition and transferability to real-life procedures. Material & Methods: Thirty-two surgical trainees were randomized into three groups: the first group (N=11) received e-learning and simulation training (PROSPECT), the second group (N=10) only received e-learning and controls (N=11) did not receive additional training. All trainees performed two supervised endovascular interventions, treating symptomatic iliac and/or superficial femoral artery stenosis. Assessments were performed using Global Rating Score and Examiner Checklist. Operative metrics and patient outcomes were compared, adjusted for case difficulty and trainees’ experience. Secondary outcomes included knowledge and technical performance 6 weeks and 3 months after PROSPECT. Results: Twenty-nine trainees performed 58 endovascular procedures. Trainees had similar baseline knowledge and skills and required 517mins ±156 to complete e-learning and 256mins ±252 to achieve competency in endovascular simulated procedures. During live procedures, the PROSPECT group showed superior technical performance with significantly less supervisor takeovers compared to the e-learning and control groups. Supervisors felt significantly more confident in allowing PROSPECT-trained trainees to perform basic(p=0.006) and complex (p=0.003) procedures. Procedural parameters and complication rates were similar between groups. After PROSPECT, trainees maintained proficiency up to 3 months. Conclusion: Training with PROSPECT results in superior endovascular skills acquisition, which transfers to the hybrid angiosuite compared to e-learning or clinical training only. It should be offered to all surgical trainees prior to treat real patients, to achieve high-quality surgical care.