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Eric A. Peck
Patrick Wouters
Paul Sergeant
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J Thorac Cardiovasc Surg 2006;131:154-162
© 2006 The American Association for Thoracic Surgery

Evolving Technology

Performance analysis of interactive multimodal CME retraining on attitude toward and application of OPCAB

Alexander Albert, MD a , Eric A. Peck, MD b , Patrick Wouters, MD, PhD c , Jan Van Hemelrijck, MD, PhD c , Christophe Bert, MD, PhD c , Paul Sergeant, MD, PhD a , *

a Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium
b Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Md
c Department of Anesthesia, University Hospital Gasthuisberg, Leuven, Belgium.

Received for publication June 24, 2005; accepted for publication August 29, 2005.

* Address for reprints: Prof Dr Paul Sergeant, Cardiac Surgery Department, Gasthuisberg University Hospital, Herestreet, B 3000, Leuven, Belgium (Email: paul.sergeant{at}uz.kuleuven.ac.be).

OBJECTIVE: The transfer of tacit and codified knowledge on a surgical technique is studied in a consecutive cohort of teams participating in interactive multimodal continuing medical education (CME) retraining in off-pump coronary artery bypass (OPCAB).

METHODS: Fifty teams of 1.3 ± 0.5 surgeons and 1.1 ± 1.9 anesthetists visited 2.2 ± 0.7 days. Variables describe the pre-visit cardiac activity and OPCAB attitude, complexity score (10 frequently cited complexity criteria), application, and conversion rate. The multimodal approach to knowledge transfer included interactive discussions (commitment; resistances; levers and process of change; methods; outcome; resource optimization), active participation in 3.8 ± 1.3 unselected cases (anchor-stitch, enucleation techniques), low-fidelity bench model (shunt placement, anastomotic technique), and CD-ROM. Exit end points included OPCAB attitude and complexity score. Late end points (3 months) included OPCAB attitude, complexity score, and application rate.

RESULTS: OPCAB was considered, upon exit, beneficial for all patients by 90% of the teams (versus 29 % pre-visit), but by only 62 % of the teams at 3 months. The complexity score downgraded at exit from 3.6 ± 2 (pre-visit) to 1.2 ± 1 (P <.001) but increased again at 3 months to 1.6 ± 1 (P =.001 versus pre-visit and P =.001 versus exit). The 3-month OPCAB rate of the surgeons was 49% ± 32% versus 23% ± 28% pre-visit (P <.0001). This was influenced by the pre-visit OPCAB rate and education, as well as by the post-visit changes in complexity scores and attitude. The conversion rate toward cardiopulmonary bypass improved from 3.5% ± 5% (pre-visit) to 1.3% ± 3% (3 months, P =.006).

CONCLUSIONS: The multimodal OPCAB re-training resulted in a substantial increase of the application, concomitant with a decrease in conversion. The positive impact on attitude and complexity score, at exit, was somewhat reduced in the following clinical confrontation.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CME = continuing medical education; CMEST = Continuing Medical Education of Surgical Technologies; ECC = extracorporeal circulation; OPCAB = off-pump coronary artery bypass; SWOT = strengths, weaknesses, opportunities, threats


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