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Title: Performance analysis of interactive multimodal CME retraining on attitude toward and application of OPCAB
Authors: Albert, Alexander ×
Peck, Eric A
Wouters, Patrick
Van Hemelrijck, Jan
Bert, Christophe
Sergeant, Paul #
Issue Date: Jan-2006
Publisher: Mosby, Inc.
Series Title: Journal of Thoracic and Cardiovascular Surgery vol:131 issue:1 pages:154-162
Abstract: 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.
URI: 
ISSN: 0022-5223
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Anesthesiology and Algology
Clinical Cardiac Surgery
× corresponding author
# (joint) last author

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