BASIC ENDOVASCULAR TECHNIQUES - Mentice · Endovascular techniques (ET) involves the handling of...

BASIC ENDOVASCULAR TECHNIQUES

INTEGRATED CLINICAL AND SIMULATION BASED COURSE

COURSE MANUAL

March 2013 BB + JS

Centre for Clinical Education – CEKU

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CONTENTS

COURSE ORGANISATION 3

PROGRAMME 4

ABOUT THE COURSE 5

MODULE 1: THEORETICAL PREPARATION 7

MODULE 2: CLINICAL PREPARATION 8

MODULE 3 -‐ SIMULATION TRAINING 9

MODULE 4: CLINICAL TRAINING. 10

APPENDICES 11

MODULE 2 REFLECTIVE REPORT ON THREE PROCEDURES 12

THE SAVE SCALE 13

GUIDELINES FOR ASSESSORS USING THE SAVE SCALE 14

MODULE 4 CASE REPORT, TEN CASES 17

MODULE 4: REFLECTIVE REPORT -‐ 10 PROCEDURES 18

COURSE EVALUATION SHEET 19


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COURSE ORGANISATION

Course director: Bo Bech, Vascular Surgery Specialist, Vascular Clinic RK-3111, Rigshospitalet, København

Faculty: • Lars Konge, Thoracic Surgery Specialist, Consultant, Clinical Lecturer, Center for Clinical

Education (CEKU), University of Copenhagen and HR & Education, København

• Bo Bech, Vascular Surgery Specialist, Vascular Clinic RK-3111, Rigshospitalet, København

• Jes Sandermann, Vascular Surgery Specialist, Surgeon in Chief, Postgraduate clinical lecturer, Dept Vascular Surgery, Viborg

• Lars Lönn, Interventional Radiology Specialist, Professor, Vascular and Radiology Clinic, Rigshospitalet, København

Administration: Lars Konge (CEKU - RH) – administrator [email protected] Tlf 32132830 Fax +45 35454437

Centre for Clinical Education, www.ceku.dk University of Copenhagen and Capital Region of Denmark Rigshospitalet, dept. 5404 (Teilumbygningen) Tel 35455404 Fax 35454437

Eastern Denmark: Bo Bech [email protected] Arb 35456620 Mob 22996168

Western Denmark:

Jes Sandermann [email protected] Tlf 78445611 Mob 41624421 (tændt i relation til disse kursusdage)


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PROGRAMME

Day 1

10.00-10.30 Wekcome and introduction

10.30-11.00 Endovascular tools: sheaths, wires, catheters, balloons, stents etc.

11.00-12.00 Puncture technique (access) in a dummy

12.00-12.30 Discussion, Q & A

12.30-13.15 Lunch

13.15-13.30 Introduction to the virtual reality simulator VIST

13.30-18.00 1st, 2nd and 3rd simulator case

19.00- Dinner

Day 2

08.30-09.00 Reflections on day 1

09.00-12.00 4th and 5th simulator case

12.00-13.00 Lunch

13.00- 15.30 Concluding SAVE-test and feedback

15.45-16.30 Discussion and Course evaluation


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ABOUT THE COURSE Endovascular techniques (ET) involves the handling of x-ray equipment, administration of contrast (angiography), use of sheats, guidewires and catheters, angioplasty of narrowed arteries (PTA) and deployment of stents. Gradually ET is becoming a greater part of the vascular treatment and includes both diagnostic and therapeutic procedures. This course is included as a new specialty specific course in the vascular specialist training

Course objectives The goal of this course is that the participants acquire basic skills in simple endovascular treatments primarily related to the iliaco-femoral segment. The course will form the basis so that its participants might later be able to pursue education in this field as an independent endovascular operator.

Learning objectives By self-study of the suggested literature the participants have familiarized themselves with the theoretical background. By assisting to a few procedures in the clinic and with subsequent reflection, the participants should be able to put this theory together with the seen endovascular interventions. By simulation training be able to assist and intervene endovasculary. After at least 10 procedures under supervision, be able to perform simple interventions.

Course format and content The course consists of integrated clinic and simulation with a composition of 4 modules as set out in the table below. Everything is done at the participant's own department apart from the actual simulation exercise, consisting of 2 days in the simulation room at CEKU, Rigshospitalet.

Table 1 Instruction Content Evaluation

Module 1 Theoretical preparation

Self study Textbook Articles Discussion in the clinic

Module 2 Clinical preparation in own department/angiosuite

Supervisors

Assistance in 3 procedures Case reports (Chart) Reflective report

Faculty Reflective report

Module 3 Simulation Training – 2 days

Instructors Train endovascular access and simulated procedures

Instructors:

SAVE scale at final test procedure

Module 4 Clinical procedure in own department/angiosuite

Supervisors

Clinical training in 10 procedures Case reports (Chart) SAVE in 2 cases Reflective report

Faculty Reflective report Overall acceptance

The course should be executed over a period of maximum 3 months. The trainees and the local supervisor coordinate the modules in relation to the period for simulation training. Simulation training is based on 4 participants for 2 simulators and at least two teachers - optimally with both vascular surgical and radiological representation.


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Instructors The trainee has a local supervisor in the vascular surgery Dept., responsible for organizing the clinical part of the course before and after the planned simulation training. This is to ensure the trainee has time allocated to the above indicated preparations and also has time included for guidance on the reflective reports. The local supervisor is also a link to the endovascular supervisor in the angiosuite / x-ray room.

The local supervisor can also function as the endovascular supervisor, as most vascular departments around the country have access to the endovascular function. Jes Sandermann acts as endovascular coordinator in Jutland, and Bo Bech in Funen and Zealand.

The local endovascular supervisor will, depending on local circumstances, be either an Interventional Radiologist or Vascular Surgery Endovascular Operator. The trainees will optimally be associated with the same person in Modules 2 and 4. In Module 2, the trainees assist the endovascular supervisor or a colleague during at least 3 procedures.

The supervisor will present the patients, presentations of the procedures and the equipment used - and along the way discuss the advantages / disadvantages / risks etc. which is the basis for the student to write an overall reflective report, to be presented at the simulation course.

In Module 4, the endovascular supervisor have selected at least 10 simple endovascular procedures, which the trainee can perform under guidance.

Evaluation of the trainee There must be written a reflective report after both Module 2 and 4.

At the end of the simulation training, the trainee will be evaluated using the SAVE scale against procedural skills.

Feedback is given to the trainee regarding focal points of the clinical practice.

After the 10th clinical procedure, the endovascular supervisor evaluates the trainee using the SAVE scale and submit this form along with the 2th. reflective report to CEKU-faculty.

After completing the course, the CEKU-faculty will review the reflective reports and the SAVE scales. This leads to an overall evaluation and a course certificate.

Evaluation of the course After the course, the trainee will be asked to evaluate the course partly orally and partly by completing an evaluation form. After each module it is expected that there is a local oral evaluation. The CEKU-faculty also expects feedback from the local, and the endovascular supervisors.


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Course fee and other expenses For vascular surgical trainees, the course will be part of specialized training and funded by SST within the 30 hours of specialty-specific courses. Travel, accommodation and meals is at the trainee’s/department's own expense. Other participants pay the specified course fee etc.

MODULE 1: THEORETICAL PREPARATION The purpose of the theoretical preparation is that the trainee acquire a basic knowledge of arteriosclerotic changes and the related symptoms. How they are examined and which treatment modalities that exist. Finally there is acquired basic knowledge of endovascular interventions, the accompanying equipment used, risks, etc.

From literature must be extracted

1. Radiation hygiene course is expected to be examined. 2. Basic knowledge of the arteriosclerotic disease 3. Indications for endovascular intervention in relation to open procedures 4. Influence of antithrombotic and anti-coagulant treatment on the impending intervention -

similar for anti-diabetic medications and contrast agents, and patients with renal impairment.

5. Knowledge of endovascular devices - guidewires, sheats, catheters, stents etc. 6. Knowledge of stages in endovascular procedures – puncture, sheath installation, guide wire

and catheter handling, crossing of stenosis/occlusions, predilatation, PTA / stenting and sheath removal.

7. Knowledge of possible complications and how they are handled - both during and after the intervention.

The theoretical module 1 is a self-study. The following literature curriculum should be read before the start of Module 3:

1. Kessel D, Robertson I. Interventional radiology: a survival guide. - 3rd ed. Chapters:

2. Strålehygiejne og røntgenstråling, SST, 1998. http://www.sst.dk/publ/publ1998/SIS/Straalehygiejne_og_roentgenstraaling_1998.pdf

The following literature can be proposed as additional reading:

3. Schneider P A. Endovascular Skills: Guidewire and Catheter Skils for Endovascular Surgery, Second edition, revised and expanded – ISBN 0-8427-4248-6 – 2003 by Marcel Dekker Inc.

4. Norgren et al. TASC II Working Group Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(Suppl. 1):S1–75

5. Schroeder TV et al. Underekstremitetsiskæmi – forebyggelse og behandling. Ufgeskriftet, konsensusrapport nr. 2, 2005

6. Rutherford's Vascular Surgery, 2-Volume Set, Expert Consult: Online and Print, 7th Edition. By Jack L. Cronenwett, MD and Wayne Johnston.

1-14 (to page 212: upper limb) 117 pages 15-16 40 pages 22 (Thrombolysis and thrombectomy) 11 pages 22 (Rendezvous and retrieval procedures) 6 pages

total 174 pages


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MODULE 2: CLINICAL PREPARATION Module 2 is a practical preparation for the simulation-based training in module 3. The trainee assists the endovascular supervisor at 3 procedures or more, during which the trainee intensely observes what happens. After each procedure the trainee should handle the endovascular tools before they are discarded. In addition the trainee should familiarize him/herself with the x-ray equipment, C arm, image intensifier, OR-table and how they are operated.

Before an endovascular procedure Has the trainee studied the case thoroughly, i.e. reviewed the patient’s history as well as the clinical, laboratory and imaging findings? The plan for the forthcoming procedure is discussed with the supervisor regarding puncture site, preparation of tools etc.

During the procedure Does the endovascular supervisor explain the various steps of the procedure as well as the tools and equipment used? The trainee should be allowed to have a feeling for how the guide wire and catheters handles during at least one of these procedures. It is important that the trainee pay attention to the monitor imaging the procedure as well as the hand movements of the endovascular supervisor.

After each procedure Does the trainee try the tools by repeating as many steps of the procedure on the OR-table, which has just been completed? In between the procedures, or at another convenient time, the trainee should try out the most frequently used tools applied on a simple model or tube placed on the OR-table and covered by a sheet. In addition the movements of the OR-table are trained.

Case reports The trainee writes a case report for each procedure attended. See guidelines in the appendix

Reflective report Having terminated the three procedures, the trainee prepares a report. Here the trainee demonstrates his/her capability to combine theory and clinical practice based on the observations made during the three cases.

The report should be 2-3 pages long, excluding the three case reports. See guidelines in page 12. It is suggested, that the trainee discuss the report with the supervisor to obtain feedback, leading to revision of the reflective report.

The final report including the case reports must be submitted to the course organiser before the simulation training (module 3) commences. Additional feedback will be given during module 3.


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MODULE 3 - SIMULATION TRAINING Purpose That the trainee in the simulator

1. Can prepare most commonly used endovascular tools on the assistant’s table 2. Familiarise him/herself with puncture techniques (in a dummy) 3. Is familiar with the various steps in a routine endovascular procedure 4. Can handle (name and recognise) the most frequently used endovascular tools 5. Obtain experience with handling different catheters 6. Can produce angiographic images in the best projections 7. Can perform PTA and stenting of the ilio-femoral arterial segment 8. Can make use of the assistant 9. Can inform the patient adequately during the procedure 10. Can explain how the most common complications are managed

Format Training in the simulator is done pairwise, changing roles being the operator and being the assistant. Trainees are paired according to previous knowledge and qualifications.

The “operator” performs the puncture and speaks/thinks aloud regarding the planned procedure and manoeuvring en route. The “assistant” prepares the assistant’s table, looks and may suggest ideas for the operator to consider.

Procedures Each course participant is guaranteed at least five procedures as operator, each lasting approximately ¾ h, consisting of 3-4 iliac and 1-2 superficial femoral artery (SFA) procedures. The selected cases are of increasing difficulty, starting with same side access and moderate stenosis and ending with cross-over and a tight stenosis.

Test The concluding simulated test procedure is individual. It will be an iliac procedure, which the trainees have not tried before. The faculty person takes on an active role, both as patient and as assessor asking detailed questions according to the SAVE scale (see p 13).

The SAVE scale assessment sheet is filled in by the faculty person, who afterwards go through the assessment with the trainee. Finally the SAVE assessment is forwarded to the local endovascular supervisor, to be included in Module 4.

The role of the faculty Initially the faculty person plays an active role, adding ”clinical realism” to the simulation. As teh trainees become more skilled the faculty becomes less visible and audible and less correcting, thus allowing the trainees their own trial and error.


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MODULE 4: CLINICAL TRAINING. In this module the trainee should perform at least 10 supervised simple endovascular procedures, diagnostic as well as therapeutic procedures. The 10 or more cases are selected by the local endovascular supervisor and completed within a time frame of 4 weeks.

The 10 procedures The trainee must be the primary operator though supervised. The trainee performs the puncture, handles guide wires and catheters, arteriography, stenting, stent dilatation and sheath removal.

The local endovascular trainer should primarily supervise the trainee and safeguard the patient and the quality of the procedure. As the trainee becomes more experienced, interaction from the supervisor is expected decrease. Verbal feedback from the supervisor should be given whenever relevant

Assessment of competency and learning Following each procedure the supervisor addresses the competence of the trainee based on the SAVE scale (see appendix), thus giving the trainee structured feedback. The SAVE scale has proven suitable in scientific studies, for assessment of endovascular competence in a simulation setting. It consists of 29 items grouped in 7 categories, and a single overall score. The supervisor may choose to assess the performance on a detailed level, i.e. the ”items level”, or to do it in more broad terms, i.e. the ”category level”, pending on the state of competence of the trainee.

When using the SAVE scale in a clinical setting two more items has to be added:

• Puncture technique and • Haemostasis

Case reports The trainee writes a 1-2 pages case report for each procedure attended. See guidelines in the appendix. The trainee should consider which elements/items need special attention during the following procedure, in order to maximise learning.

Reflective report Having terminated all ten procedures, the trainee prepares the second reflective report. The purpose is to give the trainee an opportunity to demonstrate his/her capability to combine theory and clinical practice based on the observations made and the experience gained during the ten cases. Preferable the progression during the ten cases should be reflected in the report. In addition the report will serve at a methodological basis for continued development of endovascular competence.

The report should be 5 pages long, excluding the ten case reports. See guidelines in page 18. As with the first reflective report in module 2, it is suggested, that the trainee discuss the report with the supervisor to obtain feedback, leading to revision of the reflective report.

The final report including the ten case reports must be submitted electronically to the course director. Additional feedback will be given and the course director will issue a course diploma.


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APPENDICES MODULE 2 CLINICAL CASE REPORT

Date:

Case no.:

Clinical instructor: Trainee:

E-mail:

Summary of the patient’s key problem, clinical findings, para-clinical lab-data, and prior imaging investigations:

Summary of key points to consider regarding this patient prior the procedure:

Summary of intervention plan discussed with clinical instructor:

Observation of procedure and discussion with the operator – state three important learning points:

1.

2.

3.

Summary of equipment and technique used during the procedure:


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MODULE 2 REFLECTIVE REPORT ON THREE PROCEDURES The aim of the reflective report is to demonstrate that the trainee can combine the theoretical and practical knowledge acquired during the clinical preparation.

The reflective report should include a maximum of three pages of writing plus the three case reports (max. one page each). The report should be structured according to four sections:

1. Forethoughts and patient management plan Discuss the forethoughts and stipulated patient management plans of the three cases according to the literature and current understanding of physio-pathological aspects of the vascular diseases and their management including rationale for choice of technical approach and equipment. Describe and discuss key choices made according to anticipated problems or challenges and the strategies planned in order to overcome these.

2. Intra-operative procedures Describe and discuss according to the literature key issues regarding intra-operative procedures, techniques, manipulation of tools and imaging. Describe and discuss key aspects of intra-operative challenges and problems and strategies applied to overcome these. Describe and discuss any adaptations of primary management plans.

3. Post-procedure evaluation Describe and discuss immediate and long-term management plan of the three cases. Visit the patient on the ward later in the day of the interventional procedure, and if not discharged, also on the following morning. Interview the patient about his/her experience of the procedure and events. Make an overall evaluation of the patient management including pre-planning, intra-operative procedure, and follow-up and discuss according to the literature.

4. Reflection Summarise your reflections on the three cases in a general conclusion or lessons learned regarding pre-procedure forethought and planning, procedure performance and strategy adaptation, and post-procedure evaluation?

Supervision and feedback Discuss the report with your local tutor and revise according to feedback. Submit the final report to the course administrator, who will forward it to CEKU faculty for review and feedback.

The report must be signed by the clinical tutor and the trainee.

Language: Danish


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THE SAVE SCALE


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GUIDELINES FOR ASSESSORS USING THE SAVE SCALE 1. Procedure plan and Preparation -Case summary:

Briefly highlight clinical indication for arteriography and endovascular treatment: 1) Anamnesis: patient age, Fontaine-classification (stage of ischemia) and walking distance, co-morbidity and renal function, medication, social status. 2) Examination: pulse, wound, distal pressure. 3) Diagnostic imaging: US, MRA, CTA, DSA.

-Choice of plan:

1) Specify the plan to visualize the level of the stenosis (iliaca – SFA/PFA – crural) and possible endovascular treatment.

2) Present the procedural steps during the phases of: preparation - access – diagnosing – treatment – post-treatment.

3) Specify appropriate tools for the procedure.

-Prediction of challenges and complications: 1) Specify possible technical obstacles and critical anatomical points in the procedure. 2) Specify potential complications during and after the procedure and how to prevent these.

-Preparation of the assistant table:

Shows clear ability to prepare the assistant table with ingredients and tools with a systematic approach.

2. Imaging - Radiographic equipment handling: Shows clear economy of movements for handling the patient table and the C-arm. - Imaging – quality of arteriographic pictures:

1) Chooses correct angles and visualizes bifurcations (3D understanding). 2) Visualizes the stenosis from two angles. 3) Centres anatomical structures correctly. 4) Records overlapping pictures. 5) Saves pictures for documentation. 6) Demonstrates radiation discipline.

- Demonstrates correct use of fluoroscopy with a good overview of manipulated tools: Visualizes the important parts of manipulated tools. - Use of contrast fluid and timing:

1) Inject the appropriate volume of contrast fluid. 2) Apply the correct forces during injection. 3) Correctly time the injection.


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3. Tools - External technique - Selection of appropriate tools: This implies knowledge of tools (types, purposes, properties). Shows clear ability to select the appropriate tools: guide wire, sheath, diagnostic catheter, guiding-catheter, stent, dilatation catheter. - Preparation and Handling of tools:

1) Prepares tools correctly and safely. 2) Exchanges tools fluidly. 3) Handles guide wires and catheters with stability. 4) Demonstrates awareness of sheath and guide wire position. 5) Demonstrates flushing of sheaths and catheters. 6) Deploys stent safely. 7) Inflates dilatation catheter safely. 8) Demonstrates clear economy of gross motor movements. 9) Demonstrates an aseptic technique.

- Demonstrates awareness and respect for the puncture site

4. Endovascular - Internal technique during fluoroscopy - Knowledge of vascular anatomy and pathology:

1) Shows clear ability to name relevant anatomical structures during the procedure. 2) Shows clear ability to evaluate fluoroscopic pictures and the stenosis properly (degree and length of the stenosis, vessel diameter).

- Knowledgeable about the “common rules” for treatment of the specific vascular structure/bed - Manipulation of tools: 1) Progressive and fluid movements of tools. 2) Appropriate position of tools. 3) Demonstrates precision of the endovascular technique. 4) Demonstrates stability of tools.

3) Demonstrates well-coordinated movements of several tools simultaneously. 4) Applying appropriate forces on stents and dilatation catheters. 7) Ability to pass anatomical obstacles with tools. 8) Awareness of guide wire position.

- Respect for tissue and stenosis - Safe removal of the tools


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5. Procedure - Sequencing of the steps: 1) Adhere to the plan. 2) Administration of drugs (ex. Heparine). - Progression: Demonstrates flow of operation without need for verbal prompts. - Adaptability: Ability to recognize and adapt to unforeseen circumstances using an alternative plan (ex. upon cannulating a wrong vessel). - Chooses the treatment correctly according to angiography and the patient status To treat or not to treat? How to treat: endovascular or open surgery?

6. Communication and use of assistant - Can inform the patient correctly during the procedure - Communicates with and activates the assistant appropriately during the procedure

7. Post-planning and treatment of complications - Specify the immediate post-treatment plan until hospital discharge:

1) Rest in the bed. 2) Medication. 3) Check for Creatinin. 4) Reporting symptoms related to complications (ex. bleeding, ischaemia). 5) Hospital discharge.

- Specify the long-term follow-up plan:

1) Altered ischemic symptoms: better-equal-worse? (walking distance, wound healing, when to report back to the department).

2) Follow-up in the outpatient clinic (Duplex, distal pressure). 3) Medication. 4) Smoking cessation.

- Specify the treatment of possible technical per-operative complications:

1) Bleeding from the puncture site (compression, operation). 2) Dissection (arteriography, PTA, stent, operation). 3) Vessel rupture (arteriography, covered stent, operation). 4) Distal embolisation (arteriography, aspiration, thrombolysis, thrombectomy).

8. Overall level of endovascular expertise - Your “gut-feeling” of the operator’s overall level of endovascular expertise


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MODULE 4 CASE REPORT, TEN CASES

Use this form for each of the ten cases. Each report might include more than one page.

Date:

Case no:

Clinical instructor: Trainee:

E-mail:

Summary of patient’s key problem, clinical findings, para-clinical lab-data, and prior imaging investigations:

Summary of forethoughts and patient management plan including post-intervention follow-up:

Indicate three key challenges met during the procedure and strategies to overcome these:

1.

2.

3.

Indicate three aspects of your performance in need of improvement to be focused on in your next case and describe your strategy to accomplish this:

1.

2.

3.

Summary of equipment and technique used during intervention:


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MODULE 4: REFLECTIVE REPORT - 10 PROCEDURES After all the ten cases the trainee writes a reflective report. The aim of the reflective report is to demonstrate that the trainee can combine the theoretical and practical knowledge acquired during the clinical training. In addition the report serves as a preparation for future learning by having the trainee reflecting on the learning process and how deliberate practice and reflection in and on cases support the steadily advancement of performance.

The reflective report should include a maximum of five pages of writing plus the ten case reports (max. two pages each). The report should be structured according

1. Forethoughts and patient management plan Discuss the forethoughts and stipulated patient management plans of the ten cases according to the literature and current understanding of physio-pathological aspects of the vascular diseases and their management including rationale for choice of technical approach and equipment. Describe and discuss key choices made according to anticipated problems or challenges and the strategies planned in order to overcome these.

2. Intra-operative procedures Describe and discuss according to the literature key issues regarding intra-operative procedures, techniques, manipulation of tools and imaging. Describe and discuss key aspects of intra-operative challenges and problems and strategies applied to overcome these. Describe and discuss any adaptations of primary management plans.

3. Post-procedure evaluation Describe and discuss adaptations to immediate and long-term management plan of the ten cases according to post-procedural follow-up on patients Make an overall evaluation of the patient management including pre-planning, intra-operative procedure, and follow-up and discuss according to the literature.

4. Reflection Summarise your reflections on the ten cases in a general conclusion or lessons learned regarding pre-procedure forethought and planning, procedure performance and strategy adaptation, and post-procedure evaluation?

Reflect on your development of performance from case 1 to 10. Describe and discuss your learning strategies and how you used the case reports, the clinical instructor, the in-training assessments, and knowledge of quality of results in advancing your performance.

Supervision and feedback Discuss the report with your local tutor and revise according to feedback. Submit the final report to the course administrator, who will forward it to CEKU faculty for review and feedback.

The report must be signed by the clinical tutor and the trainee.

Language: Danish


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COURSE EVALUATION SHEET date:

”Basale Endovaskulære Teknikker – integreret klinisk og simulationsbaseret kursus” This introductory course to Endovascular Techniques includes a variety of training and assessment components. In order to improve the course we would like your evaluation. Please evaluate the individual components as the course progresses, and submit the evaluation form together with the final report.

Evaluation of course components Please rate from 1 to 7. Please note that the meaning of the scale varies between questions.

Theoretical preparation (Modul 1) Rate 1-7 To what extent did you prepare theoretically for the course?

(1= not at all, 7= optimally)

-

Further comments specifically related to the introductory theoretical preparation for the course:

Introductory observations and reflective report (Modul 2) Rate 1-7

How was the duration of the observation period including the 3 cases used for the reflective report? (1=too short, 4=optimal, 7=too long)

-

To what extent did you have a constructive dialogue with the endovascular operator? (1=not at all, 7=optimally)

-

How much did you learn from the clinical observations? (1=nothing, 7=very much)

-

How much did you learn from completing the reflective report? (1=nothing, 7=very much)

-

To what extent did the introductory observations and the reflective report offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

-

Overall evaluation of the introductory observation and reflective report (1=very bad, 7=very good)

-

Further comments specifically related to the introductory observations and reflective report:


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Simulation training (Modul 3) Rate 1-7

Practical preparation To what degree did the observations (Modul 2) prepare you for the simulation based training? (1=not at all, 7=optimally)

-

Training

How was the duration of the simulation based training? (1=too short, 4=optimal, 7=too long)

-

To what extent did you have a constructive dialogue with the teacher? (1=not at all, 7=optimally)

Teacher A Teacher B Teacher C

-

-

How much did you learn from the simulation based training? (1=nothing, 7=very much)

-

To what extent did the simulation based training offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

-

Following the simulation based training; to what degree did you fell prepared for clinical training? (1=not at all, 7=optimally)

-

The test-procedure How was the duration of the test-procedure? (1=too short, 4=optimal, 7=too long)

-

How much did you learn from the test-procedure? (1=nothing, 7=very much)

-

To what extent did the test-procedure offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

-

Overall evaluation of the simulation based training (1=very bad, 7=very good)

-

Further comments specifically related to the simulation based training and the tests:


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Clinical training 10 cases (Modul 4) Rate 1-7

Clinical Training

How was the duration of the clinical training? (1=too short, 4=optimal, 7=too long)

How much did you learn from the clinical training? (1=nothing, 7=very much)

-

Following the clinical training; to what degree did you fell prepared for unsupervised clinical practice? (1=not at all, 7=optimally)

To what extent did the clinical training offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

How well did the simulation training prepare you for clinical training? (1=not at all, 7=optimally)

How was the amount and quality of feedback you received from your local endovascular supervisor before submitting the final report? (1=very unsatisfactory, 7=optimally)

Overall evaluation of the clinical training (1=very bad, 7=very good)

Further comments specifically related to the clinical training:

The final report must be completed and submitted to [email protected] within 30 days following the clinical training period. The final report must include a copy of the 10 clinical case reports and the final SAVE-scale score sheet filled in by your local endovascular supervisor.

The final reflective report Rate 1-7

How much did you learn from completing the final report? (1=nothing, 7=very much)

To what extent did the final report offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

Overall evaluation of the final report (1=very bad, 7=very good)

Further comments specifically related to the final report:


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Please evaluate your overall satisfaction and learning outcome from the course.

Overall evaluation of the course Rate 1-7

How was the duration of the course? (1=too short, 4=optimal, 7=too long)

-

How much did you learn from the course? (1=nothing, 7=very much)

-

To what extent did the course offer a suitable challenge to you? (1=too easy, 4=optimal, 7=too difficult)

Before this introductory course to endovascular techniques; to what degree did you fell competent to practice unsupervised in the clinical setting? (1=not at all, 7=optimally)

After this course; to what degree do you fell competent to practice unsupervised in the clinical setting? (1=not at all, 7=optimally)

To what degree have your instructors been competent in teaching you endovascular techniques? (1=not at all, 7=optimally)

In total, how was your experience with the course? (1=very bad, 7=very good)

To what degree can you recommend this course to your fellow trainees? (1=not at all, 7=fully)

How was the communication with the steering committee at CEKU, RH? (1=very bad, 4=appropriate, 7=very good)

Further overall comments to course:

Thank you for completing this evaluation

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