{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T19:40:16Z","timestamp":1781206816341,"version":"3.54.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T00:00:00Z","timestamp":1606608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Peter","award":["TOF 1959"],"award-info":[{"award-number":["TOF 1959"]}]},{"name":"Fabiola Butler who support the Cardiac 3D Printing Program at the Hospital for Sick Children"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The hands-on surgical training course utilizes 3-dimensional (3D)-printed heart models to simulate complex congenital heart operations. This study aimed to validate a model and assessment tool in the simulation of 2 techniques of the Norwood operation and investigate whether technical performance improves following rehearsal with or without proctor presence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Five \u2018experienced\u2019 and 5 \u2018junior\u2019 surgeons performed 2 techniques of the Norwood operation on 3D-printed models of hypoplastic left heart syndrome. Performances were retrospectively assessed by 10 raters with varying experience in congenital heart surgery (CHS) (Medical Doctorate versus non-Medical Doctorate). Assessments were made with the procedure-specific Hands-On Surgical Training-CHS tool. Results were analysed for technical performance and rater consistency. Following validation, 30 surgeons (24 with proctor guidance and 6 with training videos and objective feedback only) simulated the Norwood operation twice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Performance scores were consistently higher for experienced surgeons and raters discriminated clearly between the experienced and junior surgeons (P \u2264 0.001). The hands-on surgical training-CHS tool showed high inter-rater (0.86) and intra-rater (0.80) reliability among all raters. Scores for both experienced and junior surgeons were highly consistent across all raters, with no statistically significant difference (P\u2009=\u20090.50). All surgeons successfully performed the Norwood operation. Sixty attempts were scored in total. Eighty-seven percentage (26\/30) of surgeons\u2019 scores (mean: attempt 1\u2009=\u200992, attempt 2\u2009=\u2009104) and times [mean: attempt 1\u2009=\u20091:22:00, attempt 2\u2009=\u20091:08:00 (h:mm:ss)] improved between the 2 attempts by 9% and 15% respectively (P \u2264 0.001). Total scores of all surgeons in the non-proctored subgroup (6) improved by 15% on average (mean: attempt 1\u2009=\u200986, attempt 2\u2009=\u2009105, P\u2009=\u20090.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Procedure-specific assessment tools can be developed to evaluate technical performance for complex CHS simulation and be performed reliably by non-expert raters. Rehearsal both under supervision and independently leads to technical skill improvement further supporting its value in CHS training.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa321","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T19:11:25Z","timestamp":1596222685000},"page":"316-324","source":"Crossref","is-referenced-by-count":10,"title":["Assessment tool validation and technical skill improvement in the simulation of the Norwood operation using three-dimensional-printed heart models"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6572-0090","authenticated-orcid":false,"given":"Nabil","family":"Hussein","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Cardiovascular Surgery, Department of Surgery, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osami","family":"Honjo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Cardiovascular Surgery, Department of Surgery, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Barron","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Cardiovascular Surgery, Department of Surgery, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Haller","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Cardiovascular Surgery, Department of Surgery, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G","family":"Coles","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Cardiovascular Surgery, Department of Surgery, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen","family":"Van Arsdell","sequence":"additional","affiliation":[{"name":"Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA"},{"name":"Department of Surgery, Mattel Children\u2019s Hospital at UCLA, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lim","sequence":"additional","affiliation":[{"name":"The Center for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Joon","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics, The Labbatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada"},{"name":"Department of Diagnostic Imaging, Hospital for Sick 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