Surgery Oral Board Practice: Vascular Access Scenario Example

Oral Board Practice Scenario

• 👨‍⚕️ A 64-year-old male patient with end-stage renal disease, diabetes, hypertension, and peripheral vascular disease presents for vascular access evaluation.
• 💡 The patient has a history of failed dialysis catheters and recurrent infections, with his current tunnel catheter needing replacement.
• 🩺 Initial assessment includes a comprehensive review of surgical history for vascular access, vein mapping, and arm ultrasounds.

Surgical Procedure Steps

• 🏥 A left radio-arterio venous fistula is planned, with the patient consented and brought to the operating room.
• 🔪 The procedure involves an end-to-side anastomosis of the cephalic vein to the radial artery at the wrist.
• ⚠️ Concerns arise regarding the adequacy of outflow due to a weak thrill and a thick, non-distending vein wall after the anastomosis.

Simulator Feedback and Features

• 📊 The simulator provides an overall score and grades performance based on essential attributes from the American Board of Surgery.
• 🎯 Feedback highlights gaps in knowledge, such as pre-operative assessment for central venous stenosis and cardiac function.
• 📚 Specific recommendations are given for vascular access scenarios and pre-operative assessment modules within the simulator to address identified weaknesses.
• 🗣️ The simulator offers detailed commentary, tips, and tricks for challenging scenarios, covering confusing topics for general surgeons.
• ✅ The system is currently in beta (v1.9) with plans for major upgrades and aims to provide unlimited unique oral board scenarios 24/7 with diverse examiners and natural conversation.