During the Covid pandemic, the medical community has changed his behaviour. Because the hands-on activities, workshops or surgery simulation courses have been suspended sine die. We present the possibility of performing surgical skills training at home, synchronously from different hospitals, using simple simulators that you can easily move. Our objective is analyse the feasibility of online training sessions on open vascular surgery techniques using simulators during the Covid pandemic.

Two types of sessions were designed: carotid endarterectomy and bypass anastomosis. We planned three meetings for every exercise, each with ten expected participants. The training sessions' targets were vascular trainees on their third, fourth, or fifth-year accompanied by a local tutor. We specially designed a training box, including the material to perform the exercise (artery model, surgical instrumental and sutures). The model for the carotid endarterectomy consisted of a bifurcated vessel with a plaque inside it. The bypass artery model consisted of a tube. The box include a bovine patch to close the carotid endarterectomy (biological patch) and a biological prosthetic bypass. Every group shared a Zoom -link to complete the online connection for two hours. Every session started with a brief online introduction to the materials and the expected performance of the exercise. The tutors were asked not to give the trainees advice. After finishing the activity, every participant put the model in a container and sent it to the organisers. They also sent the video recordings for further analysis. Finally, a telematic pooling took place between all the participants, including feedback from the session and information from everyday practice in each department. Two blinded examiners performed the ratings. They assessed the surgery performance applying an operative performance rating system (OPRS) and evaluated the model using an end product rating score (EPRS).

The six planned workshops were performed on six consecutive Mondays from June 22 to July 27 2020. We invited sixty-three trainees from eighteen different Spanish hospitals to join the workshops. 32 participants for carotid exercises and 31 for bypass. The majority of participants were in their fourth year of training. During the online sessions, the connection was correct in audio and video with no technical problems. Two blinded senior vascular surgeons analysed the 53 samples provided according to EPRS scoring. The evaluators also analysed 25 carotid videos (2 videos not legible, five not sent) and 17 bypass videos (4 videos not dispatched). The fifth-year trainees showed better EPRS results, both in carotids and bypass exercises. OPRS analysis showed better performance for the fifth-years trainees in carotids but not in bypass. When analysing time, we also see differences depending on the practice. There were no statistical differences between the participants according to their training stage in either category studied. The results were sent to the participants via e-mail after completing the analysis. Eleven participants sent us their feedback (30,6%). All them rated as satisfied or very satisfied. Considered the course very useful (4,5/5), would recommend the course to others (4,7/5) and would repeat it in the same format (4,7/5).

Our model represents a mix of the simulation model and online surgical simulation. The online support we have performed in a scheduled manner has forced the participants and the tutors to work synchronically from different Spanish hospitals. Our experience is an example of what can be done online: more than fifteen people connected at a time, performing a practical exercise as if they were at the same facility. The teamwork and willingness of the attendees have been vital to the right results. In the era of rapidly expanding technology, shorter vascular training paradigms, increased public scrutiny of surgical outcomes, and Covid Pandemic, simulators are an exciting and necessary development in vascular surgeons' training. A structured curriculum should accompany their use in training with competency assessment. Our present experience will help plan courses with a similar online structure and the collaborative work in the different hospitals with their tutors and participants.