In a recent European needs assessment identifying curricular content for simulation-based education, basic endovascular skills were ranked as second most important. (1) A 'PROficiency-based Stepwise Endovascular Curricular Training program' (PROSPECT), developed to teach (vascular) surgical trainees basic endovascular skills outside of the operating room, combining E-learning and simulation based training has proven it's superiority to traditional training in a single centre randomised controlled trial. (2) However, a follow up study showed that real life adherence is low with a dropout rate of 65%. A survey completed by participants and faculty identified lack of training time within the working schedule, limited trainee motivation and non-availability of logistical and technical support as most important barriers to broad PROSPECT implementation. (3) To overcome these barriers, massed training may be a potential solution. These programs offer the same content in a limited timespan, making it easier to exempt trainees from their clinical duties. Hence, the PROSPECT program was condensed into a one-week bootcamp-style training (C-PROSPECT). Though, massed training has shown to be inferior for learning psychomotor skills in basic surgical procedures (4), this has not yet been studied in more complex endovascular procedures. This study aimed to compare distributed versus massed training using the PROSPECT program to acquire basic endovascular skills and technical skills retention at various time intervals after both training modalities.

A multicentre prospective study allocated participants to the original distributed D-PROSPECT or massed, compact version C-PROSPECT based on logistics like travel time and availability of participants and instructors. Technical skills were assessed using a Global Rating Scale (GRS) (max score 55 points), Examiner's checklist (max score 85 points) and validated simulator metrics (Figure 1). Data was collected pre- and post-program. Skills retention was assessed at six weeks, three, six and twelve months after program completion. Descriptive statistics were obtained, and a paired Student T-test was used to compare scores pre- and post-program. A non-paired Student T-test was selected for hypothesis testing. Reported p values are tested two-sided, with a significance level of .05.

Over a period of four years and in two countries, D-PROSPECT was implemented in two centres and C-PROSPECT in three. In total, 22 participants completed D-PROSPECT (27% in Denmark, 73% in Belgium) and 27 completed C-PROSPECT (56% in Denmark, 44% in Belgium). There was no dropout in the C-PROSPECT group; in the included D-PROSPECT group, the dropout rate was 41% (15/37). Participants who completed either the C- or D-PROSPECT program showed significant improvement for all assessment parameters after the program, combined with decreased standard deviations (Table 1): procedure time (mean 27.8 vs. 16.0 minutes, p = <.001), fluoroscopy time (mean 12.5 vs. 7.6 minutes, p = <.001), contrast volume (mean 77.1 vs. 50.0 ml, p = <.001), number of roadmaps (mean 9.4 vs. 7.2, p = <.001), GRS (mean 20.8 vs. 42.0, p = <.001) and Examiner's Checklist (mean 44.9 vs. 77.5, p = <.001). Pre- and post-program scores of participants in the C-PROSPECT group did not differ significantly from D-PROSPECT participants, except for total procedure time and GRS in the post-test (Table 1). Preliminary analysis of retention data showed no significant differences between C- and D-PROSPECT except for fluoroscopy time at six months retention (Table 1). Data collection is still in progress.

PROSPECT significantly improves the quality of simulated endovascular performances, as previously established, and confirmed in this study. Participants who completed the massed training course successfully acquired basic endovascular skills. However, when compared to distributed training, total procedure time was significantly longer and global rating scale score significantly lower after program completion. Further data collection is required to confirm these findings and thoroughly assess retention data of both training modalities. A massed training form of PROSPECT may be considered to decrease drop-out and offer standardized training to obtain basic endovascular skills during endovascular surgery training, but long-term skill retention data is awaited.

1 Nayahangan LJ, van Herzeele I, Konge L, Koncar I, Cieri E, Mansilha A, et al. Achieving Consensus to Define Curricular Content for Simulation Based Education in Vascular Surgery: A Europe Wide Needs Assessment Initiative. European Journal of Vascular and Endovascular Surgery 2019;58(2):284-91. Doi: 10.1016/J.EJVS.2019.03.022. 2 Maertens H, Aggarwal R, Moreels N, Vermassen F, van Herzeele I. A Proficiency Based Stepwise Endovascular Curricular Training (PROSPECT) Program Enhances Operative Performance in Real Life: A Randomised Controlled Trial. European Journal of Vascular and Endovascular Surgery 2017;54(3):387-96. Doi: 10.1016/J.EJVS.2017.06.011. 3 Soenens G, Lawaetz J, Bamelis AS, Nayahangan LJ, Konge L, Eiberg J, et al. International Implementation of a PROficiency based StePwise Endovascular Curricular Training (PROSPECT) in Daily Practice. European Journal of Vascular and Endovascular Surgery 2021;62(6):992-8. Doi: 10.1016/J.EJVS.2021.09.029. 4 Andersen SAW, Konge L, Cayé-Thomasen P, Sørensen MS. Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice. JAMA Otolaryngology-Head & Neck Surgery 2015;141(10):913-8. Doi: 10.1001/JAMAOTO.2015.1563.