2026 Poster Presentations
P444: RESULTS OF AN INTERPROFESSIONAL SIMULATION FOR ICA INJURY MANAGEMENT
Akshaya Raman, BA1; Jonathan Goulazian, BS1; Carl H Snyderman, MD, MBA2; 1University of Pittsburgh School of Medicine; 2UPMC Center for Cranial Base Surgery
Background: Internal carotid artery (ICA) injury is a rare, life-threatening complication of skull base surgery. We previously published an evidence-based ICA management algorithm from expert consensus and literature. Building on these materials, we executed a sequential curriculum: Phase 1 tested the algorithm with surgeons using a cadaveric simulation, and Phase 2 implemented an interprofessional course to identify team knowledge gaps and foster structured cross-specialty dialogue.
Methods: Phase 1: Skull base surgeons (N=17) completed a cadaveric ICA injury simulation after pre-learning with the expert consensus article and TEAM-ICA algorithm. Post-course surveys (5-point Likert) assessed satisfaction, relevance, comprehensiveness, utility, and confidence. Wilcoxon signed-rank tests compared ratings against the neutral midpoint (3). Open-ended responses were thematically analyzed. Simulation sessions were video-recorded, and clips highlighting best practices were edited into instructional videos.
Phase 2: An interprofessional cohort (N=17; surgeons, anesthesiologists, nurses, surgical technicians, neurophysiologists) completed a mannequin-based OR simulation with mock supplies and scripted cue cards representing intraoperative events (e.g., tachycardia + hypotension, neurophysiologic changes, full suction capacity). Phase 1 instructional videos, together with the TEAM-ICA algorithm and expert consensus article, were distributed as pre-learning. After simulation, a structured debriefing with senior members from each specialty ensured voice equity. Surveys measured readiness, role clarity, and communication. A multiple-choice test based on learning materials was administered prior to simulation, with item and domain analysis to identify knowledge gaps.
Results:
Phase 1: Surgeons reported uniformly high satisfaction (mean 5.0/5), course relevance (4.82 ± 0.39), comprehensiveness (4.76 ± 0.44), instructor effectiveness (4.88 ± 0.33), and utility of the ICA model (4.94 ± 0.24); all significantly greater than neutral (p<0.0001). Surgeons also reported moderate-to-high confidence in managing ICA injury (mean 3.94 ± 0.75, p=0.0015 vs. neutral) after our course. Qualitative comments highlighted the TEAM-ICA materials as most valuable (“the algorithm for ICA injury,” “contents of the manual,” “the learning materials”), alongside repeated calls for “more hands-on time.”
Phase 2: The majority of interprofessional participants (70.6%) reported no prior instruction in ICA injury management. Baseline role clarity was rated lowest (mean 3.50/5), compared with communication awareness (3.94/5) and team response confidence (3.81/5). Knowledge testing revealed significant gaps in hemorrhage control (23.5% correct on acceptable methods) and supply selection (64.7%), while communication was a relative strength (94.1%). Structured debriefings exposed differing specialty perspectives on supply needs and physiologic targets, providing an environment to reconcile discordance outside an actual patient crisis.
Conclusion: This sequential curriculum shows that surgeons rated the algorithm-informed simulation highly and valued the educational materials. The interprofessional phase identified critical knowledge and role-clarity discordance, with the majority reporting no prior instruction in ICA injury management, highlighting an important target for educational intervention. The team enactment model proved replicable and, when combined with structured debriefings ensuring voice equity, created a forum for cross-specialty discourse. Importantly, this model is designed for dissemination to other institutions to incorporate heterogeneous perspectives for applicability across diverse surgical teams and make learning materials widely accessible. This work represents a scalable framework for ICA injury preparedness that advances patient safety through education.
