Poster3-08: INNOVATIVE TEACHING TOOL FOR THE AXILLARY LYMPH NODE DISSECTION
Anthony Cyr, Lauren Huckaby, Jennifer Steiman; University of Pittsburgh

Introduction: Surgery for breast cancer, including staging of the axilla, is a key component in general surgery training and may require axillary lymph node dissection (ALND). Following the trend towards non-operative management of the axilla, recent data has shown a decline in resident exposure to ALND;  however, graduating residents are still expected to be competent. The spatial anatomy of the axilla presents a unique challenge to performing the operation safely and adequately. As a result, we developed an innovative program to enhance learning and promote retention of axillary anatomy.

Methods: During a 1-hour education session, general surgery residents were asked to recall the anatomy of the axilla without instruction, including 10 key features: medial pectoral bundle, pectoralis major and minor muscle, thoracodorsal neurovascular bundle, long thoracic nerve, serratus anterior muscle, axillary vein, subscapularis muscle, latissimus dorsi and lymph nodes. Groups of 6-8 residents then used various art supplies to recreate the structures of the axilla. A review of models and the correct anatomy was provided following their creation. An online survey was then distributed immediately after the program and 6 weeks later to assess recall of the anatomic components.

Results: Of the residents who attended the session and completed a survey, the median number of correct anatomy responses was 7, as compared to 4 for residents who did not attend (p= 0.111). The most and least commonly recalled anatomic structures were the axillary vein (n=18) and the subscapularis muscle (n=3), respectively. After 6 weeks, the axillary vein remained the most commonly recalled item, whereas no residents listed the subscapularis muscle. In assessing residents who completed the survey at 6 weeks, a median loss of 2 elements was observed (p=0.17).

Conclusions: Utilization of an innovative teaching tool for ALND anatomy demonstrated a trend toward better retention of the key elements. Gaps in knowledge were also exposed with regards to the most and least common structures recalled from the teaching session. Such information can be used in developing future programs in ALND instruction, especially since exposure during surgical training is declining.