Results of an Interprofessional Simulation for ICA Injury Management

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