S90
Surgical Forum Abstracts
J Am Coll Surg
Teaching laparoscopic proctosigmoidectomy (LS) to residents: A comparison of a high fidelity synthetic model and live porcine model
(PGY-1,2) surgical residents (83% response rate) either before (presim) or after (post-sim) they completed a 1 month simulation rotation. Results were statistically analyzed with a chi-square test.
Jonah J Stulberg MPH, Conor P Delaney MD, PhD, MCh, FACS, Anthony J Senagore MD, FACS, Bradley J Champagne MD, Sudip Sarker MD, Jon Efron MD, Morris E Franklin MD, Sang Lee MD, David Rivadeneira MD, FACS, Eric Weiss MD University Hospitals Case Medical Center, Cleveland, OH
RESULTS: 83% of the residents responded as ‘very interested’ in a simulation curriculum and 67% that it should be ‘mandatory for surgical training’ with no differences between pre-sim (n⫽11) and post-sim (n⫽19) (p⫽0.37, 0.27). There was a statistical difference in the pre-sim and post-sim PEV of simulation in teaching upper endoscopy (p⬍0.03), colonscopy (p⬍0.03), bronchoscopy (p⬍0.02), and basic laparoscopy (p⬍0.05) with a greater number identifying the value as ‘good’ or ‘excellent’ in post-sim vs. pre-sim. Most junior residents identified simulation as better than traditional general surgery rotations for learning laparoscopy (67%) and endoscopy (70%) with no statistical difference between groups.
INTRODUCTION: The technical challenge of laparoscopic proctosigmoidectomy (LS) and resulting prolonged learning curve have made effective teaching of the procedure difficult. We explored the effectiveness of a high fidelity synthetic model for use in resident training. METHODS: PGY 4 and 5 general surgery residents received a series of technical lectures on LS. Residents then performed LS using a high fidelity synthetic plastic model (PM) under faculty supervision, followed by LS in a live, step-based porcine model (LM). Residents were scored using one validated and one novel error scoring system, utilizing structured technical skills assessment to evaluate discrete procedural steps. Faculty and residents provided global scores for each model. RESULTS: Residents gave higher global scores to both models than faculty (PM: 6.0 vs 4.2 [p⫽0.02]; LM: 9.2 vs 7.7 [p⫽0.005]). Residents and faculty gave LM higher global scores (8.70 vs 5.44 (p⬍0.001)). All residents felt both models were sufficiently complex for an adequate educational experience, supported by a similar number of intraoperative errors during LM vs PM colectomy (mean 1.9 vs 2.1 per case [p⫽0.83]). Task specific analysis scores showed improved task completion and effectiveness of LM over PM (7.5 vs 5.1; p⫽0.05). CONCLUSIONS: A high fidelity synthetic model provides an additional training process that does not require the cost and complexities of laboratory based training with animal or cadaver models, and may therefore provide a potential adjunctive training aid for teaching residents laparoscopic colectomy.
Simulation rotation offers junior surgical residents a perceived improvement in technical training compared to traditional training models Benjamin J Herdrich MD, Kristoffel R Dumon MD, Jon B Morris MD, FACS, Noel N Williams MD, FRCSI The University of Pennsylvania School of Medicine, Philadelphia, PA INTRODUCTION: Surgical simulation is an attractive method of surgical training and can aid the acquisition of technical skills in a low risk environment. We hypothesized that the perceived educational value (PEV) of a simulation rotation for junior surgical residents would be higher than that of a traditional general surgery rotation for specific disciplines, and participation would improve the PEV. METHODS: A voluntary anonymous survey assessing the educational quality of a simulation curriculum was distributed to 36 junior
CONCLUSIONS: Simulation curriculum is viewed by many junior residents as being an essential part of junior resident training and targets endoscopic and laparoscopic skills better than traditional rotations. Participation in a simulation rotation improves the perceived educational value for individual disciplines and maintains the overall interest for a simulation curriculum.
Achieving residency-wide proficiency for Fundamentals of Laparoscopic Surgery (FLS) skills training Mouza T Goova MD, Lisa A Hollett RN, MA, Seify T Tesfay RN, MS, Deborah C Hogg BS, Daniel J Scott MD, FACS University of Texas Southwestern Medical Center, Dallas, TX INTRODUCTION: The Fundamentals of Laparoscopic Surgery (FLS) is one of the best available programs for laparoscopic training. The purpose of this study was to assess skill acquisition for different levels of surgical trainees. METHODS: During a single academic year, all surgery residents (n⫽91, R1-5) were enrolled in an IRB-approved protocol for FLS skills training. R1 residents were enrolled in a more complex curriculum and these outcomes have been previously reported. During two-month intervals, R2-5 trainees underwent FLS pre-testing (1 repetition of 5 tasks), self-practice until previously published proficiency levels were achieved, and post-testing. Values are mean ⫾ s.d (Mann-Whitney U, p⬍0.05 significant). RESULTS: All residents completed the curriculum. At pre-testing 65% of trainees passed the FLS skills certification criteria vs. 100% at post-testing (p⬍0.001). All levels of residents demonstrated significant improvement after training (R2: 247 ⫾ 69 vs. 431 ⫾ 44, p⬍0.001; R3: 304 ⫾ 56 vs. 463 ⫾ 21, p⬍0.001; R4: 334 ⫾ 70 vs. 421 ⫾ 54, p⬍ 0.001; R5: 292 ⫾ 57 vs. 431 ⫾ 48, p⬍0.001). CONCLUSIONS: This study documents that all levels of residents may be suitable for FLS training, as significant skill acquisition is uniformly achieved after proficiency-based practice. More widespread adoption of this curriculum is encouraged.