A structured, extended training program to facilitate adoption of new techniques for practicing surgeons

Jacob A Greenberg, MD, EdM, Sally Jolles, MA, Sarah Sullivan, PhD, Sudha P Quamme, MD, MS, Caprice C Greenberg, MD, MPH, Carla Pugh, MD, PhD. University of Wisconsin

Introduction:  The project goal was to critically evaluate the implementation and development process for a newly designed Continuing Medical Education (CME) level course for laparoscopic Total Extraperitoneal (TEP) inguinal hernia repair. Despite evidence that the laparoscopic approach for inguinal hernia repair leads to faster recovery, the overwhelming majority of surgeons continue to utilize an open approach.  Moreover, the traditional model of utilizing short CME courses, rarely leads to adoption of new techniques. Our hypothesis is that our newly developed seven-step program will lead to safe adoption of the TEP approach.

Methods and Procedures:  A team of experts in simulation, coaching, and TEP convened to design an educational training program for TEP. Using an iterative process we developed a curriculum incorporating simulation, intraoperative training, and surgical coaching.   Assessments were created to monitor each stage of the program. Eligible surgeons who performed primarily open inguinal hernias with a case load of at least 50 inguinal hernia repairs a year and had an interest in adopting TEP into their practice were recruited through email and postal mailings. Coaches were identified by study team members based on procedural expertise and completed a formal training program in surgical coaching.  Our target enrollment for this pilot project was three practicing surgeons who were willing to commit to at least eight months of structured training.

Results:  The orientation day incorporated didactic and procedural teaching including video-based review and a written assessment.   A simulator was used for a baseline assessment of participants’ operative skills. After the baseline assessment, trainees were familiarized with the principles of surgical coaching and were given the opportunity to go over their performance on the simulator with their assigned coach. The next stage involved GlovesOn training, where the participant scrubbed in with a procedural expert to observe and perform TEP repairs in the expert’s operating room.  This was followed by the surgical coach precepting several cases in the participant’s operating room.  The final stage of training involved video-based review of the participant’s first 10 independent cases with their surgical coach.  Upon program completion, subjects returned for an exit interview and post-test simulation assessment with their surgical coach.

Conclusions:  We were able to successfully implement a CME-level program for training practicing surgeons to adopt the TEP approach. Necessary considerations for replicating this program at another institution include institutional infrastructure, departmental support and resources, and a team of dedicated personnel for programmatic adaptation and implementation.

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