Identifying Educational Gaps and Exploring the Role for Virtual Patients in the Training and Evaluation of Decision-Making for Laparoscopic Inguinal Hernia Repair

Andrea M Petrucci, MD, Jessica Ruglis, PhD, Susanne P Lajoie, PhD, Gerald M Fried, MD, Liane S Feldman, MD, Melina C Vassiliou, MD

McGill University Health Center, McGill University


Surgeons have been slow to adopt laparoscopic inguinal hernia repair (LIHR) in part due to the protracted learning curve for both technical skills and clinical decision-making. Virtual patients (VPs) are being increasingly used to teach and evaluate clinical reasoning skills and have a potential role within a hernia curriculum. Conducting a needs assessment is the first step towards the creation of an effective curriculum. The purpose of this qualitative study was to conduct a learning needs assessment for the creation of a LIHR curriculum for general surgery residents and to explore the potential value of VPs to teach decision-making.

This was an exploratory qualitative study with semi- structured interviews. Participants included male and female residents at all levels of training and attending surgeons who perform hernia surgery. They were recruited through non- probabilistic purposive sampling. All interviews were recorded and transcribed. Grounded theory, a systematic qualitative approach, was used for data collection and analysis.

Six trainees (1 PGY-2, 4 PGY-3 and 1 PGY-5) and 6 experts (2 fellows and 4 attending surgeons) were interviewed. Experts and more senior trainees spontaneously acknowledged the importance of clinical decision making for successful LIHR, whereas junior trainees did not recognize decision making as an important element of the operation, or something that needed to be taught (“Don’t know what they don’t know”). The majority of novices felt that they would be ready to practice LIHR after graduation, however experts believed that most trainees are not competent in this procedure at the end of their training. Common themes that emerged for LIHR were the steep learning curve compared to open repair, the need for more targeted education, the value of using videos over textbooks for teaching, the importance of exposure to cases in the operating room for learning and the significance of self-directed instruction. Knowledge of anatomy was considered to be an essential element for competence in LIHR. Participants expressed that VPs would be useful for teaching and evaluating clinical-decision making for LIHR. They suggested that VPs would allow for exposure to difficult scenarios that are rarely encountered in the operating room.

Expert surgeons acknowledge the importance of decision-making skills more than novice surgical trainees. Novices may underestimate the complexity of the procedure, and seem to be more confident about their skills than experts. VPs may have an important role to play for teaching clinical decision- making for LIHR. The findings of this needs assessment will inform the creation of a VP for LIHR.

Session: Poster Presentation

Program Number: P170

« Return to SAGES 2013 abstract archive