3-year general surgery residency program; outcomes on abdominal procedures and the impact of using a simulated laparoscopic training program

Rodrigo Tejos¹, Rubén Avila¹, Pablo Achurra¹, Anne Rosberg¹, Rodrigo Kusanovich², Felipe Bellolio², Nicolás Jarufe², Julian Varas¹, Jorge Martinez². ¹Center of Experimental Surgery and Simulation, Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, ²Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago

Introduction: The aim of a General Surgery Residency (GSR) is to train an autonomous and competent specialist, nevertheless the duration of these programs varies in different countries. The shorter-lasting GSR must optimize residents’ exposure to surgical time. Simulated training is a tool which could help to optimize surgical training during the GSR. The aim of this article is to describe the outcomes of a 3-year GSR program and to analyze the effect of introducing a validated laparoscopic surgery training program (LSTP) in the number and type of abdominal surgical procedures performed by residents.

Methods: A non-concurrent cohort study was designed. We included graduated surgeons (GS) between the years 2012-2015 (four generations). Data was obtained from institutional records and from prospective residents' records during their GSR. Only surgical interventions of the abdomen as a primary surgeon were described and analyzed. The control group (NLSTP) were GS from 2012, not trained with LSTP. Surgical procedures per program year (PGY), surgical technique, priority of the intervention and hospital-site were described. We calculate the annual range of procedures and residents per staff to analyze the institutional changes effects on resident’s surgical exposition in the follow-up period. Statistical analysis was performed with ANOVA test for related samples, X2 or Student’s T test according to the nature of data.

Results: Interventions of 28 GS were analyzed (NLSTP: 5 GS and LSTP: 23 GS). The average of procedures and residents per staff for the entire follow-up period were 166 and 0.98 respectively. There were no statistically significant differences when comparing the annual average of procedures and residents per staff. Residents performed a mean of 372 abdominal procedures, with a higher mean number of medium to complex procedures in the LSTP group (table 1). Residents trained with LSTP performed a higher number of all and laparoscopic abdominal procedures [384 vs 319 (p=0.04)] and [183 vs 148 (p? 0.05)] respectively (figure 1).

Conclusion: General surgeons graduated from a 3-year residency program performed diverse abdominal procedures through each PGY. Introduction of a laparoscopic simulated training program appears to increase the number of all and laparoscopic abdominal procedures.