A Multicenter Needs Assessment for Improvements in Mis and Flexible Endoscopy Training for Surgery Residents

Aimee K Gardner, PhD1, Ross E Willis, PhD2, Brian J Dunkin, MD3, Kent R Van Sickle, MD2, Kimberly M Brown, MD4, Michael S Truitt, MD5, John M Uecker, MD6, Lonnie Gentry7, Daniel J Scott, MD1. 1University of Texas Southwestern Medical Center, 2University of Texas Health Sciences Center San Antonio, 3Houston Methodist Hospital, 4University of Texas Medical Branch, 5Dallas Methodist Hospital, 6University of Texas Medical Center at Austin, 7Baylor University Medical Center at Dallas

Background: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of Minimally Invasive Surgery (MIS) and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing these procedures. The purpose of this study was to determine resident and faculty perceptions regarding training and competency in MIS and flexible endoscopy with the goal of identifying training needs and to solicit input on curriculum design.

Methods: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery & gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol.

Results: Ninety-five faculty (14.9 ± 12.8 years in practice, 100% perform MIS, 68% perform flexible endoscopy) and 121 residents (26 PGY1, 27 PGY2, 21 PGY3, 26 PGY4, 21 PGY5) responded, with response rates of 65% and 51%, respectively. Faculty reported that the quality of incoming interns was no different than 10 years ago, but the quality of graduating residents was slightly worse. Faculty indicated the importance (scale 1-5, 5 very important) for graduates to be competent in basic (4.7 ± 1.0) and advanced (4.1 ± 1.0) MIS and diagnostic (4.1 ± 1.2) and therapeutic (3.0 ± 1.2) endoscopy. Residents and faculty reported increasing autonomy as PGY level increased but that autonomy was limited for advanced MIS and therapeutic endoscopy, with PGY5s performing less than 60% of these procedures. PGY5s and faculty rated trainee ability to perform 34 different procedures independently at graduation. PGY5s and faculty reported this level of competency as 89% and 86% for basic MIS, 21% and 14% for advanced MIS (26% and 16% for 8 most common operations), 83% and 63% for diagnostic endoscopy, and 27% and 21% for therapeutic endoscopy, respectively. PGY5s indicated that they would need a fellowship to be comfortable offering basic MIS (5% said yes), advanced MIS (52%), diagnostic endoscopy (5%), and therapeutic endoscopy (62%). Residents reported that clinical experience, didactic lectures, and SCORE modules were the most common curricular components for MIS, whereas clinical experience, virtual reality simulators, and physical models were more common for endoscopy. The ideal MIS curriculum as designed by faculty would include the following: clinical experience (48% of time), physical simulators (12%), live animal models (12%), virtual reality simulators (8%), videos (9%), other (11%). For endoscopy, components would include clinical experience (52%), virtual reality simulators (15%), physical simulators (10%), live animal models (9%), videos (7%), and other (7%). The ideal curriculum sculpted by residents followed these same trends, but with more time dedicated to clinical experience.

Conclusions: These data indicate that both residents and faculty perceive significant competency gaps for both MIS and flexible endoscopy, with the most notable shortcomings for advanced and therapeutic cases, respectively. The development of improved training methods in these areas is encouraged.

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