A National Training Program for Laparoscopic Colorectal Surgery in the Uk

Introduction: The aim of this study was to investigate the educational impact of a national training programme (NTP) for laparoscopic colorectal surgery by analysing peer- and self- assessments of trainers and trainees.

Methods: Colorectal surgeons enrolled in the NTP (trainees) were trained in a series of individual live cases by expert laparoscopic surgeons (trainers). Trainers rated their trainees after each supervised case, using a Global Assessment Score form. Trainees completed a similar self-assessment form. The target score was set at 5 (=independent performance). Proficiency gain curves were analysed by CUSUM charts and interrater agreement by Bland Altman plots.

Results: Analysis involved data of 252 cases (38 trainees and 20 trainers). The median number of training cases per trainee was 5.5 (range 1-25). Trainers rated slightly higher then the trainees self-assessment [Variation +0.02 (2 SD=+/-1.3)]. On average the target score was reached approximately after case 15. A more detailed analysis of the CUSUM charts showed that theatre setup, exposure of the operating field, exteriorisation of the specimen and anastomosis was completed independently after five supervised sessions, whereas dissection of the vascular pedicle, mobilisation of the colon/ rectum took more than 15 procedures.

Conclusions: These early results are supportive evidence for the efficacy of the National Training Programme in Laparoscopic Colorectal Surgery. Trainees scored themselves slightly lower than their trainers suggesting adequate insight. Furthermore, when planning training it should be noted that different stages of the operation are learnt at different rates.

Figure: CUSUM chart of peer assessments by the trainer, with breakdown of the different components.

Session: Podium Presentation

Program Number: S031

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