Benjamin R Veenstra, MD2, Kristine U Makiewicz, MD2, Kunal H Patel, MD1, Jose M Velasco, MD, FACS2. 1MetroHealth Medical Center, 2Rush University Medical Center
Mandated changes in traditional surgical training have resulted in less resident operative exposure and acquisition of technical skill, estimated at a year’s worth of clinical experience. Recent literature suggests that a significant portion of incoming fellows may be inadequately prepared to perform basic laparoscopic operations independently. The role of surgical simulation in comprehensive curriculums, particularly in complex, yet institutionally low volume cases, remains to be defined.
We identified hiatal hernia repair with Nissen fundoplication as an advanced laparoscopic, yet institutionally low volume procedure. A comprehensive, longitudinal curriculum was created, consisting of three components. The first is a web based cognitive component with pertinent atlases and videos. The second is an inanimate model, constructed in our simulation center, which houses a replica operating room suite, complete with fully functional laparoscopic equipment. The model was validated after critique and adjustment by five, advanced laparoscopic surgeons. Residents underwent individualized instruction on this inanimate model. The third component consists of laparoscopic repair in a cadaver model. Eight PGY-4 residents participated. Evaluation of all phases of the curriculum was achieved by completing pre and post surveys and self and attending evaluations using the GOALS criteria.
Six out of eight residents completed the cognitive course. All residents (n=8) completed the inanimate model proctoring session. While seven residents attended the cadaveric course, only four performed the entire procedure while three performed portions. This was due to time and cadaver availability. Overall, both the inanimate and cadaveric components of the curriculum increased resident comfort level with the required laparoscopic skills needed to complete the operation. In the inanimate model, a 0.76 increase was seen on average with each question, between the pre and post surveys (1-5 Likert Scale of comfort level with one being the least comfortable and 5 being the most). A 0.83 increase was seen for those completing the cadaver course. An increase in skill level was also seen going from the inanimate lab to the cadaver lab, on both self and attending evaluations.
Surgical training is on the verge of a paradigm shift. We feel a comprehensive curriculum to address advanced, yet institutionally low volume cases is necessary to better prepare residents for both practice and fellowship. Specifically, a tactile model, followed by cadaveric course affords residents a more realistic opportunity to gain operative exposure, technique and skill. This study demonstrates the successful implementation and feasibility of such a curriculum.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78328
Program Number: P281
Presentation Session: Poster (Non CME)
Presentation Type: Poster
