Melanie H Howell, MD, MS, Katherine MacCallum, MD, John Paul Bellistri, MD, Francis B Baccay, MD. Montefiore Medical Center
INTRODUCTION: Laparoscopic surgery poses unique challenges when it comes to resident education. Skills needed for learning laparoscopy are different than for open procedures, thus tools for training residents must be different. Video recording of an individual’s performance is not a new concept. Analysis of a recorded activity can be used to instruct the learner in an environment that is focused and low intensity. We implemented a training strategy that is designed to build spatial reasoning by integrating: a review of recorded operations, a feedback questionnaire, as well as one-on-one instruction.
METHODS: Our study was completed with categorical surgery residents (PGY2 through PGY5) who were recorded performing a laparoscopic cholecystectomy. The residents were given a questionnaire before each performance. The personalized video and the pre-operative questionnaire was reviewed after the procedure by the resident and the instructor. The resident was instructed to re-watch the video performance as much as possible before the next cholecystectomy. The attendings were surveyed on the residents’ improvement over time. These residents were followed for up to 4 years.
RESULTS: Eighty-two general surgical residents participated: 50 males and 32 females, left-handed 19.5%, right-handed 78%, ambidextrous 2.4%. The indication for lap cholecystectomy was varied: acute cholecystitis 19.5% (16/82), with cholelithiasis 37.8% (31/82), cholelithiasis or biliary colic alone 13.4% (11/82), gallstone pancreatitis 24.4% (20/82), gallbladder polyp/mass 4.9% (4/82). The average number of times the resident watched the video between cases was 3 times. PGY2 residents reviewed their videos more often than PGY5s. Overall, the PGY2 and PGY3 residents found this exercise to be the most beneficial; a feeling of improvement peaked at the fourth year of training. We noticed the largest decrease in time for the procedure was between the third and fourth years of training. Predictably the knowledge of anatomy improved with each PGY year.
CONCLUSIONS: While this is a limited study in terms of statistical analysis, the principles are sound for building a protocol for the improvement of resident education. Instructing someone in laparoscopy can be difficult. We believe that our three-step approach can be an adjunct to laparoscopic simulations. By integrating video recordings, resident self-awareness questionnaires, and attending feedback; we can improve the residents’ knowledge of the 2D representation of actual patient anatomy. The utilization of individualized video recording allows the resident the opportunity for visual repetition and the development of meaningful spatial vocabulary that is so necessary when learning laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79298
Program Number: P284
Presentation Session: Poster (Non CME)
Presentation Type: Poster