Nisha Dhanabalsamy, MD, Obiyo Osuchukwu, MD, Julia Samame, MD, Shawn Fu, MD, Carlos Galvani, MD, Iman Ghaderi, MD. University of Arizona
INTRODUCTION: Simulation-based training has become an integral part of most residency training programs in the US. The objective of this study was to assess whether operative time and pigs’ mortality rate can be used as outcome measures of residents’ operative performance during a structured laparoscopic training course in the animal lab.
METHODS: Since 2009, the Arizona Center for Endoscopic Surgery (ACES) Residency Training Program implemented a 2-day intensive laparoscopic training program to help general surgery residents develop operative skill in basic and advanced laparoscopic procedures. In 2014, we implemented a structured curriculum consisting of didactic lectures, skill simulations, and laparoscopic surgery training in a live porcine model. This included instruction and assessment of residents’ operative performance by faculty instructors using standardized, validated assessment tools. Both Junior (PGY1-2) and Senior residents (PGY3-5) participated. All residents performed the same procedures on two consecutive days on live pigs. Junior residents performed laparoscopic cholecystectomy and incisional hernia repair, and senior residents performed Nissen fundoplication, splenectomy, and low anterior resection. To assess the impact of the new structured curriculum, we compared the operative time and mortality rate between the first (December 2014 until June 2015) and second year of the program (August 2015 until May 2016). Fischer extract test was used and statistical significance was considered at p<0.05.
RESULTS: A total of 80 residents (40 Junior residents and 40 Senior residents) were included. The operative time significantly decreased from day 1 to day 2 after implementation of the structured program (Table 1). Moreover, the pigs’ mortality rate significantly decreased in the second half of the course (Table 2).
Table.1
| Operative time (mins) | |
| Day 1 | 361 |
| Day 2 | 325 |
Table 2:
| Dec 2014- June 2015 | Aug 2015 -May 2016 | P value | |
| Mortality N(%) | 15(37.5) | 4(10) | 0.008 |
| No Mortality N(%) | 25(62.5) | 36(90) | 0.008 |
CONCLUSIONS: In this study, we demonstrated that operative time and mortality rate in a porcine model can be used as outcome indictors to assess residents’ operative performance in a simulated environment, especially due to its similarities to human subjects. In spite of its costs and other logistical issues, this study shows the value of using live porcine models for resident training, as a preparatory adjunct to hands-on operative experience
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80822
Program Number: P282
Presentation Session: Poster (Non CME)
Presentation Type: Poster
