‘See One, Do One, Teach One’: Inadequacies of Current Methods To Train Surgeons in Hernia Repair

Adrian Park, MD¹, Hamid R Zahiri, DO¹, Carla Pugh, MD², Melina Vassiliou, MD³, Guy R Voeller, MD⁴. ¹Anne Arundel Medical Center, ²University of Wisconsin, ³McGill University, ⁴University of Tennessee

Introduction

In an effort to improve the quality of hernia care and patient outcomes, SAGES is developing an educational program for surgeons. Training in hernia repair is still too widely characterized by the "see one, do one, teach one" model. The most efficient and effective educational programs are based on an assessment of learner needs and current training gaps. The goal of this study was to perform a needs assessment focused on surgical training to guide the creation of a curriculum intended to improve the care of hernia patients.

Methods

This mixed methods study conducted by the SAGES Hernia Task Force (HTF) incorporated the use of selected interviews in addition to an online survey. Subjects were asked about their perceived deficits in resident training to care for hernia patients, preferred training topics about hernias, ideal learning modalities and education development.

Results

18 HTF members, 27 chief residents and fellows, and 31 surgical residents were interviewed. Among the HTF members, there was consensus that residency exposes trainees to a wide spectrum of hernia repairs by a variety of surgeons. They cited outdated materials, techniques and paucity of feedback as barriers to effective hernia education. Additionally, they identified the “see one, do one, teach one” method of training as prevalent and clearly inadequate. The topics least addressed were system-based approach to hernia care (46%) and patient outcomes (62%). Residents considered preoperative and intraoperative decision-making (90%), complications (94%) and technical approach for repairs (98%) to be well taught during training. Instructional methods used in residency include assisted/supervised surgery (96%), web-based learning (24%), and simulation (30%). Residents’ preferred learning methods included simulation ( 82%), web based training (61%), hands on laboratory (54%) and videos (47%), in addition to supervised surgery. Trainees reported their most desired training topics as basic techniques for inguinal and ventral hernia repairs (41%) vs. 68% who wanted advanced technical training. These numbers mirror those reported by attending surgeons, 36% and 71%, respectively.

Conclusions

Consensus exists among HTF members and surgical trainees regarding the lack of standardization in training and care, inadequate patient follow-up and poor outcome measures for hernia repair. A comprehensive, dynamic and flexible educational program using a variety of instructional methods to address key deficits in the care of hernia patients would be welcomed by surgeons.