The Pareto-Analysis for Establishing Content Criteria in Surgical Training

K.h. Kramp1, M.j. van Det2, N.j.g.m. Veeger1, Pierie J.p.e.n.1. 1Medical Center Leeuwarden, 2Hospital group twente

Introduction: Currently, there is no widely used method to calibrate in vitro surgical training to the in vivo challenges during surgery on patients. The Pareto-principle states that in any population that contributes to a common effect a relative few account for the bulk of the effect. This is the first study that evaluates the Pareto-principle for establishing content criteria for surgical training.


Method: Verbal corrections of supervising surgeons during a laparoscopic cholecystectomy performed by trainees in the OR were documented and tallied. The corrections were rank-ordered and a cumulative distribution curve was used to calculate which corrections accounted for 80% of the total number of verbal corrections. 


Results: The behaviour of 9 surgeons supervising 62 laparoscopic cholecystectomies performed by 12 novice trainees were analyzed. In total, 235 different verbal corrections were used 1570 times and were categorized into 40 different clusters of aimed changes in novice behaviours. The 32 highest ranking verbal corrections (14%) and the 11 highest ranking clusters (28%) accounted for 80% of the total number of verbal corrections.


Conclusions: The Pareto-principle is a highly potential tool for identifying the few types of novice behaviour that account for the majority of corrections given by supervisors during a laparoscopic cholecystectomy on humans. Replicating this study for other surgical procedures could be an opportunity for creating surgical training tools that are more effectively calibrated to on-the-job challenges.

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