Acquisition of Data for Outcomes and Procedure Transfer

Brian J. DunkinBy Brian Dunkin, MD, SAGES Past President

When was the last time you learned a completely new procedure and brought it to the operating room for the first time? How did you do it? Read a book? Watched a video? Attended a course? Worked with a colleague? Chances are, it was a combination of all of these things. And, you had to do it on your own.

Isn’t it amazing that in these modern times of rapid change in surgery there is no real infrastructure to help practicing surgeons learn new techniques and safely adopt them into practice? SAGES is working to change that.

One of the SAGES programs that is changing how practicing surgeons learn new operations is called ADOPT (Acquisition of Data for Outcomes and Procedure Transfer). This innovative program transforms the usual hands-on post-graduate course conducted during the SAGES annual meetings into a gateway to a one-year longitudinal curriculum that is improving successful procedural adoption.

ADOPT is the brainchild of the Continuing Education Committee, currently led by Drs. John Paige, Elisabeth McLemore, Vanessa Palter, and Jonathan Dort as well as myself. It was first introduced at the 2015 annual meeting with a focus on abdominal wall reconstruction and a second round of training was again offered in 2016.

The ADOPT pathway begins by ensuring that the expert faculty who are going to be instructors for the program are also excellent teachers. Each ADOPT expert must attend a special train-the-trainers (TT) course to prepare them to be good surgical coaches.

Next, mentees who enroll in the program must complete a pre-course survey to understand their practice better and what they hope to gain from the course (See Figure Below). Then, during the annual meeting mentees participate in a hands-on training program with their expert mentors. During the training, mentees are asked about their specific goals and the course experience is modified to meet them. By the end of the day, the experts have come to understand each trainee’s needs and skills and assigned them a personal take-home message to work on before their first case.

As the year progresses, there are multiple touch points for mentors and mentees to connect in order to help the mentees navigate through the early part of their learning curve. These touch points include webinars, video review of actual procedures, and a face-to-face meeting at the American College of Surgeons annual meeting. The International Hernia Collaborative Facebook page was also used to foster immediate from an expert on-line community to provide input on challenges faced in adopting new procedures and managing difficult patients. In addition, mentees complete 3 and 6 month surveys about their performance of abdominal wall reconstruction. The whole program concludes with a presentation of results at the next SAGES annual meeting.

ADOPT is not only providing a better training curriculum, it is also creating a community where expert and less experienced surgeons can come together to foster successful procedural adoption. The results so far have been impressive. In December 2016 Jonathan Dort et al. published the results of the ADOPT program in Surgical Endoscopy (DOI 10.1007/s00464-016-5366-z published on-line December 2016).

To quote: “Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence in employing a components separation via an open approach (p = 0.051).”

Following on the success of the ADOPT program to teach practicing surgeons advanced techniques in abdominal wall reconstruction, the same methodology is being applied to teach laparoscopic colectomy at the SAGES 2017 Annual Meeting in Houston, Texas. Led by Drs. Jaime Sanchez and Peter Marcello, the ADOPT colectomy program will guide practicing surgeons to adopt laparoscopic right and left colectomy into their practice.
With programs like SAGES ADOPT, no longer are annual meeting post-graduate courses a single event that is unlikely to lead to successful procedural adoption. Now, these courses are the entryway into a 12 month longitudinal training program conducted by expert coaches. So stop relying on YouTube, out-of-date text books, and cryptic articles to learn a new procedure.

Sign-up for ADOPT and join a community of surgeons like yourself receiving expert guidance from mentors who have taken the time to learn how to be effective coaches.

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