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A rural, community-based program can train surgical residents in advanced laparoscopy
Frederick D Reynolds1, Leonidas Goudas, Randall S Zuckerman
1Department of Surgery, Mary Imogene Bassett Hospital, Cooperstown, NY 13326, USA.
Journal of the American College of Surgeons
|October 3, 2003
Summary
Surgical residents can master advanced laparoscopy during residency. A rural program demonstrated that increased case volume correlates with greater surgeon confidence post-training.
Area of Science:
- Surgical Education
- Minimally Invasive Surgery
- Laparoscopic Techniques
Background:
- Advanced laparoscopy demands complex skills, often hindered by limited cases and experienced staff for residents.
- Traditional training pathways face challenges in providing sufficient exposure to advanced laparoscopic procedures.
- This study investigates the feasibility of acquiring advanced laparoscopic skills within a standard residency program.
Purpose of the Study:
- To evaluate if surgical residents can achieve proficiency in advanced laparoscopy without fellowship training.
- To assess the long-term adoption and confidence levels of graduates performing advanced laparoscopic procedures.
- To determine the impact of case volume on resident confidence and skill acquisition.
Main Methods:
- A survey and telephone interview methodology was employed to contact general surgery residents who completed training between 1992 and 2000 at a rural community hospital.
- Advanced laparoscopy was defined as procedures excluding cholecystectomy, appendectomy, and diagnostic laparoscopy.
- Data collection focused on the types of advanced laparoscopic procedures performed and surgeon confidence levels.
Main Results:
- 100% of surveyed graduates are performing advanced laparoscopy, with high rates for specific procedures like Nissen fundoplication (92.9%) and colectomy (78.6%).
- Over half (57.1%) of respondents felt confident performing advanced laparoscopy immediately after residency, with recent graduates expressing universal confidence.
- Graduates from the last three years averaged 50 advanced laparoscopic cases during their residency.
Conclusions:
- Advanced laparoscopic surgical skills can be effectively taught and acquired within a rural, community-based residency program.
- A higher volume of advanced laparoscopic cases during residency is directly associated with increased confidence among graduating surgeons.
- Residency programs can successfully prepare surgeons for advanced laparoscopic practice, challenging the necessity of fellowship training.