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Deciphering the inflection points to achieve proficiency for each procedure step during training in laparoscopic
B Skjold-Ødegaard1,2,3, S Hamid3, R-J Lindeman3
1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
BJS Open
|September 14, 2021
Summary
Achieving proficiency in laparoscopic appendicectomy requires approximately 30 procedures for junior surgical trainees. Proficiency rates significantly increase after this threshold, though specific skills like specimen removal may need more practice.
Area of Science:
- Surgical Education
- Minimally Invasive Surgery
- Proficiency Assessment
Background:
- Laparoscopic appendicectomy is a cornerstone of surgical training, with minimum procedure numbers often mandated for general surgery certification.
- Despite its frequency, objective data on trainee proficiency development in laparoscopic appendicectomy remain limited.
- This study addresses the scarcity of data by investigating the learning curve and proficiency attainment in this common surgical procedure.
Purpose of the Study:
- To determine the number of laparoscopic appendicectomies required for junior trainees to achieve proficiency.
- To identify specific surgical steps within the procedure that present greater challenges to trainees.
- To analyze factors influencing proficiency rates and operating times during surgical training.
Main Methods:
- A prospective observational cohort study involving 19 junior surgical trainees performing laparoscopic appendicectomies under supervision.
- Trainee performance was assessed using a six-point scale within a structured training program.
- Lowess graphs were utilized to identify inflection points in the learning curve, with proficiency rates and operating times analyzed.
Main Results:
- Overall proficiency in laparoscopic appendicectomy was achieved by 93% of trainees after completing more than 30 procedures, compared to 51% with 30 or fewer (OR 11.9).
- Significant variation in proficiency was observed across individual surgical steps, with specimen removal requiring fewer cases (under 15) and mesoappendix division requiring more (over 55).
- Operating time decreased by a median of 7 minutes after trainees surpassed 30 procedures.
Conclusions:
- Proficiency in laparoscopic appendicectomy for junior trainees is influenced by the specific technical demands of individual surgical steps.
- Targeted training focusing on challenging aspects of the procedure, such as mesoappendix division, could optimize the learning curve.
- Achieving proficiency may require tailored training interventions rather than solely relying on cumulative procedure numbers.
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