Defining operative experience targets in surgical training: A systematic review
Conor Toale1, Aisling O'Byrne2, Marie Morris3
1Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
Surgery
|August 29, 2022
Summary
Surgical trainees often exceed mandated case numbers to achieve competence. However, evidence linking current operative experience targets to patient outcomes is lacking, suggesting a shift to criterion-based performance goals is needed.
Area of Science:
- Medical Education
- Surgical Training
- Competency-Based Education
Background:
- The surgical learning curve is a recognized aspect of training.
- Operative experience volume is a common proxy for surgical competence.
- Current training targets may not adequately reflect necessary experience for patient outcomes.
Purpose of the Study:
- To critically evaluate evidence on the link between surgical training experience and trainee competence.
- To assess the relationship between procedural volume and surgical skill acquisition.
Main Methods:
- Systematic review of major databases (PubMed, Embase, Web of Science, Cochrane).
- Inclusion criteria focused on studies defining the relationship between procedural volume and competence/proficiency/mastery.
- Evaluation of educational impact using a modified Kirkpatrick model.
Main Results:
- 30 studies were included from 3,672 records.
- 14 studies used operative time, and 8 used trainer assessments to define competence thresholds.
- 5 studies linked trainee case volumes to patient outcomes (Kirkpatrick Level 4b).
Conclusions:
- Many trainees achieve competence beyond current experience targets.
- Limited evidence connects operative experience targets to patient outcomes across surgical subspecialties.
- A transition to criterion-referenced operative performance targets in surgical training is supported.
