Novel Approach to Residents Training in Breast Surgery Using Human Donors

Given the high incidence rate of breast cancer and shortage of fellowship trained specialists, general surgeons are frequently responsible for these patients. Residents have less operative exposure to breast surgery due to duty hour restrictions and decreased resident autonomy. We created a curriculum using human donors designed to teach junior residents to perform breast lumpectomy and sentinel lymph node biopsies.

All eighteen junior surgery residents were invited. We chose fresh human donors to represent tissue planes more accurately. We inserted Savi Scout reflectors (Merit Oncology, Inc) in each breast for tumor localization. An olive pit plus 1 mL of methylene blue was inserted in the axilla for SLN identification. In session 1, attendings discussed proper technique and residents performed the procedures and received feedback. In session 2 after 2 mo, residents performed the same operation without any guidance. They were graded on technique during both sessions and filled out a postsession survey to gauge confidence.

Seven PGY1 and six PGY2 residents participated. Half of the respondents strongly felt this session improved their understanding of lumpectomies, sentinel lymph node biopsies, and axillary anatomy. Most felt strongly that their skills improved and these skills were transferable to the operating room. In attending evaluations, PGY1 residents significantly improved in all aspects of the procedures; PGY2 residents showed nonstatistical significant improvement.

Residents find these sessions helpful in learning anatomy, improving confidence and efficiency, and facilitating skill acquisition that is transferable to the operating room. We believe this approach should be considered in general surgery training programs.