Keeping Open Surgery Alive: A Competency-Based Approach to Elevating Resident Skills

The study purpose was to determine if: (1) surgical residents would incrementally acquire open-procedural abilities for complex abdominal and vascular exposures through quarterly cadaver-based instruction, (2) chief residents would achieve parity with attending general surgeons when performing open surgical procedures for trauma.

Surgical education requires a solution for balancing the need to develop open-procedural skills for trauma and emergency surgery with the dwindling opportunity to perform these critical procedures during training.

We implemented a 4-module open-procedures sequence on a quarterly basis for all levels [post-graduate years (PGY) 1-PGY5] of residents (N = 60) using human cadavers. Knowledge and procedural competencies were assessed for all residents over 3 years. We compared the procedural performance of PGY5s to attending general surgeons for 33 trauma procedures, with both groups assessed by independent faculty with no knowledge of their training. Comparative analyses were performed using t tests (P < 0.05) and effect sizes (Cohen's d).

Course outcomes demonstrate sustained acquisition of knowledge (P < 0.01) and procedural performance (P < 0.05) across all levels of residents. There were no significant differences between the performance of PGY5 residents and attending general surgeons when performing the 33 trauma procedures.

The outcomes of this course demonstrate that developing the ability to perform open procedures during residency may require creative approaches that are nonetheless effective in preparing surgeons for future practice. The course modules are implemented in sequence with one module per quarter; however, alternate implementation schedules could accommodate most residency programs.