Approaches to Education and Training on How to Diagnose and Treat Acute Appendicitis in Norway: A Mixed-Method Study

Clinical practice in diagnosing and treating appendicitis vary, and how this impacts trainees is unclear and not well investigated. The aim of this study was to explore current practice and trainees' perception to identify areas for improvement.

A mixed-method study comprising two parts: One consisted of two time-point surveys to heads of surgical departments (2022 and 2025) and to surgical trainees (2025), and secondly, bi-institutional focus groups were conducted.

The survey to heads of departments had a response rate of 92.5% (37/49) in 2022 and 86.1% (31/36) in 2025. It demonstrated variations in hospital size (population base: 11,000-700,0000) and appendectomies performed annually (25-1000). Use of laparoscopic technique increased significantly from 2022 to 2025. The trainee survey had a response rate of 23% (81/345). 69 (85%) of the trainees did not receive a structured competence assessment. 71 (88%) use tools in preparation for surgery, and 42 (55%) used a simulator before their first laparoscopic appendectomy. Assessment by a consultant surgeon and/or a more experienced trainee is considered appropriate for competence assessment, but evaluation board, mandatory course, and number of assists is highlighted. Themes in the focus groups included expression of security, lack of structured assessment, lack of standardized surgical technique, falling motivation for simulation, and lack of satisfactory digital learning tools. Trainees proposed several suggestions for improvement.

There are variations among the hospitals where training takes place. Trainees express a need for sufficient feedback, regular competency assessment, and quality-assured learning tools.