Analysis of a structured training programme in laparoscopic cholecystectomy

Şehitoğlu, İbrahim; Tay, Kiang-Hiong; Lim, Swee Ho; Ravintharan, T.; Tan, Ngian Chye

doi:10.1007/s00423-007-0269-z

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…These studies refer to the progress individual residents make during their training or to the number of interventions they need to perform to reach a benchmark performance for specific procedures. Studies aimed to discover a plateau in the residents' learning curve in selected cases [40,41], under supervision [35,37], or with a stepwise approach [36,38,39]. Of the seven studies, six surgical studies (general surgery and obstetrics and gynecology) describe a decrease in operation time between the first and last cases performed by residents [35-38,40,41].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

139

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

139

View full text Add to dashboard Cite

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“…They found that the only significant difference between the groups was a longer operative time, while the conversion rate and complication rate were the same. In a similar study comparing consultant surgeons, trainee surgeons, and trained surgeons, the authors found that there were no differences among the three groups in conversion rates, bile duct injury rates, general complication rates, or length of stay; however, the duration of operation in the trainee surgeons was significantly longer compared to the other two groups [21]. In the setting of LC for acute cholecystitis, Abelson et al reported that advanced laparoscopic fellowship-trained surgeons had significantly lower conversion rate and shorter operative time than the nonfellowship-trained surgeons; however, the complication rates were not significantly different [22].…”

Section: Discussionmentioning

confidence: 99%

Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital

Atta

Mohamed

Sewefy

et al. 2017

Gastroenterology Research and Practice

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Laparoscopic cholecystectomy (LC) is one of the first laparoscopic procedures performed by surgical trainees. This study aims to determine preoperative and/or intraoperative predictors of difficult LC and to compare complications of LC performed by trainees with that performed by trained surgeons. A cohort of 180 consecutive patients with cholelithiasis who underwent LC was analyzed. We used univariate and binary logistic regression analyses to predict factors associated with difficult LC. We compared the rate of complications of LCs performed by trainees and that performed by trained surgeons using Pearson's chi-square test. Patients with impacted stone in the neck of the gallbladder (GB) (OR, 5.0; 95% CI, 1.59–15.77), with adhesions in the Triangle of Calot (OR, 2.9; 95% CI, 1.27–6.83), or with GB rupture (OR, 3.4; 95% CI, 1.02–11.41) were more likely to experience difficult LC. There was no difference between trainees and trained surgeons in the rate of cystic artery injury (p = .144) or GB rupture (p = .097). However, operative time of LCs performed by trained surgeons was significantly shorter (median, 45 min; IQR, 30–70 min) compared with the surgical trainees' operative time (60 min; IQR, 50–90 min). Surgical trainees can perform difficult LC safely under supervision with no increase in complications albeit with mild increase in operative time.

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“…There is no doubt that the traditional practice of the "See one, do one, and teach one" residency training programme is no longer acceptable [22]. Effective training programmes must ensure that patient safety is not compromised [23][24][25][26]. Moreover, additional surgical training through courses as well as systematic training in management skills [27] is becoming increasingly important and must be subsidised.…”

Section: Discussionmentioning

confidence: 99%