Correlation between experience targets and competence for general surgery certification

Siqueira, Jullyana de Souza; Gough, Michael

doi:10.1002/bjs.10145

Cited by 45 publications

(53 citation statements)

References 15 publications

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“…Measures of learning surgical technique fall into two categories: surgical process and patient outcome. The relationship between surgeon experience and technical competence has long been controversial, and a number of recent reports have expressed concerns regarding indicative numbers as a representation of competence. The operative achievements in the 2013 UK CCT cohort varied widely, with two‐thirds of applicants achieving elective targets, but only half the requisite emergency experience, and 5 per cent non‐operative targets.…”

Section: Discussionmentioning

confidence: 99%

Operative learning curve trajectory in a cohort of surgical trainees

Brown

Abdelrahman

Patel

et al. 2017

British Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Operative learning curve trajectory in a cohort of surgical trainees

Brown

Abdelrahman

Patel

et al. 2017

British Journal of Surgery

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“…De Siqueria and Gough have studied the association between operative experience in general surgery and the attainment of competency in the UK. They found that trainees performed more operations than current UK requirements for CCT before achieving competency, and concluded that minimum procedural experience did not accurately reflect competence.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of operative experiences of general surgery trainees during training

Elsey

Griffiths

Humes

et al. 2016

British Journal of Surgery

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Background: General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery.Methods: Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data.

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“…"Guidance for the award of a certificate of completion of training in the UK also stipulates that, among the competences defined in the general surgery curriculum, trainees should be able to demonstrate that they have performed a minimum number of logged surgical procedures" [71]. This minimum number of operative procedures for inguinal hernia was given as 60 procedures [71]. But no further information is provided for ventral incisional hernia repair procedures [71].…”

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

“…This minimum number of operative procedures for inguinal hernia was given as 60 procedures [71]. But no further information is provided for ventral incisional hernia repair procedures [71]. In Germany there is a requirement for evidence to be provided of having conducted at least 50 hernia repairs during 6 years of general surgery training [72].…”

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

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Correlation between experience targets and competence for general surgery certification

Abstract: A minimum number of index procedures did not reflect competence in a significant proportion of trainees. A more reliable tool is required for certification.

Cited by 45 publications

References 15 publications

Operative learning curve trajectory in a cohort of surgical trainees

Operative learning curve trajectory in a cohort of surgical trainees

Meta-analysis of operative experiences of general surgery trainees during training

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

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