General surgery primary operator rates: a guide to achieving future competency

Abstract

Background: Competency in surgical training is a topic of much recent discussion, with concern regarding the adequacy of current training schemes to achieve competency. Most programmes use caseload and primary operator rates to assess trainee progression. Some trainees still lack technical competence even when recommended procedural numbers are met. It is possible that current measures of individual's capabilities used in surgical education are outdated. Methods: Logbook data of New South Wales general surgical trainees between 2010 and 2012 was obtained through General Surgeons Australia. The top 10 most common operations recorded in trainee logbooks were identified. Individual trainee data were grouped by the surgical education and training year and primary operator versus assistant experience. The data were analysed focusing on the primary operator rate, comparing between trainee levels to identify progression. Results: A total of 183 319 operations were recorded in New South Wales general surgery trainee logbooks. A positive association was demonstrated between trainee seniority and primary operator rates for the most common procedures, indicating trainee's continual progression in experience as they advance. However, laparoscopic inguinal hernia repair, oversew of gastroduodenal ulcer, open cholecystectomy and right hemicolectomy showed poor primary operator rates among trainees regardless of trainee year, despite these operations being among the 10 most common. Conclusion: General surgical trainees accumulate operative experience with progression through the surgical education and training programme, highlighting expected technical progression and competency of trainees for common procedures. For less common or more complicated procedures, the use of entrustable professional activities and accompanying simulation training could be used to achieve the necessary technical expertise.

Acute surgical experience of Australian general surgical trainees

“…In our study, case volumes and primary operator rates significantly varied according to the operation type. This is similar to another Australian logbook study, reporting on the 10 most common logbook trainee operations in New South Wales, which found that certain operations (cholecystectomy and right hemicolectomy) were associated with poor primary operator rates regardless of trainee seniority.…”

Operative experience in essential emergency general surgery procedures: is autonomy achievable during surgical training?

“…This retrospective longitudinal cohort study assessed the experience and autonomy of general surgery trainees in New Zealand in 10 emergency general surgery procedures. The data demonstrated that trainees acquire increasing levels of PO and APO rates during their training, in line with expectations of the training programme and previously published data 15 . This is reflected in the multivariate analysis, demonstrating that for most procedures SET year and case volume per training term are independently associated with reaching the 70% PO and APO thresholds.…”

Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

“…Over time, those who had prior experience but were not routinely performing laparoscopic surgery and those without prior experience, were both able to perform laparoscopic surgery with minimum risks. A steep increase in primary operators among local doctors reflected the progression of technical independence, which is essential for long-term sustainability but difficult to attain over a short time period [21]. Furthermore, endoscopic surgical procedures in neurosurgery, gynecology, urology, and orthopedic surgery were phased in by local doctors, supported by the trained nurses and functional equipment.…”