The growing discrepancy between resident training in colonic surgery and the rising number of general surgery graduates

Käser, Samuel; Rickenbacher, Andreas; Cabalzar-Wondberg, Daniela; Schneider, Marcel; Dietrich, Daniel; Misselwitz, Benjamin; Clavien, Pierre‐Alain; Turina, Matthias

doi:10.1007/s00384-018-3209-1

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Furthermore, about 25% of the index procedures have been performed by residents. While LCHE was expectedly the most frequent resident procedure and PPPD was not performed by surgeons in training, especially the low number of sigmoid resections is alarming and supports the data gained by Kaser et al [2], who have recently stated that fewer colonic surgeries are used for resident training. The authors also state that due to a trend toward specialization and the advancing complexity of the procedures, resident procedures are reduced.…”

Section: Discussionsupporting

confidence: 57%

“…The creation of specialized surgical centers limits the availability of basic general surgical procedures in specialized centers and of complex surgeries in primary care hospitals. Furthermore, the European working time directive reduces the time residents spend in the hospital and the operating room (OR) and Kaser et al [2] further demand to better utilize surgical teaching opportunities and to re-structure surgical training. Surgical training needs to adapt to these changes, e.g., by using simulators to enable skill acquisition outside of the OR.…”

Section: Introductionmentioning

confidence: 99%

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See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

et al. 2020

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Introduction Due to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence-based learning technique of surgical skills is the sub-step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi-center trial was to determine the status quo of the sub-step concept in Germany. Methods Over 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus-preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub-steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub-step concept was performed before and after the study. Results In total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub-steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub-steps (43.3%). Reasons for not assisting sub-steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub-steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub-step concept. The number of resident procedures was overestimated, and the number of performed sub-steps was underestimated. After the study, these estimations were more realistic. Conclusion Even though the sub-step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

et al. 2020

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“…Furthermore, surgical training in Switzerland includes abdominal general surgery as well as musculoskeletal trauma and many general surgeons in smaller, peripheral Swiss hospitals still perform a broad spectrum of surgical procedures, preventing adequate specialization. Additionally, the implementation of working hour directives and the increased number of surgical residents have resulted in a decreased exposure to colorectal surgery during surgical training, which might furthermore impact on learning of complex MIS techniques [51]. However, centralization with resulting increased caseloads at specialized centers may result in increased MIS amenability for rural and low-income populations in the future.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in access to minimally invasive general surgery: a comprehensive nationwide analysis across 20 years

et al. 2020

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Background Minimally invasive surgery (MIS) has profoundly changed standards of care and lowered perioperative morbidity, but its temporal implementation and factors favoring MIS access remain elusive. We aimed to comprehensibly investigate MIS adoption across different surgical procedures over 20 years, identify predictors for MIS amenability and compare propensity score-matched outcomes among MIS and open surgery. Methods Nationwide retrospective analysis of all hospitalizations in Switzerland between 1998 and 2017. Appendectomies (n = 186,929), cholecystectomies (n = 57,788), oncological right (n = 9138) and left hemicolectomies (n = 21,580), rectal resections (n = 13,989) and gastrectomies for carcinoma (n = 6606) were included. Endpoints were assessment of temporal MIS implementation, identification of predictors for MIS access and comparison of propensity score-matched outcomes among MIS and open surgery. Results The rates of MIS increased for all procedures during the study period (p ≤ 0.001). While half of all appendectomies were performed laparoscopically by 2005, minimally invasive oncological colorectal resections reached 50% only by 2016. Multivariate analyses identified older age (p ≤ 0.02, except gastrectomy), higher comorbidities (p ≤ 0.001, except rectal resections), lack of private insurance (p ≤ 0.01) as well as rural residence (p ≤ 0.01) with impaired access to MIS. Rural residence correlated with low income regions (p ≤ 0.001), which themselves were associated with decreased MIS access. Geographical mapping confirmed strong disparities for rural and low-income areas in MIS access. Matched outcome analyses revealed benefits of MIS for length of stay, decreased surgical site infection rates for MIS appendectomies and cholecystectomies and higher mortality for open cholecystectomies. No consistent morbidity or mortality benefit for MIS compared to open colorectal resections was observed. Conclusion Unequal access to MIS exists in disfavor of older and more comorbid patients and those lacking private insurance, living in rural areas, and having lower income. Efforts should be made to ensure equal MIS access regardless of socioeconomic or geographical factors.

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“…Intestinal operations A study from Switzerland showed that less than 5% of all segmental colectomies between 2006 and 2015 were performed by residents [55]. During the same time period, the annual number of graduates increased by more than 100%.…”

Section: Literature Regarding Training In Gep-netmentioning

confidence: 99%

Training in endocrine surgery

Gimm

Barczyński

Mihai

et al. 2019

Langenbecks Arch Surg

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Background/purpose In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. Methods A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. Results For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs.Conclusions Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.

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The growing discrepancy between resident training in colonic surgery and the rising number of general surgery graduates

Cited by 6 publications

References 18 publications

See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

Inequalities in access to minimally invasive general surgery: a comprehensive nationwide analysis across 20 years

Training in endocrine surgery

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