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Continued professional development of surgeons remains a challenging and unstandardized enterprise. The Continuing Education Committee of SAGES created the Acquisition of Data for Outcomes and Procedure Adoption (ADOPT) program, incorporating a standardized training approach into hands-on courses with a year-long longitudinal mentorship experience. To evaluate the program's transferability to other procedures following its successful application to a SAGES hernia course, the ADOPT method was applied to the SAGES 2017 laparoscopic colectomy course. Participant data included demographics, training and experience, as well as pre-and post-course self-reported colectomy case volumes and procedure confidence. Confidence levels were for techniques taught in the course using a 5-point scale: 1 = not confident at all to 5 = completely confident. Participants reported confidence in the following skills for laparoscopic right and left colectomy: (1) formulating an operative plan, (2) identifying proper anatomical planes and isolating anatomic structures, and (3) competently conducting the technical steps of the procedure. A total of 18 surgeons enrolled in the SAGES 2017 Colon Program, 10 of whom completed the 6-month post-course questionnaire (56%). Participants reported significantly higher confidence in all skills at 6 months compared to pre-course (p ≤ 0.015). Most participants (60%) reported an increase in the number of procedures performed. The lowest pre-course case volume group (≤ 5 annual cases, n = 5 6-month survey responders) demonstrated a trend for increased procedure volume post-course (5.6 vs. 2, p = 0.057). The overwhelming majority of survey respondents (90%) felt either "confident" or "extremely confident" performing the procedures learned (range 80-100% across tasks). Participants found the program to be an advantageous method of becoming competent and confident in performing these procedures. The application of the ADOPT program to the laparoscopic colectomy course was successful in increasing surgeon confidence and demonstrated a trend in improving surgeon procedure counts in the novice participant group.

Background: Developing faculty competencies in curriculum development, teaching, and assessment using simulation is critical for the success of the Consortium of the American College of Surgeons Accredited Education Institutes program. The state of and needs for faculty development in the Accredited Education Institute community are unknown currently. The Faculty Development Committee of the Consortium of the Accredited Education Institutes conducted a survey of Accredited Education Institutes to ascertain what types of practices are used currently, with what frequency, and what needs are perceived for further programs and courses to guide the plan of action for the Faculty Development Committee., Methods: The Faculty Development Committee created a 20-question survey with quantitative and qualitative items aimed at gathering data about practices of faculty development and needs within the Consortium of Accredited Education Institutes. The survey was sent to all 83 Accredited Education Institutes program leaders via Survey Monkey in January 2015 with 2 follow-up reminders. Quantitative data were compiled and analyzed using descriptive statistics, and qualitative data were interpreted for common themes., Results: Fifty-four out of the 83 programs (65%) responded to the survey. Two-thirds of the programs had from 1 to 30 faculty teaching at their Accredited Education Institutes. More than three-quarters of the programs taught general surgery, emergency medicine, or obstetrics/gynecology. More than 60% of programs had some form of faculty development, but 91% reported a need to expand their offerings for faculty development with "extreme value" for debriefing skills (70%), assessment (47%), feedback (40%), and curriculum development (40%). Accredited Education Institutes felt that the Consortium could assist with faculty development through such activities as the provision of online resources, sharing of best practices, provision of a blueprint for development of a faculty curriculum and information related to available, credible master programs of faculty development and health professions education., Conclusion: Many Accredited Education Institutes programs are engaged in faculty development activities, but almost all see great needs in faculty development related to debriefing, assessment, and curricular development. These results should help to guide the action and decision-making of the Consortium Faculty Development Committee to improve teaching within the American College of Surgeons Accredited Education Institutes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Practicing surgeons commonly learn new procedures and techniques by attending a "hands-on" course, though trainings are often ineffective at promoting subsequent procedure adoption in practice. We describe implementation of a new program with the SAGES All Things Hernia Hands-On Course, Acquisition of Data for Outcomes and Procedure Transfer (ADOPT), which employs standardized, proven teaching techniques, and 1-year mentorship. Attendee confidence and procedure adoption are compared between standard and ADOPT programs., Methods: For the pilot ADOPT course implementation, a hands-on course focusing on abdominal wall hernia repair was chosen. ADOPT participants were recruited among enrollees for the standard Hands-On Hernia Course. Enrollment in ADOPT was capped at 10 participants and limited to a 2:1 student-to-faculty ratio, compared to the standard course 22 participants with a 4:1 student-to-faculty ratio. ADOPT mentors interacted with participants through webinars, phone conferences, and continuous email availability throughout the year. All participants were asked to provide pre- and post-course surveys inquiring about the number of targeted hernia procedures performed and related confidence level., Results: Four of 10 ADOPT participants (40%) and six of 22 standard training participants (27%) returned questionnaires. Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence improvements in employing a components separation via an open approach (p = 0.051), and performing an open transversus abdominis release, though the difference did not achieve statistical significance (p = 0.14)., Discussion: These results suggest that the ADOPT program, with standardized and structured teaching, telementoring, and a longitudinal educational approach, is effective and leads to better transfer of learned skills and procedures to clinical practice.

Background: Advanced laparoscopic suturing (LS) tasks were developed based on a needs assessment. Initial validity evidence has been shown. The purpose of this multicenter study was to determine expert proficiency benchmarks for these tasks., Methods: 6 tasks were included: needle handling (NH), offset-camera forehand suturing (OF), offset-camera backhand suturing (OB), confined space suturing (CF), suturing under tension (UT), and continuous suturing (CS). Minimally invasive surgeons experienced in LS completed the tasks twice. Mean time and median accuracy scores were used to establish the benchmarks., Results: Seventeen MIS surgeons enrolled, from 7 academic centers. Mean (95% CI) time in seconds to complete each task was: NH 169 (149-189), OF 158 (134-181), OB 189 (154-224), CF 181 (156-205), UT 379 (334-423), and CS 416 (354-477). Very few errors in accuracy were made by experts in each of the tasks., Conclusions: Time- and accuracy-based proficiency benchmarks for 6 advanced LS tasks were established. These benchmarks will be included in an advanced laparoscopic surgery curriculum currently under development., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Key research priorities for surgical simulation have been identified in recent years. The aim of this study was to establish the progress that has been made within each research priority and what still remains to be achieved., Methods: Members of the Association for Surgical Education Simulation Committee conducted individualized literature reviews for each research priority that were brought together by an expert panel., Results: Excellent progress has been made in the assessment of individual and teamwork skills in simulation. The best methods of feedback and debriefing have not yet been established. Progress in answering more complex questions related to competence and transfer of training is slower than other questions. A link between simulation training and patient outcomes remains elusive., Conclusions: Progress has been made in skills assessment, curricula development, debriefing and decision making in surgery. The impact of simulation training on patient outcomes represents the focus of simulation research in the years to come., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum., Methods: Workshops were conducted at 3 national meetings. Participants completed preworkshop and postworkshop questionnaires to define experience, confidence in using simulation, intention to implement, as well as workshop content quality. The course consisted of (A) a didactic review of Preparation, Implementation, and Debriefing and (B) facilitated small group simulation sessions followed by debriefings., Results: Of 78 participants, 51 completed the workshops. Overall, 65% indicated that residents at their institutions used patient simulation, but only 33% used the American College of Surgeons-the Association of Program Directors in Surgery team-training modules. The workshop increased confidence to implement simulation team training (3.4 ± 1.3 vs 4.5 ± 0.9). Quality and importance were rated highly (5.4 ± 00.6, highest score = 6)., Conclusions: Preparation for simulation-based team training is possible in this workshop setting, although the effect on actual implementation remains to be determined., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To review the current state of simulation use in surgery and to offer direction for future research and implementation of evidence-based findings., Background: Simulation-based training (SBT) in surgery has surged in recent years. Although several new simulators and curricula have become available, their optimization and implementation into surgical training has been lagging., Methods: Members of the Association for Surgical Education Simulation Committee with expertise in surgical simulation review and interpret the literature and describe the current status of the use of simulation in surgery, identify the challenges to its widespread adoption, and offer potential solutions to these challenges. The review focuses on simulation research and implementation of existing knowledge and explores possible future directions for the field., Results: Skill acquired on simulators has repeatedly and consistently been demonstrated to transfer to the operating room, and proficiency-based training maximizes this benefit. Several simulation-based curricula have been developed by national organizations to support resident training, but their implementation is lagging because of inadequate human resources, difficult integration of SBT into educational strategy, and logistical barriers. In research, lack of coordinated effort, flaws in study design, changes in simulator-validation concepts, limited attention to skill retention, and other areas are in need of improvement., Conclusions: Future research in surgical simulation should focus on demonstrating the cost-effectiveness of SBT and its impact on patient outcomes. Furthermore, to enable the more widespread incorporation of best practices and existing simulation curricula in surgery, effective implementation strategies need to be developed.

Background: Our aim was to report the longitudinal assessment of technical performance of general surgery residents on select tasks from multiple programs over a 2-year period., Methods: An institutional review board-approved, multi-institutional collaborative study was undertaken with yearly resident performance assessments over a 3-year period. General surgery residents (postgraduate year [PGY] 1 to 5) were tested on 3 laparoscopic and 5 open simulated surgical tasks. Resident performance was compared individually over time and among interns and more senior residents., Results: Forty-one residents from 4 residency programs were evaluated. Scores increased in all tasks with each assessment, plateauing at a lower PGY level for open tasks compared with laparoscopic tasks. Change in performance scores between assessments were higher for interns compared with more senior residents (P < .003)., Conclusions: Resident performance on basic open and laparoscopic tasks assessed over time improved the most between the PGY 1 and 2 levels and was dependent on task difficulty. This documented skill evolution may allow tailoring of skills curricula to both meet existing needs and minimize performance variability., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Surgery residents are required to achieve performance milestones to advance in their residency. Level-specific, technical performance norms that could be used as milestones, however, do not currently exist. Our aim was to develop level-specific, technical performance norms for general surgery residents on select simulated tasks across multiple institutions., Study Design: An IRB-approved, prospective, multi-institutional collaborative study with voluntary participation of residents was undertaken at the start of the 2011-2012 academic year. General surgery residents (PGY I-V) from seven institutions were tested on three laparoscopic and five open simulated surgical tasks, and their performance was assessed based on task time and errors. Means and standard deviations of performance for each resident level were calculated and compared. Residents with performance 1 standard deviation below the mean were considered outliers., Results: A total of 147 residents were evaluated. Mean resident age was 28 ± 3 years; 42 % were female; and they had attended 74 different medical schools. Senior residents (PGY III-V) had more clinical and simulator experience than junior residents (PGY I-II) (p < 0.001). Resident performance scores progressively increased in all tasks reaching a plateau at a lower PGY level for open tasks. Depending on the task, 0-18 % of residents were outliers. When surveyed, 66 % of residents agreed that national performance norms for residents should exist., Conclusions: Performance norms were established for select tasks in a representative sample of US surgery residents. Such performance norms allow a more informed assessment of resident skill through comparison to national data and enable the identification of outliers who may benefit from additional training.

Background: In an effort to fulfill its charge to develop and maintain a comprehensive educational program to serve the members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the SAGES Continuing Education Committee (CEC) reports a summary of findings related to its evaluation of the 2012 SAGES annual meeting., Methods: All attendees to the 2012 annual meeting had the opportunity to complete an immediate postmeeting questionnaire as part of their continuing medical education (CME) certification in which they identified up to two learning themes, answered questions related to potential practice change items that are based on those learning themes, and complete a needs assessment related to important learning topics for future meetings. In addition, participants in the postgraduate and hands-on courses were asked to complete questions about case volume and comfort levels related to procedures/topics in those courses. All respondents to this initial survey were sent a 3-month follow-up questionnaire in which they were asked how successfully they had implemented the intended practice changes and what, if any, barriers they encountered. Postgraduate and hands-on course participants completed case volume and comfort level questions. Descriptive statistical analysis of this deidentified data was undertaken., Results: Response rates were 42% and 56% for CME-eligible attendees/respondents for the immediate postmeeting and 3-month follow-up questionnaires, respectively. Top learning themes for respondents were Bariatric, Hernia, Foregut, and Colorectal. Improving minimally invasive surgical (MIS) technique and managing complications related to MIS procedures were top intended practice changes. Partial implementation was common with top barriers including cost restrictions, lack of institutional support, and lack of time., Conclusions: The 2012 annual meeting analysis provides insight into educational needs among respondents and will help with planning content for future meetings.

Background: The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers., Methods: A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation., Results: Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources., Conclusion: Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Objective: : To identify the features of effective debriefing and to use this to develop and validate a tool for assessing such debriefings., Introduction: : Simulation-based training has become an accepted means of surgical skill acquisition. A key component of this is debriefing-yet there is a paucity of research to guide best practice., Methods: : Phase 1-Identification of best practice and tool development. A search of the Medline, Embase, PsycINFO, and ERIC databases identified current evidence on debriefing. End-user input was obtained through 33 semistructured interviews conducted with surgeons (n = 18) and other operating room personnel (n = 15) from 3 continents (UK, USA, Australia) using standardized qualitative methodology. An expert panel (n = 7) combined the data to create the Objective Structured Assessment of Debriefing (OSAD) tool. Phase 2-Psychometric testing. OSAD was tested for feasibility, reliability, and validity by 2 independent assessors who rated 20 debriefings following high-fidelity simulations., Results: : Phase 1: 28 reports on debriefing were retrieved from the literature. Key components of an effective debriefing identified from these reports and the 33 interviews included: approach to debriefing, learning environment, learner engagement, reaction, reflection, analysis, diagnosis of strengths and areas for improvement, and application to clinical practice. Phase 2: OSAD was feasible, reliable [inter-rater ICC (intraclass correlation coefficient) = 0.88, test-retest ICC = 0.90], and face and content valid (content validity index = 0.94)., Conclusions: : OSAD provides an evidence-based, end-user informed approach to debriefing in surgery. By quantifying the quality of a debriefing, OSAD has the potential to identify areas for improving practice and to optimize learning during simulation-based training.

Background: Changes in surgical training have decreased opportunities for experiential learning in the operating room (OR). With this decrease, a commensurate increase in debriefing-dependent simulation-based activities has occurred. Effective debriefing could optimize learning from both simulated and real clinical encounters., Methods: Thirty-three semistructured interviews with surgeons, anesthesiologists, and OR nurses from the United Kingdom, United States, and Australia identified the goals of debriefing, core components of an effective debrief, and solutions to its effective implementation. Interviews were audiotaped, transcribed, and coded using emergent theme analysis., Results: Core components of an effective debrief include having the appropriate approach, establishing a learning environment, learner engagement, managing learner reaction, reflection, analysis, diagnosis, and application to real clinical practice. Solutions to enhance practice involve promotion of a debriefing culture within the surgical community with protected time to conduct a structured debriefing., Conclusions: A need exists to enhance surgical training through regular structured debriefing. Identifying the key components of an effective debrief is a first step toward improving practice and embedding a debriefing culture within the OR., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This article focuses on key aspects of the "nontraditional" surgical subjects of organizational structure and team interaction. First, the deficiencies in team dynamics found within the modern operating room (OR) and their resultant consequences are highlighted. Next, essential human factors concepts related to error generation, organizational culture, high reliability, and team science as applied to the OR environment are reviewed. Finally, various strategies for improving OR team function, including the use of high-fidelity simulation (HFS) in team training are discussed., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objectives: Our study determined whether depth perception defects and hand-eye dominance affect an individual's ability to perform laparoscopic skills., Methods: The study cohort comprised 104 third-year medical students from LSU School of Medicine who completed a questionnaire including information on handedness and were tested for eye dominance and depth perception by using standardized methods. Training sessions involved an initial recorded performance, a 20-minute practice session, followed by a final recorded performance. Recorded sessions were randomized and rated by using a visual analog scale (maximal possible score = 16) based on overall performance (OPS) and depth perception (DPS). A general linear model was used to correlate depth perception defects and hand-eye dominance with assessment scores for OPS and DPS., Results: Students with depth perception defects scored significantly lower on their initial performance than did those with normal depth perception (OPS, 4.80 vs. 7.16, P=0.0008; DPS, 5.25 vs. 6.93, P=0.0195). After training, the depth perception defect group continued to have lower scores compared with the normal depth perception group. However, the 2 groups showed similar increases in pre- to posttraining performance scores (OPS, 3.84 vs. 3.18, P=0.0732). Hand-eye dominance did not significantly affect scores., Conclusions: Depth perception defects appear to compromise an individual's ability to perform basic laparoscopic skills. Individuals with defects can improve their skills by a proportion comparable to that of people with uncompromised depth perception. Differences in hand-eye dominance do not correlate with performance differences in basic laparoscopic skills. Although further research is necessary, the findings indicate that training can be tailored for individuals with depth perception defects to improve laparoscopic performance.