1. Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme.
- Author
-
Skjold-Ødegaard, Benedicte, Ersdal, Hege Langli, Assmus, Jörg, and Søreide, Kjetil
- Subjects
- *
APPENDECTOMY , *WORK , *LAPAROSCOPY , *RESEARCH funding , *SCIENTIFIC observation , *FISHER exact test , *SEVERITY of illness index , *APPENDICITIS , *TREATMENT duration , *DESCRIPTIVE statistics , *MULTIVARIATE analysis , *HOSPITAL medical staff , *LONGITUDINAL method , *ODDS ratio , *CLINICAL competence , *CONFIDENCE intervals , *DATA analysis software , *EXPERIENTIAL learning , *REGRESSION analysis - Abstract
Background: Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon's experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees. Methods: A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees' overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A "Challenging" procedure was defined as a combination of either/or "perforation" and "difficult". Trainees who had performed > 30 appendectomies were defined as "experienced". The trainees were asked if they had used simulation or web-based tools the week prior to surgery. Results: 142 procedure evaluation forms were included of which 19 (13%) were "perforated", 14 (10%) "difficult" and 24 (17%) "Challenging". Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0–75.6). Experienced trainees performed "proficient" more often than non-experienced (OR 34.5, 95% CI 6.8–176.5). "Difficult" procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0–0.9). In "Challenging" procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1–0.9). The procedures assessed as "difficult" had significantly longer operating time with a median (IQR) of 90 (75–100) min compared to 59 (25–120) min for the non-difficult (p < 0.001). Conclusion: Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a "difficult" procedure had most overall impact on proficiency evaluation. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF