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Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Sep2024, Vol. 38 Issue 9, p4939-4946. 8p. - Publication Year :
- 2024
-
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]
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 38
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 179326343
- Full Text :
- https://doi.org/10.1007/s00464-024-11007-2