The impact of intensive laparoscopic training course with structured assessment and immediate feedback on residents' operative performance in animal lab.

INTRODUCTION: The objective of this study was to examine the impact of an intensive laparoscopic training course incorporating structured assessment and immediate feedback on residents' operative performance in animal lab. METHODS: Surgical residents participated in a 2-day intensive laparoscopic training course. They performed the same procedures on two consecutive days on live pigs. Junior residents (PGY1-2) performed laparoscopic cholecystectomy and incisional hernia repair and the senior residents (PGY3-5) performed laparoscopic Nissen fundoplication, splenectomy, and low anterior colon resection. Assessment tools with proven validity evidence (global and procedure-specific rating tools for operative assessment of laparoscopic skills) were used to assess their operative performance. Faculty assessment and self-assessments were completed immediately after each procedure on both days. The Wilcoxon rank test was used to examine the effect of training on resident performance after one repetition. RESULTS: Forty surgical residents (20 junior and 20 senior residents) participated. There was a significant improvement in general laparoscopic skills during incisional hernia repair and Nissen fundoplication using global rating scales (p < 0.05). Moreover, there was an improvement in their performance during cholecystectomy, incisional hernia repair, and low anterior colectomy when procedure-specific skills assessments were used (p < 0.05). There was a positive correlation between residents' self-reported confidences and their operative performance CONCLUSION: Trainees showed significant improvements in performance in general and procedure-specific laparoscopic skills in a wide range of procedures after an intensive training course. This study demonstrates the benefit of a structured training curriculum in improving operative performance in basic and advanced laparoscopic skills in a simulated environment. Future studies are needed to examine the duration of training required to achieve skill retention and competency.

Faculty feedback versus residents' self-assessment of operative performance: Different but complementary.

BACKGROUND: Surgical training requires development of both technical and cognitive skills. The study analyzed feedback by faculty and residents' self-assessments during a laparoscopic training course to identify structure of feedback in this context and compared the focus of trainees to faculty. METHODS: This study collected assessments by surgical residents and faculty during an intensive laparoscopic training course at a single institution. The residents' operative performance was assessed using validated assessment tools including free text feedback. Assessments were completed immediately following procedures. Feedback was analyzed using qualitative method. RESULTS: Eighty (80) residents participated. Three themes were identified: Assessment, instruction and occasion. Faculty provided significantly more feedback than trainees. Moreover, the content of feedback was different. Residents focused on technical performance, while faculty commented on technical and cognitive skills, efficiency and level of independence. Errors were mainly addressed by faculty. CONCLUSION: This study demonstrated differences in cognitive focus of trainees and faculty. Text feedback is informative in understanding perceived challenges. Faculty provided explicit assessment and instruction for improvement. The effectiveness of self-assessment and feedback should be further studied.

Robotic-Assisted Simultaneous Repair of Paraesophageal Hernia and Morgagni Hernia: Technical Report.

Morgagni hernias are a rare form of congenital diaphragmatic hernia, accounting for 2%-3% of cases. The presence of a simultaneous Morgagni hernia and paraesophageal hernia (PEH) is even more rare, with only a few reported cases in the surgical literature. Both open and laparoscopic surgical approaches have been previously described. Herein we discuss a robotic-assisted surgical approach to the repair of simultaneous Morgagni hernia and PEH in a 65-year-old woman. Simultaneous repair of Morgagni hernia and PEH is indicated mainly when symptoms are generally indistinctive. The use of robotic technology allowed for both hernias to be repaired both primarily and with mesh reinforcement.