Assessing the impact of a 2-day laparoscopic intestinal workshop.

BACKGROUND: Surgical educators have responded to the demand for increased skills in minimally invasive surgery by offering short technique-focused workshops at academic centres. The purpose of this study was to determine the impact of a comprehensive laparoscopic intestinal workshop for the adoption of laparoscopic colonic surgery. METHODS: A 2-day comprehensive laparoscopic intestinal surgery workshop included didactic teaching and supervised hands-on practice of numerous laparoscopic colon resections on a cadaveric model. Participants completed pre-, post- and 6-month postcourse questionnaires. RESULTS: The participants (n = 39) had been in practice for a mean of 10 (interquartile range 3-18) years. Fifty-one percent (n = 20) were already performing laparoscopic colectomies as part of their practices prior to the course. Regardless of whether they were performing laparoscopic colectomies prior to the course or not, attending the 2-day workshop improved their self-assessed preparedness to perform laparoscopic colectomies. Six months after the intestinal workshop, 10 of 16 respondents who were not performing laparoscopic colectomies prior to the course had performed at least 1 since the course. Seven of these individuals had a preceptor for their first case. Reasons cited for not performing a laparoscopic colectomy since the workshop included perceived inadequate surgical skill set, a lack of preceptor and the lack of an appropriate patient. CONCLUSION: A comprehensive laparoscopic intestinal workshop contributed to the perceived acquisition of advanced laparoscopic surgical skills. Local laparoscopic preceptorship was an important adjunct to the workshop for the incorporation of laparoscopic colorectal surgery into practice.

Current awareness in Canada of clinical practice guidelines for colorectal cancer screening.

INTRODUCTION: The Canadian Task Force on Preventive Health Care (CTF-PHC) recently revised its screening recommendations for colorectal cancer (CRC). We wished to assess the effect of this change on the screening beliefs and clinical practice of primary care physicians. METHODS: We surveyed 160 primary-care physicians, quasi-randomly sampled, in June-July 2001 and again in April-July 2002, 9 months after publication of the guidelines. Descriptive statistics and McNemar chi2 analyses were carried out on data from physicians who responded to both surveys. RESULTS: Of the those sampled, 47% responded to both surveys. After the publication of the CTF-PHC guidelines, the proportion reporting that they recommend CRC screening to their patients at average risk increased from 43% to 60% (p = 0.02). Before publication of the revised guidelines 48% stated that the CTF-PHC did not support screening, compared with 24% afterward (p = 0.01). CTF-PHC guidelines were acknowledged by 30% to be a source of CRC screening information. Around 9 months post-publication, 24% of the physicians stated their awareness of the revised screening guidelines. The most commonly cited reasons for not recommending CRC screening to average-risk patients were that the evidence is inconclusive and that CTF-PHC guidelines do not support screening. CONCLUSIONS: After publication of the revised CTF-PHC guidelines more primary-care physicians reported that they recommend CRC screening to their average-risk patients. The belief that the evidence is inconclusive nevertheless remains a considerable barrier to implementation. To increase the use of screening for CRC, additional strategies are required.