There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland

BACKGROUND

Surgical training curricula have changed little over the past decades. Current advances in surgical techniques, especially in minimally invasive surgery, as well as the rapidly changing socioeconomic environment pose a major challenge for the training of young surgeons. The aim of this survey was to provide a representative overview of the surgical training landscape in Switzerland focusing on laparoscopic surgical training: How do department chairs of teaching hospitals deal with the above challenges, and what should a future training curriculum look like?

METHODS

This is a prospective, questionnaire-based, cross-sectional study among the heads of departments of all certified surgical teaching hospitals in Switzerland.

RESULTS

The overall response rate was 56% (48/86) and 86% (19/22) for tertiary centers. Two-thirds of the centers (32) organize themselves in training networks. Laparoscopic training courses are offered in 25 (52%) hospitals, mainly in tertiary centers. Self-training opportunities exist in 40 (83%) hospitals. In addition to commercial (27) and self-built (7) box trainers, high-fidelity trainers are available in 16 (33%) hospitals. A mandatory training curriculum exists in 7 (15%) facilities, and a training assessment is performed in 15 (31%) institutions. Thirty-two (65%) heads of departments indicated that residents have sufficient practical exposure in the operating room, but the ability to work independently with obtaining the specialist title is seen critically (71%). They state that the surgical catalog does not adequately reflect the manual skills of the resident (64%). The desire is for training to be restructured from a numbers-based to a performance-based curriculum (53%) and for tools to assess residents' manual skills (56%) to be introduced.

CONCLUSIONS

Department chairs stated that the existing curriculum in Switzerland does not meet the requirements of a modern training curriculum. This study highlights the need to create an improved, competency-based curriculum that ensures the training of a new generation of surgeons, taking into account the growing evidence of the effectiveness of state-of-the-art training modalities such as simulation or proficiency-based training.

Evaluation of a novel universal robotic surgery virtual reality simulation proficiency index that will allow comparisons of users across any virtual reality simulation curriculum

STUDY OBJECTIVE

Evaluate a universal proficiency metric for Robotic Surgery Virtual Reality (VR) simulation that will allow comparison of all users across any VR curriculum.

DESIGN

Retrospective analysis of VR Simulation metrics.

SETTING

Two training institutions.

PATIENTS OR PARTICIPANTS

Residents, fellows and practicing surgeons.

INTERVENTIONS

Analysis of the Mimic robotic Virtual Reality (VR)-Simulation database of over 600,000 sessions was utilized to calculate Mean scores for each exercise. Those Mean scores were then normalized to 100. Subject's scores were also averaged and normalized to 100. We called this Index score the MScore Proficiency Index (MPI^©). Scores above 100 were better than average; Less than 100 were worse than average.

MEASUREMENTS AND MAIN RESULTS

Seventeen thousand six hundred and forty eight sessions were analyzed (2017-2020) comparing 77 students (residents to practicing surgeons) working in 7 different curriculums. On average, each student spent 8 h and 24 min on simulation, attempted 26.5 different exercises, and became proficient in 20.6 exercises per user. The MPI^© mean score for all participants in all curricula was an MPI^© of 104.9 (SD: 15.5). Thirteen students were 1 standard deviation below the norm with an average MPI^© of 80.15. This group averaged 9 h 27 min each on the simulator attempting 23.46 exercises but becoming proficient in only 10.38 (47%) of them in 224 sessions. Twelve students were 1 standard deviation above the norm with an average MPI^© of 127.05. This group averaged 6 h 31 min each on the simulator attempting 29.08 exercises but becoming proficient in 27.5 (95%) of them in 196 sessions.

CONCLUSION

A universal skill-based performance index (MPI^©) was calculated and found to be a reliable tool that could be used to identify relative proficiency among students in different robotic surgery VR Simulation curriculums. An individual user's proficiency can be utilized to identify a student's progress in a given curriculum. Future studies of MPI^© will determine if machine learning can provide timely personalized feedback to the user.