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.

The exploration of remote simulation strategies for the acquisition of psychomotor skills in medicine: a pilot randomized controlled trial

Background

Progress in remote educational strategies was fueled by the advent of the COVID-19 pandemic. This pilot RCT explored the efficacy of a decentralized model of simulation based on principles of observational and peer-to-peer learning for the acquisition of surgical skills.

Methods

Sixty medical students from the University of Montreal learned the running subcuticular suture in four different conditions: (1) Control group (2) Self-learning (3) Peer-learning (4) Peer-learning with expert feedback. The control group learned with error-free videos, while the others, through videos illustrating strategic sub-optimal performances to be identified and discussed by students. Performance on a simulator at the end of the learning period, was assessed by an expert using a global rating scale (GRS) and checklist (CL).

Results

Students engaging in peer-to-peer learning strategies outperformed students who learned alone. The presence of an expert, and passive vs active observational learning strategies did not impact performance.

Conclusion

This study supports the efficacy of a remote learning strategy and demonstrates how collaborative discourse optimizes the students' acquisition of surgical skills. These remote simulation strategies create the potential for implantation in future medical curriculum design.Trial Registration: NCT04425499 2020-05-06.

Telementoring of in-home real-time laparoscopy using whatsapp messenger: An innovative teaching tool during the COVID-19 pandemic. A cohort study

Background

COVID-19 pandemic has decreased worldwide surgical activity, thus impairing the training of surgical residents. As a coping strategy, we opted for laparoscopic simulation with endotrainer; however, due to social distancing rules, a face-to-face tutoring training method is unfeasible. In this context telementoring using WhatsApp® Messenger (owned by Facebook Inc., Menlo Park, CA) with a Smartphone aims to train surgical residents in laparoscopy from their homes during the pandemic.

Methods

Trainers and surgical residents who were at home participated in this study. They used endotrainers with Smartphone cameras and were trained by video calls using WhatsApp. The baseline and final score of intracorporeal knotting was measured, according to the Fundamentals of Laparoscopic Surgery (FLS) methodology, measuring the difference in means with the paired t-test. Recommendations for virtual surgical tutoring were followed and user satisfaction was measured using the Likert scale.

Results

40 surgical residents participated. The average distance between the mentor and the trainee was 12.87 km. Average bandwidth was 32.5 Megabits per second (Mbits/s), latency was 424.5 ms (ms), good quality image with immediate feedback was achieved. The statistically significant difference between basal and final measurement was 23.7 points (p < 0.001). All participants found telementoring a good educational tool.

Conclusion

Smartphone telementoring using WhatsApp® Messenger is an effective educational tool for acquiring laparoscopic skills with a statistically significant difference. This type of training represents a new teaching resource in the light of the recommendations of social distancing during a pandemic.