Web-based minimally invasive surgery training: competency assessment in PGY 1-2 surgical residents

Scott R Schell, Timothy C Flynn
Current Surgery 2004, 61 (1): 120-4

OBJECTIVES: Little published literature describes accurate evaluation and assessment of surgical residents' technical competencies. Work-hour limitations and the proposed changes in training duration challenge our ability to provide core technical competencies, particularly during PGY-1-2. We identified minimally invasive surgery as a particularly challenging competency training area, requiring significant allocation of resident and faculty time and resources, with inconsistent training results. This project evaluated a standardized competency training curriculum in minimally invasive surgery in comparison to existing training.

METHODS: The Laparoscopy 101-a Resource for Resident Education minimally invasive surgery competency training curriculum consists of CD-ROM-based self-paced didactic self-instruction modules, skills laboratories, and web-based testing, evaluation, and reporting. Five didactic self-study modules and their corresponding web-based examinations were selected for this study. PGY 1-2 residents (11/group) were enrolled. PGY-1 residents received no formal minimally invasive surgery training in our program before participating, whereas PGY-2 residents were exposed to the minimally invasive surgery training program in place in our department. PGY-1 residents completed the training modules and web-based testing over 4 days. PGY-2 residents underwent testing before (pre-test) and after (post-test) completing identical training modules and testing over an identical time period. Test results were examined and compared in both groups. A user-satisfaction survey assessed resident opinions about the quality of the curriculum, use of the CD-ROM/web-based system, and trainee perceptions about performance.

RESULTS: PGY-2 Pre-test scores were equivalent to PGY-1 scores after training (mean overall performance, 52.4% vs 65.5% p = ns). PGY-2 Post-test scores were significantly higher when compared with pre-test scores (mean overall performance; pre: 52.4% vs post: 85.3% p <== 0.001). Interestingly, post-training scores were significantly higher for PGY-2 than PGY-1 (mean overall performance PGY-1: 52.4% vs PGY-2: 65.5% p = ns). Competencies achieved persisted 6 months after initial training in both PGY 1-2 groups without additional training using this curriculum. Overall user satisfaction was positive in each category evaluated.

CONCLUSIONS: The Laparoscopy 101 minimally invasive surgery curriculum (1) p;rovides a structured self-paced curriculum for minimally invasive didactic training that is well accepted by trainees; (2) yields PGY-1 competencies equivalent to PGY-2 who receive training in our department's existing program; and (3) yields significant improvement in PGY-2 minimally invasive surgery competencies. Training effects persist to 6 months without reinforcement. Our observations of PGY-2 performance and competency suggest that this training would best be instituted during PGY-2.

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