Nepomnayshy Dmitry, Whitledge James, Birkett Richard, Delmonico Theodore, Ruthazer Robin, Sillin Lelan, Seymour Neal E
Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA,
Surg Endosc. 2015 Feb;29(2):349-54. doi: 10.1007/s00464-014-3674-8. Epub 2014 Jul 9.
Since fundamentals of laparoscopic surgery (FLS) represents a minimum proficiency standard for laparoscopic surgery, more advanced proficiency standards are required to address the needs of current surgical training. We wanted to evaluate the acceptance and discriminative ability of a novel set of skills building on the FLS model that could represent a more advanced proficiency standard-advanced laparoscopic surgery (ALS).
Qualitative and quantitative analyses were employed. Quantitative analysis involved comparison of expert (PGY 5+), intermediate (PGY 3-4) and novice (PGY 1-2) surgeons on FLS and ALS tasks. Composite scores included time and errors. Standard FLS errors were added to task time to create the composite score. Qualitative analysis involved thematic review of open-ended questions provided to experts participating in the study.
Out of 48 participants, there were 15 (31 %) attendings, 3 (6 %) fellows and 30 (63 %) residents. By specialty, 54 % were general/MIS/bariatric/colorectal (GMBC) and 46 % were other (urology and gynecology). There was no difference between experience level and performance on FLS and ALS tasks for the entire cohort. However, looking at the GMBC subgroup, experts performed better than novices (p = 0.012) and intermediates performed better than novices (p = 0.057) on ALS tasks. There was no difference for the same group in FLS performance. Also, GMBC subgroup performed significantly better on FLS (p = 0.0035) and ALS (p = 0.0027) than the other subgroup. Thematic analysis revealed that the majority of experts felt that ALS was more realistic, challenging and clinically relevant for specific situations compared to FLS.
For GMBC surgeons, we were able to show evidence of validity for a series of advanced laparoscopic tasks and their relationship to surgeon skill level. This study may represent the first step in the development of an advanced laparoscopic skills curriculum. Given the high degree of specialization in surgery, different advanced skills curricula will need to be developed for each specialty.
由于腹腔镜手术基础技能（FLS）是腹腔镜手术的最低熟练标准，因此需要更高级的熟练标准来满足当前外科培训的需求。我们希望评估一套基于FLS模型构建的新技能的接受度和区分能力，该技能可代表更高级的熟练标准——高级腹腔镜手术（ALS）。
采用定性和定量分析。定量分析包括对专家（PGY 5+）、中级（PGY 3-4）和新手（PGY 1-2）外科医生在FLS和ALS任务上的比较。综合评分包括时间和错误。将标准FLS错误添加到任务时间中以创建综合评分。定性分析包括对参与研究的专家提供的开放式问题进行主题审查。
48名参与者中，有15名（31%）主治医师，3名（6%）研究员和30名（63%）住院医师。按专业划分，54%为普通外科/微创外科/减重外科/结直肠外科（GMBC），46%为其他专业（泌尿外科和妇科）。整个队列在FLS和ALS任务上的经验水平和表现之间没有差异。然而，在GMBC亚组中，专家在ALS任务上的表现优于新手（p = 0.012），中级医生在ALS任务上的表现优于新手（p = 0.057）。同一组在FLS表现上没有差异。此外，GMBC亚组在FLS（p = 0.0035）和ALS（p = 0.0027）上的表现明显优于其他亚组。主题分析显示，与FLS相比，大多数专家认为ALS在特定情况下更真实、更具挑战性且与临床相关。
对于GMBC外科医生，我们能够证明一系列高级腹腔镜任务的有效性及其与外科医生技能水平的关系。本研究可能代表了高级腹腔镜技能课程开发的第一步。鉴于外科手术的高度专业化，需要为每个专业开发不同的高级技能课程。
