Department of Surgery, University of Washington, 1959 NE Pacific St., Box 3564101, Seattle, WA, 98195, USA.
Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
Surg Endosc. 2023 Oct;37(10):8057-8063. doi: 10.1007/s00464-023-10290-9. Epub 2023 Jul 24.
After completion of training, practicing surgeons rely on hands-on courses to expand their procedure armamentarium and improve their surgical technique. However, such courses vary in standardized teaching methods. SAGES developed the Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program as a method of longitudinal instruction utilizing standardized teaching techniques, mentorship, and webinars to cover additional techniques. This study examines the adoption of learned techniques and participant confidence before and after an ADOPT course focused on extended-view totally extraperitoneal (eTEP) hernia repair.
A hands-on course focused on eTEP hernia repair was conducted with enrollment capped at 10 participants. Pre-course and post-course surveys at 3, 6, and 12 months determined implementation of the learned procedure, case volume, and confidence with eTEP skills. A 5-point Likert scale (1 = not confident at all to 5 = completely confident) assessed confidence levels. Survey responses were summarized using descriptive statistics.
Of the 10 participants, 10 (100%) completed the pre-course survey, and 7 (70%) completed at least one post-course survey. Median age was 48.5 years (36,56) with a median of 16 years (2,23) in practice, mostly in the community setting (70%). After the course, 50% had performed an eTEP procedure, and 100% reported considering this technique during surgical planning. Participants reported higher confidence in eTEP-specific skills at three months post-course from pre-course levels. The highest change in confidence was seen for the following skills: accessing the retromuscular/extraperitoneal space for ventral hernia and recognizing when the linea alba has been violated, p < 0.05.
This study shows that rapid incorporation of learned techniques can be achieved through the ADOPT format. Furthermore, through longitudinal mentorship and a structured hands-on course, the ADOPT course supports practicing surgeons to attain autonomy and confidence even when teaching a relatively technically challenging procedure, such as eTEP.
完成培训后，执业外科医生依赖实践课程来扩展他们的手术工具，并提高他们的手术技术。然而，这些课程在标准化教学方法上存在差异。SAGES 开发了获取数据以进行结果和程序转移 (ADOPT) 计划，作为一种利用标准化教学技术、指导和网络研讨会来涵盖其他技术的纵向指导方法。本研究考察了在专注于扩展视场完全腹膜外 (eTEP) 疝修补术的 ADOPT 课程前后，参与者对所学技术的采用情况和信心。
进行了一项专注于 eTEP 疝修补术的实践课程，参与者人数上限为 10 人。在课程前和课程后 3、6 和 12 个月进行调查，以确定所学程序的实施情况、手术量以及对 eTEP 技能的信心。采用 5 分李克特量表（1=完全没有信心，5=完全有信心）评估信心水平。调查结果采用描述性统计进行总结。
在 10 名参与者中，10 名（100%）完成了课程前调查，7 名（70%）完成了至少一次课程后调查。中位数年龄为 48.5 岁（36，56），中位数从业年限为 16 年（2，23），主要在社区环境中（70%）。课程后，50%的参与者进行了 eTEP 手术，100%的参与者报告在手术计划中考虑了该技术。与课程前相比，参与者在课程后 3 个月报告对 eTEP 特定技能的信心更高。在以下技能方面，信心的变化最大：进入腹横筋膜/腹膜外间隙进行腹疝修补术，以及识别白线是否受损，p<0.05。
本研究表明，通过 ADOPT 模式可以快速采用所学技术。此外，通过纵向指导和结构化实践课程，ADOPT 课程支持执业外科医生在进行相对具有技术挑战性的手术（如 eTEP）时实现自主性和信心。
