A multilevel, step-based model to evaluate progress in procedure efficiency for laparoscopic appendicectomy in surgical training: structured evaluation using ‘ebb-and-flow’ and ‘string-of-pearls’ concepts

Søreide, Kjetil; Skjold-Ødegaard, Benedicte

doi:10.1093/bjsopen/zrac071

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Assessment tools for basic procedures such as appendicectomy [15] or advanced procedures such as laparoscopic colectomy [16] or robotic rectal surgery [17] have been developed. Recent reviews have focused on the specific approach, for example laparoscopic colectomy [18].…”

Section: Introductionmentioning

confidence: 99%

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Hertz,

Rattenborg,

Haug

et al. 2024

Colorectal Disease

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AimThere is currently an increased focus on competency‐based training, in which training and assessment play a crucial role. The aim of this systematic review is to create an overview of hands‐on training methods and assessment tools for appendectomy and colon and rectal surgery procedures using either an open, laparoscopic or robot‐assisted approach.MethodA systematic review of Medline, Embase, Cochrane and Scopus databases was conducted following the PRISMA guidelines. We conducted the last search on 9 March 2023. All published papers describing hands‐on training, evaluation of performance data and development of assessment tools were eligible. The quality of studies and the validity evidence of assessment tools are reported.ResultsFifty‐one studies were identified. Laparoscopic assessment tools are abundant, but the literature still lacks good‐quality assessment tools for open appendectomy, robotic colectomy and open rectal surgery. Overall, there is a lack of discussion regarding the establishment of pass/fail standards and the consequences of assessment. Virtual reality simulation is used more for appendectomy than colorectal procedures. Only a few of the studies investigating training were of acceptable quality. There is a need for high‐quality studies in open and robotic‐assisted colon surgery and all approaches to rectal surgery.ConclusionThis review provides an overview of current training methods and assessment tools and identifies where more research is needed based on the quality of the studies and the current validity evidence.

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Section: Introductionmentioning

confidence: 99%

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Hertz,

Rattenborg,

Haug

et al. 2024

Colorectal Disease

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“…Honourable mentions go to Herrod et al for their meta-analysis of antibiotic therapy for appendicitis 4 , Stieler et al for an interesting paper on somatic syndromes in acute presentations 5 , and Soreide et al for a surgical education piece on learning curves for laparoscopic appendicectomy 6 . We look forward to reading future high-quality emergency surgery papers in BJS Open .…”

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confidence: 99%

Emergency general surgery in BJS Open—papers of note in 2022

2023

BJS Open

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Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme

Skjold-Ødegaard,

Ersdal,

Assmus

et al. 2024

Surg Endosc

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Background Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon’s experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees. Methods A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees’ overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A “Challenging” procedure was defined as a combination of either/or “perforation” and “difficult”. Trainees who had performed > 30 appendectomies were defined as “experienced”. The trainees were asked if they had used simulation or web-based tools the week prior to surgery. Results 142 procedure evaluation forms were included of which 19 (13%) were “perforated”, 14 (10%) “difficult” and 24 (17%) “Challenging”. Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0–75.6). Experienced trainees performed “proficient” more often than non-experienced (OR 34.5, 95% CI 6.8–176.5). “Difficult” procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0–0.9). In “Challenging” procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1–0.9). The procedures assessed as “difficult” had significantly longer operating time with a median (IQR) of 90 (75–100) min compared to 59 (25–120) min for the non-difficult (p < 0.001). Conclusion Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a “difficult” procedure had most overall impact on proficiency evaluation. Graphical Abstract

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A multilevel, step-based model to evaluate progress in procedure efficiency for laparoscopic appendicectomy in surgical training: structured evaluation using ‘ebb-and-flow’ and ‘string-of-pearls’ concepts

Cited by 4 publications

References 19 publications

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Training and assessment for colorectal surgery and appendicectomy– a systematic review

Emergency general surgery in BJS Open—papers of note in 2022

Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme

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