TY - JOUR
T1 - Proctored preceptorship model for learning eTEP repair for inguinal hernia for general surgery residents
AU - Mnouskin, Y.
AU - Assaf, D.
AU - Barkon-Steinberg, G.
AU - Rachmuth, J.
AU - Carmeli, I.
AU - Keidar, A.
AU - Rayman, S.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. Aim: Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. Methods: Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups—Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. Results: Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). Conclusion: Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.
AB - Background: Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. Aim: Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. Methods: Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups—Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. Results: Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). Conclusion: Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.
KW - Competence-based education
KW - Laparoscopic inguinal hernia repair
KW - Surgical education
KW - Surgical training
KW - TEP
KW - eTEP
UR - http://www.scopus.com/inward/record.url?scp=85116115946&partnerID=8YFLogxK
U2 - 10.1007/s10029-021-02507-4
DO - 10.1007/s10029-021-02507-4
M3 - Article
C2 - 34591214
AN - SCOPUS:85116115946
SN - 1265-4906
VL - 26
SP - 1053
EP - 1062
JO - Hernia : the journal of hernias and abdominal wall surgery
JF - Hernia : the journal of hernias and abdominal wall surgery
IS - 4
ER -