Skip to main content

Abstract

Many aspects of surgical training have evolved considerably, affecting how we train surgeons to reach and maintain proficiency. Specifically, advancements in disease management and technology have expanded the knowledge and skill base necessary for trainees prompting the development of governing bodies in surgical education. Together with principles of learning psychology, such as Ericsson’s deliberate practice and the Dreyfus educational model, the emphasis on proficiency-based training has grown. An example includes the development of simulation-based training in all modalities of surgery and the demonstration of its impact on both skill acquisition and transferability of skills to the operating room. Indeed ongoing simulation continues to evolve with changes such as the shift from time and repetitions to expert-derived levels and the increasing focus on higher-level patient and clinical outcomes. Further examples such as the development of core competencies, entrustable professional activities (EPAs), and video-based review serve to provide frameworks for ongoing training both within and beyond residency. Given these extraordinary advancements, proficiency-based education is expected to remain a core part of surgical training and expand further into surgical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kotsis SV, Chung KC. Application of the “see one, do one, teach one” concept in surgical training. Plast Reconstr Surg. 2013;131(5):1194–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Halstead WS. The training of the surgeon. Bull Johns Hopkins Hospital. 1904;xv:267–75.

    Google Scholar 

  3. Polavarapu H, Kulaylat A, Sun S, Hamed O. 100 years of surgical education: the past, present, and future. Bull Am Coll Surg. 2013;98(7):22–7.

    PubMed  Google Scholar 

  4. Satava RM. Virtual reality surgical simulator. The first steps. Surg Endosc. 1993;7(3):203–5.

    Article  CAS  PubMed  Google Scholar 

  5. Martin J, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg. 1997;84:273–8.

    CAS  PubMed  Google Scholar 

  6. Scott DJ. Proficiency-based training for surgical skills. Semin Colon Rectal Surg. 2008;19(2):72–80.

    Article  Google Scholar 

  7. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005;241(2):364–72.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bridges M, Diamond D. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  9. Scott D, Bergen P, Rege R, Laycock R, Tesfay S, Valentine RJ, Euhus D, Jeyarajah DR, Thompson W, Jones D. Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg. 2000;191(3):272–83.

    Article  CAS  PubMed  Google Scholar 

  10. Rosser J, Rosser L, Savalgi R. Skill acquisition and assessment for laparoscopic surgery. Arch Surg. 1997;132(2):200–4.

    Article  CAS  PubMed  Google Scholar 

  11. Derossis A, Fried G, Abrahamowicz M, Sigman H, Barkun J, Meakins J. Development of a model for training and evaluation of laparoscopic skills. Am J Surg. 1998;175(6):482–7.

    Article  CAS  PubMed  Google Scholar 

  12. Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458–63; discussion 463–454.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Peters J, Fried G, Swanstrom L, Soper N, Sillin L, Schirmer B, Hoffman K, Committee TSF. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery. 2004;135(1):21–7.

    Article  PubMed  Google Scholar 

  14. Grantcharov T, Kristiansen V, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004;91(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  15. Hamilton E, Scott D, Kapoor A, Nwariaku F, Bergen P, Rege R, Tesfay S, Jones D. Improving operative performance using a laparoscopic hernia simulator. Am J Surg. 2001;182(6):725–8.

    Article  CAS  PubMed  Google Scholar 

  16. Korndorffer J, Dunne B, Sierra R, Stefanidis D, Touchard C, Scott D. Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg. 2005;201(1):23–9.

    Article  PubMed  Google Scholar 

  17. Korndorffer J, Hayes D, Dunne JB, Sierra R, Touchard C, Markert R, Scott D. Development and transferability of a cost-effective laparoscopic camera navigation simulator. Surg Endosc. 2005;19:161–7.

    Article  PubMed  Google Scholar 

  18. Andreatta P, Woodrum D, Birkmeyer J, Yellamanchilli R, Doherty G, Gauger P, Minter R. Laparoscopic skills are improved with LapMentor™ training results of a randomized, double-blinded study. Ann Surg. 2006;243(6):854–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ahlberg G, Enochsson L, Gallagher A, Hedman L, Hogman C, McClusky D III, Ramel S, Smith D, Arvidsson D. Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg. 2007;193(6):797–804.

    Article  PubMed  Google Scholar 

  20. Hyltander A, Lilijegren E, Rhodin P, Lonroth H. The transfer of basic skills learned in a laparoscopic simulator to the operating room. Surg Endosc. 2002;16:1324–8.

    Article  CAS  PubMed  Google Scholar 

  21. McCashland T, Brand R, Lyden E, de Garmo, P.a. The time and financial impact of training fellows in endoscopy. CORI research project. Clinical outcomes research initiative. Am J Gastroenterol. 2002;95(11):3129–32.

    Article  Google Scholar 

  22. Ferlitsch A, Glauninger P, Gupper A, Schillinger M, Haefner M, Gangl A, Schoefl R. Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy. Endoscopy. 2002;34(9):698–702.

    Article  CAS  PubMed  Google Scholar 

  23. Moorthy K, Munz Y, Jiwanji M, Bann S, Chang A, Darzi A. Validity and reliability of a virtual reality upper gastrointestinal simulator and cross validation using structured assessment of individual performance with video playback. Surg Endosc. 2004;18(2):328–33.

    Article  CAS  PubMed  Google Scholar 

  24. Cohen J, Cohen S, Vora K, Xue Xi, Burdick JS, Bank S, Bini EJ, Bodenheimer H, Cerulli M, Gerdes H, Greenwald D, Gress F, Grosman I, Hawes R, Mullin G, Schnoll-Sussman F, Starpoli A, Stevens P, Tenner S, Villanueva G. Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc. 2006;64(3):361–8.

    Article  PubMed  Google Scholar 

  25. Hochberger J, Matthes K, Maiss J, Koebnick C, Hahn E, Cohen J. Training with the compact EASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc. 2005;61(2):204–15.

    Article  PubMed  Google Scholar 

  26. Gerson L. Evidence-based assessment of endoscopic simulators for training. Gastrointest Endosc Clin N Am. 2006;16:489–509.

    Article  PubMed  Google Scholar 

  27. Brunner WC, Korndorffer JR Jr, Sierra R, Massarweh NN, Dunne JB, Yau CL, Scott DJ. Laparoscopic virtual reality training: are 30 repetitions enough? J Surg Res. 2004;122(2):150–6.

    Article  PubMed  Google Scholar 

  28. Scott D, Young W, Tesfay S, Frawley W, Rege R, Jones D. Laparoscopic skills training. Am J Surg. 2001;181(2):137–42.

    Article  Google Scholar 

  29. Brunner W, Korndorffer J, Sierra R, Dunne JB, Yau CL, Corsetti R, Slakey D, Townsend M, Scott D. Determining standards for laparoscopic proficiency using virtual reality. Am Surg. 2005;71(1):29–35.

    Article  PubMed  Google Scholar 

  30. Korndorffer J, Scott D, Sierra R, Brunner W, Dunne JB, Slakey D, Townsend M, Hewitt R. Developing and testing competency levels for laparoscopic skills training. JAMA. 2005;140(1):80–4.

    Google Scholar 

  31. Scott D, Ritter EM, Tesfy S, Pimentel E, Nagji A, Fried G. Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training. Surg Endosc. 2008;22(8):1887–93.

    Article  PubMed  Google Scholar 

  32. Satava R, Gallagher A, Pellegrini C. Surgical competence and surgical proficiency: definitions, taxonomy, and metrics. J Am Coll Surg. 2003;196(6):933–7.

    Article  PubMed  Google Scholar 

  33. Dulan D, Rege R, Hogg D, Gilberg-Fisher K, Arain N, Tesfay S, Scott D. Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery. 2012;152(3):477–88.

    Article  PubMed  Google Scholar 

  34. Dulan G, Rege R, Hogg D, Gilberg-Fisher K, Arain N, Tesfay S, Scott D. Proficiency-based training for robotic surgery: construct validity, workload, and expert levels for nine inanimate exercises. Surg Endosc. 2012;26(6):1516–21.

    Article  PubMed  Google Scholar 

  35. Martin J, Stefanidis D, Dorin R, Goh A, Satava R, Levy J. Demonstrating the effectiveness of the fundamentals of robotic surgery (FRS) curriculum on the RobotiX mentor virtual reality simulation platform. J Robot Surg. 2020. https://doi.org/10.1007/s11701-020-01085-4.

  36. Satava R, Stefanidis D, Levy J, Smith R, Martin J, Monfared S, Timsina L, Darzi AW, Moglia A, Brand T, Dorin R, Dumon K, Francone T, Georgiou E, Goh A, Marcet J, Martino M, Sudan R, Vale J, Gallagher A. Proving the effectiveness of the fundamentals of robotic surgery (FRS) skills curriculum: a single-blinded, multispecialty, multi-institutional randomized control trial. Ann Surg. 2019;272(2):384–92.

    Article  Google Scholar 

  37. Bittner J, Coverdill J, Imam T, Deladisma A, Edwards M, Mellinger J. Do increased training requirements in gastrointestinal endoscopy and advanced laparoscopy necessitate a paradigm shift? A survey of program directors in surgery. J Surg Educ. 2008;65(6):418–30.

    Article  PubMed  Google Scholar 

  38. Vassiliou M, Kaneva P, Poulose B, Dunkin B, Marks J, Sadik R, Sroka G, Anvari M, Thaler K, Adrales G, Hazey J, Lightdale J, Velanovich V, Swanstrom L, Mellinger J, Fried G. How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy? Am J Surg. 2010;191(1):121–5.

    Article  Google Scholar 

  39. Van Sickle K, Buck L, Willis R, Mangram A, Truitt M, Shabahang M, Thomas S, Trombetta L, Dunkin B, Scott D. A multicenter, simulation-based skills training collaborative using shared GI Mentor II systems: results from the Texas Association of Surgical Skills Laboratories (TASSL) flexible endoscopy curriculum. Surg Endosc. 2011;25(9):2980–6.

    Article  PubMed  Google Scholar 

  40. Weis J, Grubbs J, Scott D, Abdelfattah K, Abdelnaby A, Farr D, Hennessy S. Are we better off than we were 4 years ago? Measuring the impact of the ABS flexible endoscopy curriculum. Surg Endosc. 2020;34(9):4110–4.

    Article  PubMed  Google Scholar 

  41. Guzzetta A, Weis J, Hennessy S, Willis R, Wilcox V Jr, Dunkin B, Hogg D, Scott D. Proficiency-based preparation significantly improves FES certification performance. Surg Endosc. 2018;32(11):4451–7.

    Article  PubMed  Google Scholar 

  42. Ritter EM, Taylor Z, Wold K, Franklin B, Placek S, Korndorffer J, Gardner A. Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam. Surg Endosc. 2018;32(1):413–20.

    Article  PubMed  Google Scholar 

  43. Mueller C, Kaneva P, Fried G, Feldman L, Vassiliou M. Colonoscopy performance correlates with scores on the FES™ manual skills test. Surg Endosc. 2014;28(11):3081–5.

    Article  CAS  PubMed  Google Scholar 

  44. Weis J, Scott D, Busato L, Hennessy S. FES exam outcomes in year two of a proficiency-based endoscopic skills curriculum. Surg Endosc. 2020;34(3):961–6.

    Article  PubMed  Google Scholar 

  45. Korndorffer J, Kasten S, Downing S. A call for the utilization of consensus standards in the surgical education literature. Am J Surg. 2010;199(1):99–104.

    Article  PubMed  Google Scholar 

  46. Kane M. Validation. In: Educational measurement. New York: American Council on Education and Greenwood; 2006. p. 17–64.

    Google Scholar 

  47. Testing, J.C.o.S.f.E.a.P., APA, A.E.R.A.a.N.C.o., Education, M.i. The standards for educational and psychological testing. Washington, DC: APA; 1999.

    Google Scholar 

  48. Winckel C, Reznick R, Cohen R, Taylor B. Reliability and construct validity of a structured technical skills assessment form. Am J Surg. 1994;167(4):423–7.

    Article  CAS  PubMed  Google Scholar 

  49. Cohen R, Reznick R, Taylor B, Provan J, Rothma A. Reliability and validity of the objective structured clinical examination in assessing surgical residents. Am J Surg. 1990;160(3):302–5.

    Article  CAS  PubMed  Google Scholar 

  50. Korndorffer JR Jr, Clayton JL, Tesfay ST, Brunner WC, Sierra R, Dunne JB, Jones DB, Rege RV, Touchard CL, Scott DJ. Multicenter construct validity for southwestern laparoscopic videotrainer stations. J Surg Res. 2005;128(1):114–9.

    Article  PubMed  Google Scholar 

  51. McDougall EM, Corica FA, Boker JR, Sala LG, Stoliar G, Borin JF, Chu FT, Clayman RV. Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg. 2006;202(5):779–87.

    Article  PubMed  Google Scholar 

  52. Woodrum DT, Andreatta PB, Yellamanchilli RK, Feryus L, Gauger PG, Minter RM. Construct validity of the LapSim laparoscopic surgical simulator. Am J Surg. 2006;191(1):28–32.

    Article  PubMed  Google Scholar 

  53. Koch A, Buzink S, Heemskerk J, Botden S, Veenendaal R, Jakimowicz J, Schoon E. Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy. Surg Endosc. 2008;22(1):158–62.

    Article  PubMed  Google Scholar 

  54. Duffy A, Hoghle N, McCarthy H, Lew J, Egan A, Christos P, Fowler D. Construct validity for the LAPSIM laparoscopic surgical simulator. Surg Endosc. 2005;19:401–5.

    Article  CAS  PubMed  Google Scholar 

  55. Ritter EM, Scott D. Design of a proficiency-based skills training curriculum for the fundamentals of laparoscopic surgery. Surg Innov. 2007;14(2):107–12.

    Article  PubMed  Google Scholar 

  56. Fried G, Feldman L, Vassiliou M, Fraser S, Stanbridge D, Ghitulescu G, Andrew C. Proving the value of simulation in laparoscopic surgery. Ann Surg. 2004;240(3):518–25.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Alessi S. Fidelity in the design of instructional simulations. J Comput Based Instruct. 1988;15(2):40–7.

    Google Scholar 

  58. Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. Acad Med. 2010;85(5):806–12.

    Article  PubMed  Google Scholar 

  59. Lefor AK, Harada K, Kawahira H, Mitsuishi M. The effect of simulator fidelity on procedure skill training: a literature review. Int J Med Educ. 2020;11:97–106.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Nguyen T, Braga LH, Hoogenes J, Matsumoto ED. Commercial video laparoscopic trainers versus less expensive, simple laparoscopic trainers: a systematic review and meta-analysis. J Urol. 2013;190(3):894–9.

    Article  PubMed  Google Scholar 

  61. Ritter EM, Lineberry M, Hashimoto D, Gee D, Guzzetta A, Scott D, Gardner A. Simulation-based mastery learning significantly reduces gender differences on the fundamentals of endoscopic surgery performance exam. Surg Endosc. 2018;32:5006–11.

    Article  PubMed  Google Scholar 

  62. Preisler L, Svendsen M, Nerup N, Svendsen L, Konge L. Simulation-based training for colonoscopy. Establishing criteria for competency. Medicine. 2015;94(4):e440.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Wilcox V Jr, Trus T, Salas N, Martinez J, Dunkin B. A proficiency-based skills training curriculum for the SAGES surgical training for endoscopic proficiency (STEP) program. J Surg Educ. 2014;71(3):282–8.

    Article  PubMed  Google Scholar 

  64. Griswold-Theodorson S, Ponnuru S, Dong C, Szyld D, Reed T, McGaghie W. Beyond the simulation laboratory: a realist synthesis review of clinical outcomes of simulation-based mastery learning. Acad Med. 2015;90(11):1553–60.

    Article  PubMed  Google Scholar 

  65. McGaghie W, Barsuk J, Wayne D. Comprehensive healthcare simulation: mastery learning in health professions education. Evanston: Springer Nature; 2020.

    Book  Google Scholar 

  66. Dougherty D, Conway P. The “3Ts” road map to transform US health care. J Am Med Assoc. 2008;299:2319–21.

    Article  CAS  Google Scholar 

  67. Zendejas B, Cook D, Bingener J, Huebner M, Dunn W, Sarr M, Farley D. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg. 2011;254(3):502–9.

    Article  PubMed  Google Scholar 

  68. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl):S70–81.

    Article  PubMed  Google Scholar 

  69. Vygotsky L. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.

    Google Scholar 

  70. Burkitt E. Zone of proximal development. In: Encyclopaedic dictionary of psychology; 2006.

    Google Scholar 

  71. Zone of proximal development. In: Penguin dictionary of psychology; 2009.

    Google Scholar 

  72. Wells G. Dialogic inquiry: towards a sociocultural practice and theory of education. Learning in doing: social, cognitive and computational perspectives. Jessup: Cambridge University Press; 1999.

    Google Scholar 

  73. Wood D, Bruner J, Ross G. The role of tutoring in problem solving. J Child Psychol Psychiatry. 1976;17:89–100.

    Article  CAS  PubMed  Google Scholar 

  74. Kurt S. Vygotsky’s zone of proximal development and scaffolding. 2020. https://educationaltechnology.net/vygotskys-zone-of-proximal-development-and-scaffolding/. Accessed 28 Aug 2020.

  75. Moulton C-A, Dubrowski A, MacRae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect? A randomized, controlled. Trial Ann Surg. 2006;244(3):400–9.

    Article  PubMed  Google Scholar 

  76. Ericsson KA, Charness N, Hoffman R, Feltovich P. Consolidation and integration. In: Ericsson KA, Charness N, Hoffman R, Feltovich P, editors. The Cambridge handbook of expertise and expert performance. New York: Cambridge University Press; 2006. p. 180–1.

    Chapter  Google Scholar 

  77. Brashers-Krug T, Shadmehr R, Bizzi E. Consolidation in human motor memory. Nature. 1996;382(6588):252–5.

    Article  CAS  PubMed  Google Scholar 

  78. Stefanidis D, Scerbo M, Sechrist C, Mostafavi A, Heniford BT. Do novices display automaticity during simulator training? Am J Surg. 2008;195(2):210–3.

    Article  PubMed  Google Scholar 

  79. Stefanidis D, Scerbo M, Korndorffer J, Scott D. Redefining simulator proficiency using automaticity theory. Am J Surg. 2007;193(4):502–6.

    Article  PubMed  Google Scholar 

  80. Meneghetti A, Pachev G, Zheng B, Panton O, Qayumi K. Objective assessment of laparoscopic skills: dual-task approach. Surg Innov. 2012;19(4):452–9.

    Article  PubMed  Google Scholar 

  81. Korndorffer J, Stefanidis D, Scott D. Laparoscopic skills laboratories: current assessment and a call for resident training standards. Am J Surg. 2006;191(1):17–22.

    Article  PubMed  Google Scholar 

  82. Vassiliou M, Dunkin B, Marks J, Fried G. FLS and FES: comprehensive models of training and assessment. Surg Clin N Am. 2010;90(3):535–58.

    Article  PubMed  Google Scholar 

  83. Fraser S, Klassen D, Feldman L, Ghitulescu G, Stanbridge D, Fried G. Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc. 2003;17(6):964–7.

    Article  CAS  PubMed  Google Scholar 

  84. Vassiliou M, Kaneva P, Poulose B, Dunkin B, Marks J, Sadik R, Sroka G, Anvari M, Thaler K, Adrales G, Hazey J, Lightdale J, Velanovich V, Swanstrom L, Mellinger J, Fried G. Global assessment of gastrointestinal endoscopic skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc. 2010;24:1834–41.

    Article  PubMed  Google Scholar 

  85. Vassiliou M, Dunkin B, Fried G, Mellinger J, Trus T, Kaneva P, Lyons C, Korndorffer J, Ujiki M, Velanovich V, Kochman M, Tsuda S, Martinez J, Scott D, Korus G, Park A, Marks J. Fundamentals of endoscopic surgery: creation and validation of the hands-on test. Surg Endosc. 2014;28(3):704–11.

    Article  PubMed  Google Scholar 

  86. Training requirements. https://www.absurgery.org/default.jsp?certgsqe_training. Accessed 2 Sept 2020.

  87. Brissman I. ABOG announces new eligibility requirement for board certification. 2018. https://www.flsprogram.org/news/abog-announces-new-eligibility-requirement-board-certification/. Accessed 2 Sept 2020.

  88. Nasca T, Philibert I, Brigham T, Flynn T. The next GME accreditation system — rationale and benefits. N Engl J Med. 2012;366:1051–6.

    Article  CAS  PubMed  Google Scholar 

  89. Cogbill TH, Swing SR. Development of the educational milestones for surgery. J Grad Med Educ. 2014;6(1):317–9.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Ten Cate O. Competency-based education, entrustable professional activities, and the power of language. J Grad Med Educ. 2013;5(1):6–7.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, Garrity MJ, Lieberman SA, Lindeman B, Lypson ML, Minter RM, Rosenfield J, Thomas J, Wilson MC, Aschenbrener CA. Toward defining the foundation of the MD degree: core entrustable professional activities for entering residency. Acad Med. 2016;91(10):1352–8.

    Article  PubMed  Google Scholar 

  92. Lindeman B, Petrusa E, Phitayakorn R. Entrustable professional activities (EPAs) and applications to surgical training. Resources in Surgical Education; 2017.

    Google Scholar 

  93. Scott D. About the fellowship council: creating a bright future for fellowship training. 2018. https://fellowshipcouncil.org/about/. Accessed 8 Jul 2020.

  94. Birkmeyer JD, Finks JF, O’Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJ, Michigan Bariatric Surgery Collaborative. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434–42.

    Article  CAS  PubMed  Google Scholar 

  95. Keller DS, Delaney CP, Hashemi L, Haas EM. A national evaluation of clinical and economic outcomes in open versus laparoscopic colorectal surgery. Surg Endosc. 2016;30(10):4220–8.

    Article  PubMed  Google Scholar 

  96. Archampong D, Borowski D, Wille-Jørgensen P, Iversen L. Workload and surgeon’s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012;14(3):CD005391.

    Google Scholar 

  97. Hall BL, Huffman KM, Hamilton BH, Paruch JL, Zhou L, Richards KE, Cohen ME, Ko CY. Profiling individual surgeon performance using information from a high-quality clinical registry: opportunities and limitations. J Am Coll Surg. 2015;221(5):901–13.

    Article  PubMed  Google Scholar 

  98. Quinn CM, Bilimoria KY, Chung JW, Ko CY, Cohen ME, Stulberg JJ. Creating individual surgeon performance assessments in a statewide hospital surgical quality improvement collaborative. J Am Coll Surg. 2018;227(3):303–12.

    Article  PubMed  Google Scholar 

  99. Varban OA, Greenberg CC, Schram J, Ghaferi AA, Thumma JR, Carlin AM, Dimick JB, Collaborative MBS. Surgical skill in bariatric surgery: does skill in one procedure predict outcomes for another? Surgery. 2016;160(5):1172–81.

    Article  PubMed  Google Scholar 

  100. Fecso AB, Szasz P, Kerezov G, Grantcharov TP. The effect of technical performance on patient outcomes in surgery: a systematic review. Ann Surg. 2017;265(3):492–501.

    Article  PubMed  Google Scholar 

  101. Stulberg JJ, Huang R, Kreutzer L, Ban K, Champagne BJ, Steele SE, Johnson JK, Holl JL, Greenberg CC, Bilimoria KY. Association between surgeon technical skills and patient outcomes. JAMA. 2020;155(10):960–8.

    Google Scholar 

  102. Jones DB, Stefanidis D, Korndorffer JR Jr, Dimick JB, Jacob BP, Schultz L, Scott DJ. SAGES University MASTERS program: a structured curriculum for deliberate, lifelong learning. Surg Endosc. 2017;31(8):3061–71.

    Article  PubMed  Google Scholar 

  103. Feldman LS, Pryor AD, Gardner AK, Dunkin BJ, Schultz L, Awad MM, Ritter EM. SAGES video-based assessment (VBA) program: a vision for life-long learning for surgeons. Surg Endosc. 2020;34(8):3285–8.

    Article  PubMed  Google Scholar 

  104. Ritter EM, Gardner AK, Dunkin BJ, Schultz L, Pryor AD, Feldman L. Video-based assessment for laparoscopic fundoplication: initial development of a robust tool for operative performance assessment. Surg Endosc. 2020;34(7):3176–83.

    Article  PubMed  Google Scholar 

  105. Goldenberg MG, Jung J, Grantcharov TP. Using data to enhance performance and improve quality and safety in surgery. JAMA. 2017;152(10):972–3.

    Google Scholar 

  106. Jung J, Juni P, Lebovic G, Grantcharov T. First-year analysis of the operating room black box study. Ann Surg. 2020;271(1):122–7.

    Article  PubMed  Google Scholar 

  107. The SAGES Safe Cholecystectomy Program. Strategies for minimizing bile duct injuries: adopting a universal culture of safety in cholecystectomy. https://www.sages.org/safe-cholecystectomy-program/. Accessed 10 Sept 2020.

  108. Mascagni P, Fiorillo C, Urade T, Emre T, Yu T, Wakabayashi T, Felli E, Perretta S, Swanstrom L, Mutter D, Marescaux J, Pessaux P, Costamagna G, Padoy N, Dallemagne B. Formalizing video documentation of the critical view of safety in laparoscopic cholecystectomy: a step towards artificial intelligence assistance to improve surgical safety. Surg Endosc. 2020;34:2709–14.

    Article  PubMed  Google Scholar 

  109. Tokuyasu T, Iwashita Y, Matsunobu Y, Kamiyama T, Ishikake M, Sakaguchi S, Ebe K, Tada K, Endo Y, Etoh T, Nakashima M, Inomata M. Development of an artificial intelligence system using deep learning to indicate anatomical landmarks during laparoscopic cholecystectomy. Surg Endosc. 2020. https://doi.org/10.1007/s00464-020-07548-x.

  110. Hashimoto DA, Rosman G, Rus D, Meireles OR. Artificial intelligence in surgery: promises and perils. Ann Surg. 2018;268(1):70–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel J. Scott .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Nagaraj, M.B., Scott, D.J. (2022). Training to Proficiency. In: Romanelli, J.R., Dort, J.M., Kowalski, R.B., Sinha, P. (eds) The SAGES Manual of Quality, Outcomes and Patient Safety. Springer, Cham. https://doi.org/10.1007/978-3-030-94610-4_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94610-4_34

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94609-8

  • Online ISBN: 978-3-030-94610-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics