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A structured, extended training program to facilitate adoption of new techniques for practicing surgeons



Laparoscopic inguinal hernia repair has been shown to have significant benefits when compared to open inguinal hernia repair, yet remains underutilized in the United States. The traditional model of short, hands-on, cognitive courses to enhance the adoption of new techniques fails to lead to significant levels of practice implementation for most surgeons. We hypothesized that a comprehensive program would facilitate the adoption of laparoscopic inguinal hernia repair (TEP) for practicing surgeons.


A team of experts in simulation, coaching, and hernia care created a comprehensive training program to facilitate the adoption of TEP. Three surgeons who routinely performed open inguinal hernia repair with greater than 50 cases annually were recruited to participate in the program. Coaches were selected based on their procedural expertise and underwent formal training in surgical coaching. Participants were required to evaluate all aspects of the educational program and were surveyed out to one year following completion of the program to assess for sustained adoption of TEP.


All three participants successfully completed the first three steps of the seven-step program. Two participants completed the full course, while the third dropped out of the program due to time constraints and low case volume. Participant surgeons rated Orientation (4.7/5), GlovesOn training (5/5), and Preceptored Cases (5/5) as highly important training activities that contributed to advancing their knowledge and technical performance of the TEP procedure. At one year, both participants were performing TEPs for “most of their cases” and were confident in their ability to perform the procedure. The total cost of the program including all travel, personal coaching, and simulation was $8638.60 per participant.


Our comprehensive educational program led to full and sustained adoption of TEP for those who completed the course. Time constraints, travel costs, and case volume are major considerations for successful completion; however, the program is feasible, acceptable, and affordable.

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The authors would like to thank Shanu N. Kothari, MD and Michael J. Garren, MD who served as surgical coaches for this project. We would also like appreciate the surgeons who participated in this program.


This project was funded by an investigator-initiated grant from Medtronic, Inc., the Susan Behrens, MD Professorship in Surgical Education Fund, and the Wisconsin Partnership Program for Education and Research.

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Correspondence to Jacob A. Greenberg.

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Jacob A. Greenberg is a paid speaker for Medtronic, a paid consultant for Ariste Medical, and a paid speaker for W.L. Gore. Sally Jolles, Sudha Quamme, Sarah Sullivan, Carla Pugh, and Caprice Greenberg have no conflicts of interest. Efforts on this study and manuscript were made possible by a VA Career Development Award to Dr. Funk (CDA 15-060. The views represented in this article represent those of the authors and not those of the DVA or the US Government. This project was sponsored by support from Medtronic, but was product agnostic and did not require use of Medtronic products.

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Greenberg, J.A., Jolles, S., Sullivan, S. et al. A structured, extended training program to facilitate adoption of new techniques for practicing surgeons. Surg Endosc 32, 217–224 (2018).

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  • Laparoscopic inguinal hernia repair
  • Continuous professional development
  • Surgical coaching
  • Clinical performance assessment
  • Clinical outcomes
  • Simulation