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Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment

Surgical Endoscopy volume 36, pages 47–56 (2022)Cite this article

Abstract

Background

The efficacy of simulation-based training in surgical education is well known. However, the development of training programs should start with problem identification and a general needs assessment to ensure that the content is aligned with current surgical trainee needs. The objective of the present study is to identify the technical skills and clinical procedures that should be included in a simulation-based curriculum in general surgery.

Methods

A national, three-round Delphi process was conducted to achieve consensus on which technical skills and clinical procedures should be included in a simulation-based curriculum in general surgery. In total, 87 key opinion leaders were identified and invited to the study.

Results

Round 1 of the Delphi process had a response rate of 64% (56/87) and a total of 245 suggestions. Based on these suggestions, a consolidated list of 51 technical skills or clinical procedures was made. The response rate in Delphi round 2 was 62% (54/87) resulting in a pre-prioritized order of procedures for round 3. The response rate in Delphi round 3 was 65% (35/54). The final list included 13 technical skills and clinical procedures. Training was predominantly requested within general open surgical skills, laparoscopic skills, and endoscopic skills, and a few specific procedures such as appendectomy and cholecystectomy were included in the final prioritized list.

Conclusion

Based on the Delphi process 13 technical skills and clinical procedures were included in the final prioritized list, which can serve as a point of departure when developing simulation-based training in surgery.

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Author information

Affiliations

  1. Corporate HR, MidtSim, Aarhus, Central Denmark Region, Denmark

    Rune Dall Jensen & Charlotte Paltved

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Rune Dall Jensen, Charlotte Paltved & Anders Husted Madsen

  3. Department of Surgery, Hospitalsenheden Vest, Herning, Central Denmark Region, Denmark

    Claudia Jaensch & Anders Husted Madsen

  4. Department of Surgery, Odense University Hospital, Odense, Denmark

    Jesper Durup

  5. Department of Surgery, Nordsjællands Hospital Hillerød, Hillerød, Denmark

    Randi Beier-Holgersen

  6. Copenhagen Academy for Medical Education and Simulation and the Capital Region of Denmark, Copenhagen, Denmark

    Lars Konge & Leizl Nayahangan

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  1. Rune Dall Jensen
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  2. Charlotte Paltved
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  3. Claudia Jaensch
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Correspondence to Rune Dall Jensen.

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Drs. Dall Jensen, Paltved, Jaensch, Durup, Beier-Holgersen, Konge, Husted Madsen, and RN. Nayahangan have no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

Procedures identified in Delphi round 1 and ranked according to CAMES Needs Assessment Formula in Delphi round 2

  Technical skill or clinical procedure No. of procedures performed (Frequency) No. of doctors Impact Feasibility CAMES NAF score
1 Open surgery: handling of instruments, suturing, knot-tying technique 4.8 4.9 3.9 5 18.6
2 Laparoscopy: handling of instruments, suturing, knot-tying technique 4.8 4.7 4 5 18.5
3 Open surgery: ensuring hemostasis 4.8 4.9 4.2 4 17.9
4 Laparoscopy: ensuring hemostasis 4.6 4.8 4.1 4 17.5
5 Gastroscopy 4.9 4.7 3.8 4 17.4
6 Colonoscopy 4.9 4.4 4.1 4 17.4
7 Open surgery: suturing anastomosis 3.7 4.3 4.6 4.3 16.9
8 Polyp management in lower gastrointestinal endoscopy 4.6 4.2 4 4 16.8
9 Sigmoidoscopy 4.3 4.6 3.9 4 16.8
10 Lower GI endoscopy: perform biopsy 4.7 4.6 3.7 3.6 16.6
11 Upper GI endoscopy: perform biopsy 4.7 4.5 3.6 3.6 16.4
12 Endoscopic management of upper gastrointestinal bleeding 3.1 4.3 4.2 4.3 15.9
13 Ostomy construction and management 3.3 4.3 4.3 4 15.9
14 Assessment of ulcer in gastroscopy 3.3 4.2 4 4.3 15.8
15 Upper GI endoscopy: management of polyps 3.8 3.9 3.7 4 15.4
16 Small bowel resection 3.1 4.2 4.3 3.6 15.2
17 Endoscopic management of lower gastrointestinal bleeding 3.1 4.1 4 4 15.2
18 Colon resection 3.5 3.4 4.5 3.6 15.0
19 Endoscopic assessment and management of colorectal cancer 3.6 3.7 4.1 3.6 15.0
20 Exploratory laparotomy 3.5 4.6 4.2 2.6 14.9
21 Appendectomy 4.1 4.8 3.7 2.3 14.9
22 Minor surgical procedures (e.g., anorectal abscess, pilonidal disease) 4 4.6 3.6 2.6 14.8
23 Laparoscopic surgery: performing anastomosis 3.1 3.3 4.6 3.6 14.6
24 Laparoscopic surgery: ostomy construction and management 2.8 3.5 4.3 4 14.6
25 Anoscopy/rectoscopy 4.1 4.6 3.6 2.3 14.6
26 Cholecystectomy 3.9 4.3 4.3 2 14.5
27 Upper GI endoscopy: removal of foreign bodies 2.3 4.1 4.1 3.6 14.1
28 Hernia repair 3.7 4.1 4.1 2 13.9
29 Lysis of adhesions, entry of the lesser sac, Kocher maneuver, portal clamping (Pringle maneuver) 3.5 4.2 4.4 1.3 13.4
30 Lower GI endoscopy: assessment and management of hemorrhoids 3.1 3.7 3.9 2.6 13.3
31 Abdominal ultrasound 2.9 2.8 3.2 4.3 13.2
32 Prophylactic banding of esophageal varices 2.5 3.9 4.4 2.3 13.1
33 Vascular exposure of larger vessels 1.7 3 4.6 3.6 12.9
34 Preperitoneal pelvic packing, perihepatic packing 1.4 4.1 4.2 3 12.7
35 Partial gastric resection (BII), Gastrojejunal (GJ) anastomosis 1.5 2.3 4.7 4 12.5
36 Management of fascial dehiscence 2.4 4.6 4.4 1 12.4
37 Management of surgical site infection 2.9 4.8 3.6 1 12.3
38 Endoscopic retrograde cholangiopancreatography (ERCP) 3.9 1.4 4.6 2.3 12.2
39 Management of postoperative hemorrhage 2.2 4.7 4.3 1 12.2
40 Colonoscopic decompression 2.4 4.5 3.9 1.3 12.1
41 Upper GI endoscopy treatment: placement of feeding tube 3 4.2 3.6 1 11.8
42 Splenectomy 1.6 3.6 4.5 2 11.7
43 Placement of percutaneous endoscopic gastrostomy tube 2.9 3.8 4 1 11.7
44 Thoracotomy 1.1 2.1 4.6 3.6 11.4
45 Lower GI endoscopy: management of anal fissure 3 3.3 3.8 1 11.1
46 Lower GI endoscopy: management of anal fistula 3.1 2.7 4.2 1 11.0
47 Lower GI endoscopy: removal of foreign bodies 1.8 4.2 4 1 11.0
48 Placement of a Sengstaken–Blakemore tube 1.2 3.7 4.4 1.6 10.9
49 Upper GI endoscopy: stent placement 2.3 2.3 4.4 1.6 10.6
50 Lower GI endoscopy: stent placement 2.2 2.2 4.4 1 9.8
51 Transrectal ultrasound (TRUS) 2.7 1.7 3.8 1.6 9.8

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Jensen, R., Paltved, C., Jaensch, C. et al. Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment. Surg Endosc 36, 47–56 (2022). https://doi.org/10.1007/s00464-020-08235-7

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Keywords

  • Surgical education
  • Curriculum development
  • National needs assessment
  • Simulation-based education