Abstract
Purpose
Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills.
Methods
A randomised controlled trial concerning supervised hernia repair in eight training hospitals in Denmark was performed. The participants were 18 registrars [Post graduate year (PGY) 3 or more] in their first year of surgical specialist training. The intervention consisted of different modules with a skills-lab course followed by 20 supervised Lichtenstein hernia repairs. Operative performance was video recorded and blindly rated by two consultants using a previously validated skills rating scale (8–40 points). Outcome measures were change in the ratings of operative skills and operative time.
Results
In the intervention group (n = 10) the average rating of operative skills before intervention was 22.5 (20.6–24.3) and after 26.2 (23.5–28.8), p = 0.044. At follow-up after 1 year, rating was 26.9 (23.4–30.4), p = 0.019. In the conventionally trained group average rating was 23.4 (19.4–27.3) at start and 21.7 (17.3–26.1) at end, p = 0.51. At start no difference was detected between the two groups, p = 0.59; by 1 year the difference was statistically significant favouring intervention, p = 0.044. Operative time showed similar results in favour of the intervention.
Conclusions
A module-based training model in Lichtenstein hernia repair was preferable in both short and long-term compared with standard clinical training. The model will probably be applicable to other surgical training procedures.
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Acknowledgments
We thank the doctors and the staff involved in skills lab course, participating trainees, supervisors and patients accepting the video recording of the hernia repairs. Furthermore, this study owes a special thanks to the huge work of the consultants involved in the rating of the recordings. A special thanks to the Tryg foundation that sponsored the skills lab courses. Thank you to the public funders of the research: Aarhus University, Aalborg University Hospital and The Central Denmark Region.
Conflict of interest
Dr. C Carlsen declares no conflict of interest.
Dr. K Lindorff-Larsen declares no conflict of interest.
Dr. P Funch-Jensen declares no conflict of interest.
Dr. L Lund declares no conflict of interest.
Dr. L Konge declares no conflict of interest.
Dr. P Charles declares no conflict of interest.
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Additional information
Parts of the results have formerly been presented at Surgicon 2013 and AMEE 2013.
ClinicalTrials.gov identifier: NCT01877824.
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Carlsen, C.G., Lindorff-Larsen, K., Funch-Jensen, P. et al. Module based training improves and sustains surgical skills: a randomised controlled trial. Hernia 19, 755–763 (2015). https://doi.org/10.1007/s10029-015-1357-6
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DOI: https://doi.org/10.1007/s10029-015-1357-6