Training in advanced laparoscopic surgery

• Main Author: Wyles, Susannah Mary
• Other Authors: Hanna, George ; Darzi, Ara
• Published: Imperial College London 2013
• Subjects: 610
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.631197

Laparoscopic surgery is an example of a practical technique within medicine that can have a lengthy learning curve to gain competence. A change in NICE guidance in 2006 prompted the development of a National Training Programme (NTP) to train consultant surgeons in laparoscopic colorectal surgery (LCS). Using the NTP and enrolled trainers and trainees as a backbone for the studies within this research, the aim was to address “how” and “who” should be training LCS. A comprehensive search of the literature was performed. Through this, and the application of a qualitative research approach employing interview studies, data were gleaned, items derived, questionnaires developed and using a Delphi consensus technique, item importance determined. From this, three detailed assessment forms (mini-Structured Training Trainer Assessment Report (mini-STTAR) and the STTAR, and GAS form) were created to allow both the trainee and an observer to provide feedback to the trainer regarding their training structure, behaviour, attitudes and role modelling, and also the trainee’s progress to be assessed. A formal analysis of trainer and trainee learning and teaching styles and personality was performed (Honey and Mumford, Staffordshire Evaluation of Teaching Styles (SETS) and 16PF respectively), and the impact of these factors on training outcomes assessed. Detailed questionnaires addressed the trainees’ opinions of different training modalities within courses, and the NTP structure as a whole. The training of advanced laparoscopic surgery was found to best match the educational theory of cognitive apprenticeship. The cadaveric model for LCS training course was thought to be superior to porcine or virtual reality in terms of fidelity and educational value and fidelity. The assessment tools were validated and implemented successfully into the programme. Despite detailed analysis, no single psychometric test could be used to predetermine the good trainers. Overall the NTP in its current format was deemed to be acceptable.