Implementation and evaluation of a comprehensive proficiency-based curriculum in an advanced, minimally invasive procedure: a multi-institutional Canadian experience

Abstract

Introduction: A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was previously developed and shown to be more educationally effective than conventional surgery training.

Objective: To implement and evaluate this proficiency-based curriculum in 2 academic general surgery residency programs in Canada.

Setting: Two academic, general surgery residency programs at university hospitals in Ontario, Canada.

Methods: An 8-week, proficiency-based curriculum consisted of a didactic component (lectures, small group sessions, assigned readings) and a simulation-based component (proficiency-based training in laparoscopic enteroenterostomy and a simulated operating room crisis scenario). It was offered to postgraduate years 2-5 general surgery residents in 2 academic programs in Canada. Pre- and postcurriculum procedure-specific knowledge and psychomotor skills were assessed using a 25-item knowledge test and a procedure-specific assessment scale. Postcurriculum nontechnical skills were assessed using the Nontechnical Skills for Surgeons scale. Participants' perceptions about the curriculum were assessed using a questionnaire. Direct costs for curriculum implementation were recorded.

Results: Twenty-five residents participated in the curriculum across 2 programs. Completion of the curriculum resulted in significant improvement in technical skills (45 [37.5-65] versus 88 [85-93]; P < .01) and demonstration of "acceptable" situational awareness (3 [3-4]), decision-making (3 [3-4]), teamwork and communication (3 [2-4]), and leadership (3 [3-4]) skills. There was no improvement in procedure-specific knowledge (48 [40-64] versus 58 [48-60]; P = .39). Participants perceived all components of the curriculum as educationally valuable, and 96% agreed and/or strongly agreed that this curriculum should continue to be a part of academic curriculum. The average cost of curriculum implementation was $613.05 Canadian dollars per participant. Lack of faculty supervision was the main barrier to implementation with only 65% of participants agreeing and/or strongly agreeing that quantity of faculty supervision was optimal.

Conclusions: A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was successfully implemented and evaluated at 2 academic general surgery residency programs in Canada. Adequate faculty preceptor resources are essential for widespread implementation.

Keywords: Advanced minimally invasive surgery; Bariatric surgery; Proficiency-based training curriculum.