Defining operative experience targets in surgical training: A systematic review.

Clinical Competence General Surgery / education Humans Learning Curve Operative Time

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
11 2022
Historique:
received: 18 02 2022
revised: 07 06 2022
accepted: 20 07 2022
pubmed: 30 8 2022
medline: 12 10 2022
entrez: 29 8 2022
Statut: ppublish

Résumé

The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence. A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model. Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b). Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.

Sections du résumé

BACKGROUND
The surgical learning curve is an observable and measurable phenomenon. Operative experience targets are well established as a proxy measure for operative competence in surgical training across jurisdictions. The aim of this study was to critique the available evidence regarding the relationship between operative experience in surgical training and trainee competence.
METHODS
A systematic review of the PubMed, Embase, Web of Science, and Cochrane library databases was conducted in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses guidelines. Articles were sought that defined the relationship between procedural volume in surgical training and trainee competence, proficiency, or mastery. The educational impact of included studies was evaluated using a modified Kirkpatrick model.
RESULTS
Of 3,672 records identified on database searching, 30 papers were ultimately included. Fourteen studies defined operative experience thresholds using operative time as a surrogate measure of competence, whereas another 8 used trainer assessments of operative performance (Kirkpatrick level 3). A further 5 studies were able to determine the relationship between trainee case volumes and subsequent patient outcomes (Kirkpatrick level 4b).
CONCLUSION
Many studies have recorded competent trainee performance in key index procedures after reaching experience threshold numbers in excess of currently mandated targets across jurisdictions. The evidence relating current operative experience targets to patient outcomes across a range of surgical subspecialties of surgical subspecialties is lacking. This review supports a move toward criterion-based referencing of operative performance targets in surgical training.

Identifiants

DOI: 10.1016/j.surg.2022.07.015 PMID: 36038374
pubmed: 36038374
pii: S0039-6060(22)00542-6
doi: 10.1016/j.surg.2022.07.015
pii:
doi:

Types de publication

Journal Article Systematic Review Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1364-1372

Informations de copyright

Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

Conor Toale (C)

Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: conortoale@rcsi.com.

Aisling O'Byrne (A)

School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.

Marie Morris (M)

Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: https://twitter.com/MarieMorrisRCSI.

Dara O Kavanagh (DO)

Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.

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Classifications MeSH

questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Compétence clinique › Defining operative experience targets in...
questionsmedicales.fr › Professions de santé › Médecine › Spécialités chirurgicales › Chirurgie générale › Defining operative experience targets in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Defining operative experience targets in...
questionsmedicales.fr › Phénomènes psychologiques › Psychologie appliquée › Apprentissage › Courbe d'apprentissage › Defining operative experience targets in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Période périopératoire › Période peropératoire › Durée opératoire › Defining operative experience targets in...