Poster4 - 04: A NOVEL COMPETENCY-BASED CURRICULUM FOR LAPAROSCOPIC CHOLECYSTECTOMY
Jennifer N Choi, John R Martin, Nicholas Anton, Sara Monfared, Tomoko Mizota, Dimitrios Stefanidis; Indiana University

Introduction: Surgical training has been traditionally time-based, which is known to lead to significant skill variability of graduating residents. Proficiency-based curricula tailor training to individual needs, ensure uniform skill acquisition, and have become the standard for optimal skill acquisition on simulators. Our aim was to develop and implement  an innovative, proficiency-based skills curriculum for laparoscopic cholecystectomy (LC) in a general surgical residency and study its preliminary effectiveness. 

Methods: A proficiency-based curriculum for LC was developed incorporating best practices in education and skill acquisition. The curriculum consists of baseline LC VR simulator assessment, cognitive skills training (SCORE curriculum modules, SAGES safe LC website, FUSE online curriculum, and review of several LC videos), followed by technical skills training to expert level (on FLS tasks, and on the LC VR simulator), mental imagery training, and standardized expert coaching in the operating room during elective LCs. The curriculum is being implemented with PGY-2 level residents during a 1-month LC rotation in which all LCs performed at our program are directed to them. Resident performance is being assessed on the VR simulator, and intraoperatively using the LC OPRS instrument before and after training.

Results: To date, three PGY-2 level residents have completed the LC rotation. Based on VR simulator assessment, participants committed a total of 15 critical errors prior to training, and only one after training. Based on LC OPRS assessment of autonomy and technical skill, all have demonstrated significant performance improvement. Prior to training, no one obtained the critical view of safety during LC, while all obtained it after training. All residents reported that the curriculum had a significant impact on their skills.

Conclusion: We have demonstrated the feasibility of implementing an innovative proficiency based clinical curriculum for LC in a general surgery program. Our preliminary data and resident opinion suggest that this curriculum is effective in accelerating resident LC learning curve. Accumulation of further data and expansion to other programs will allow us to confirm these promising preliminary results.