PS8-08: A TRAINING CURRCULUM SIMULATATING SIGNIFICANT INTRAOPERATIVE BLEEDING DURING LAPAROSCOPIC SURGERY CAN IMPROVE RESIDENT SKILL AND CONFIDENCE
Stephen P Haggerty, MD, Jennifer Paruch, MD, Tetsuya Nakazato, MD, Kristine Kuchta, Nancy Schindler, MD; Northshore University Healthsystem

Introduction: All surgeons must have the ability to manage significant intraoperative bleeding during laparoscopic surgery. Surgical trainees acquire skill by observation, mentorship and practice. However, due to several factors, residents are given less autonomy in the operating room and during bleeding they may have less opportunity to operate independently.  We hypothesized that a hands on skills training curriculum would improve the resident’s confidence and skill in laparoscopic control of significant bleeding (LCSB), and this may lead to more live patient opportunities.

Methods: We developed a reproducible porcine model of uncontrolled bleeding and assessed the resident’s ability to follow 7 important steps to control bleeding using standard laparoscopic instruments, suction and 10 mm clips. The curriculum consisted of didactic session and lab where pre and post test skills assessment (5 point Likert scale per step, maximum 35) was performed with practice in between. We also collected pre-session needs assessment and session evaluation.  Comparisons between pre and post test skills were made using the paired t-test. Comparisons between groups were made using the Wilcoxon rank-sum test.  Statistical significance was set at p<.05.

Results: A total of 25 residents completed the curriculum (7 R3, 13 R4, 5 R5) that was given 4 times over a 2 year period.  Before the session 43% residents were not confident, 52% were somewhat confidant and 5% were very confident in LCSB. The average pretest score was 26.3±4.3 and post was 32.4±2.7 (p<.001).  R3 (pre 27.1±5.9, post 30.8±4.4, p=0.253) residents did not significantly improve from pre to post test, but R4 (pre 25.7±3.6, post 32.9±1.8, p<.001) and R5 (pre 26.6±4.4, post 33.0±2.0, p=0.024) residents did.  There were no differences in pre, post, or difference from pre to post test scores between R3, R4, and R5 residents (pre p=0.863, post 0.556, difference p=0.356).  After the curriculum was completed trainees reported very significant (89%) or significant (21%) improvement in their perceived ability and confidence in LCSB. 

Conclusion: A curriculum simulating significant intraoperative bleeding during laparoscopic surgery can improve resident skill and confidence. Further assessment during live surgery is needed to confirm the true benefit.