Poster2-04: A PROFICIENCY-BASED CLINICAL LAPAROSCOPIC CHOLECYSTECTOMY CURRICULUM FOR RESIDENTS LEADS TO BETTER PERFORMANCE COMPARED WITH TRADITIONAL TRAINING
John R Martin, MD, Nicholas Anton, MS, Elizabeth Huffman, MD, Tomoko Mizota, MD, Sara Monfared, MD, Jennifer N Choi, MD, Dimitrios Stefanidis; Indiana University School of Medicine

Introduction: Traditional training of surgical residents is time-based and characterized by random exposure to procedures, which can lead to inconsistent experience and skill acquisition. In contrast, proficiency-based curricula tailor training to individual needs and lead to uniform skill acquisition. Our aim was to compare the effectiveness of a novel proficiency-based laparoscopic cholecystectomy (LC) skills curriculum with that of traditional training in enhancing surgery residents’ operative performance.

Methods: PGY2 residents at our institution (n=10) participated in a proficiency-based LC curriculum one at a time during a month-long rotation. The residents first completed cognitive skills training in biliary surgery followed by proficiency-based training on FLS and a virtual reality LC simulator supplemented with mental imagery training. They then participated in sequential elective LC procedures in the operating room under the supervision of 7 faculty coaches. Resident LC technical performance videos were recorded at the beginning and end of their rotation. Prior to curriculum start, LC videos were also recorded from the previous year’s PGY-2 residents (n=7) at the end of their PGY-2 year to serve as control. To minimize bias all videos were assessed at the end of the study period by 4 blinded raters using the LC Operative Performance Rating Scale (OPRS) and the Global Operative Assessment of Laparoscopic Skills (GOALS).

Results: Resident LC operative performance significantly improved from baseline to curriculum completion based on all OPRS General Criteria, OPRS LC Criteria, and GOALS ratings (p<0.05 to p<0.001). Moreover, their end of rotation operative performance was significantly better than that of control residents based on GOALS (t(12)=2.1, p<0.05) and OPRS subscales for instrument handling (t(12)=2.2, p<0.05) and respect for tissue (t(11)=1.8, p<0.05).

Conclusion: A one-month, proficiency-based laparoscopic cholecystectomy curriculum significantly improved PGY2 resident ability to perform LC and led to a higher skill level compared with traditionally trained peers. The demonstrated effectiveness of this curriculum supports its wider application to other procedures.