Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery

Abstract

Objective: To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice.

Summary background data: Concerns about the adequacy of training in new techniques for practicing surgeons began almost immediately after the introduction of laparoscopic cholecystectomy. The concern was restated throughout the following decade with seemingly little progress in addressing it.

Methods: A preliminary search of the medical literature revealed no systematic review of continuing medical education for technical skills. The search was broadened to include educational, medical, and psychological databases in four general areas: surgical training curricula, continuing medical education, learning curve, and general motor skills theory.

Results: The introduction and the evolution of minimal access surgery have helped to focus attention on technical skills training. The experience in the first decade has provided evidence that surgical skills training shares many characteristics with general motor skills training, thus suggesting several ways of improving continuing medical education in technical skills.

Conclusions: The educational effectiveness of the short-course type of continuing medical education currently offered for training in new surgical techniques should be established, or this type of training should be abandoned. At present, short courses offer a means of introducing technical innovation, and so recommendations for improving the educational effectiveness of the short-course format are offered. These recommendations are followed by suggestions for research.

Figure 1. A learning curve showing the relationship between operative time and experience for laparoscopic fundoplication in children. (Used with permission from Meehan JJ, Georgeson KE. The learning curve associated with laparoscopic antireflux surgery in infants and children. J Pediatr Surg 1997; 32:426–429.)

Figure 2. A graph of the calculated probability of bile duct injury during laparoscopic cholecystectomy. (Used with permission from Southern Surgeons Club, Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. Am J Surg 1995; 170:55–59.)