Perceptions of surgical specialists in general surgery, orthopaedic surgery, urology and gynaecology on teaching endoscopic surgery in The Netherlands

Abstract

Background: Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands.

Methods: Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire.

Results: A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines.

Conclusions: A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.

Fig. 1

Specialty

Fig. 2

Total number of endoscopic operations per year as performed by respondent

Fig. 3

Respondent teaches endoscopic skill in skills course

Fig. 4

Response on statements: 1. I am worried whether the current resident-in-training works enough clinical hours to be skilled upon completion of formal training. 2. I am worried whether the current resident in-training works enough clinical hours, in my opinion, to have adequate endoscopic skills upon completion of formal training

Fig. 5

Endoscopy taught in region

Fig. 6

Number of hours of obligatory training

Fig. 7

Type of endoscopic skill training

Fig. 8

Skill training obligatory

Fig. 9

Evaluation of endoscopic training

Fig. 10

Overall opinion of tutors on the effectiveness of different training modalities

Fig. 11

Ideal percentages of training modalities embedded in endoscopic skills course

Fig. 12

Consensus guidelines

Fig. 13

Coordination and location for skills education

Fig. 14

Examination of course