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Multicenter Study
. 2020 Aug;44(8):2501-2510.
doi: 10.1007/s00268-020-05539-6.

See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

T Huber  1   2 , I Richardsen  3   4 , C Klinger  5 , M Mille  3   6 , A A Roeth  3   7 ; AsTerOiD-Study Group
Collaborators, Affiliations
Multicenter Study

See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany

T Huber et al. World J Surg. 2020 Aug.

Abstract

Introduction: Due to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence-based learning technique of surgical skills is the sub-step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi-center trial was to determine the status quo of the sub-step concept in Germany.

Methods: Over 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus-preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub-steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub-step concept was performed before and after the study.

Results: In total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub-steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub-steps (43.3%). Reasons for not assisting sub-steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub-steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub-step concept. The number of resident procedures was overestimated, and the number of performed sub-steps was underestimated. After the study, these estimations were more realistic.

Conclusion: Even though the sub-step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed.

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Conflict of interest statement

The authors have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Overview of performed sub-steps and procedures performed by residents according to the care level of the participating center (university hospital: n = 7; tertiary care: n = 7; primary and secondary care: n = 7; p > 0.05)
Fig. 2
Fig. 2
Reasons why sub-steps were not performed (young fellow: within 1 year of board examination)
Fig. 3
Fig. 3
Percentage of total performed sub-steps in PPPD procedures during the study period
Fig. 4
Fig. 4
Promotion campaign of the surgical sub-step concept of the German young surgeons working group (CAJC) (Modified from [12])
See this image and copyright information in PMC

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