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Obesity Week 2013

SET curriculum is a more effective training approach

SET group required fewer cases in a live porcine and more achieved proficiency by their 2nd case

A comprehensive simulation-enhanced training (SET) curriculum in bariatric surgery is superior compared to conventional surgical training (CT), according to researchers from the University of Toronto and St Michael's Hospital, Toronto, Canada. The research was presented at the 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2013, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event was hosted by the ASMBS and The Obesity Society (TOS).

They designed the prospective single-blinded randomised controlled trial to compare the effectiveness of training in a comprehensive SET curriculum in bariatric surgery to conventional CT. Twenty intermediate-level surgical residents were allocated to SET and CT group and final year (FY) residents were used as a comparison group. A cadaveric porcine jejunojeunostomy (JJ) model was used for baseline assessment of technical skill.

The SET group completed cognitive, technical and non-technical components of the curriculum, whilst the CT group continued conventional training. Post-intervention assessment included a knowledge test, a laparoscopic JJ on a live anesthetised porcine model, a JJ in the operating room (OR), and a simulated intraoperative crisis scenario. A minimum level of proficiency in a porcine model was required prior to progression to the OR.

Twenty out of 26 eligible participants were recruited and the baseline characteristics were equivalent between the groups.

The results revealed that the SET group demonstrated higher operative skill in a live porcine model (Bariatric Objective Structured Assessment of Technical Skill (BOSATS):56.4(11.5) vs .46.0(10.6), p=0.049) and higher non-technical skill in a simulated intraoperative crisis scenario (Non-Technical Skills for Surgeons (NOTSS):40.8(4.2) vs .31.6(8.7), p<0.001).

SET group also required fewer cases in a live porcine model (1.6(0.7) vs. 2.2(1.1)) and had more participants achieving predefined proficiency by their 2nd case (9/10 vs. 3/10, p=0.020).

This group also showed significant within-group improvement in technical skill from baseline to assessment in a live porcine model (BOSATS:39.0(15.1) vs. 56.4(11.5), p=0.002); whereas the CT group did not (BOSATS:43.5(13.4) vs. 46.0(10.6), p=0.569).

The operative skill in the OR was equivalent between the groups (BOSATS:61.1(8.8) vs. 64.1(10.8), p=0.529), as were the proportion of operative steps completed without takeover (0.86(0.26) vs. 0.67(0.16), p=0.096) and scores on the knowledge test (12.8(2.9) vs. 13.9(1.8), p=0.324).

In comparison to FY residents, SET group had equivalent operative skill in the OR (BOSATS:64.1(10.8) vs. 67.3(9.6), p=0.526), higher non-technical skills (NOTSS:40.8(4.2) vs. 31.3(6.2), p<0.001), lower knowledge scores (12.8(2.9) vs. 15.8(2.1), p=0.020), and completed an equivalent proportion of operative steps in the OR (0.86(0.16) vs. 0.86(0.14), p=0.983).

They concluded that as participation in the SET curriculum resulted in superior training outcomes when compared to conventional surgical training, implementation of this curriculum would offer standardisation of bariatric surgical training, as well as ensure that comprehensive proficiency milestones are attained prior to exposure to patient care.

To access the posters and abstracts from Obesity Week, please click here

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American Society for Metabolic and Bariatric Surgery

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