L. M. Baumann1,2, K. A. Barsness1,2 1Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 2Ann & Robert H Lurie Chidren’s Hospital,Pediatric Surgery,Chicago, IL, USA
Introduction: A number of congenital anomalies are amenable to advanced minimally invasive surgery (MIS) techniques. Unfortunately, these procedures are rare, leaving surgeons with few opportunities to develop the necessary skills to safely perform the operations minimally invasively. The majority of pediatric MIS training courses occur at annual conferences, with 4-8 hours of intensive training. Best described as “exposure courses,” little data is available to support the benefit of these courses relative to the safe implementation of new skills. The purpose of this manuscript is to determine the impact of an exposure course for advanced neonatal MIS skills on perceived comfort levels with performing advanced MIS operations independently.
Methods: A 4-hour hands-on course for advanced neonatal MIS procedures was held at an international surgical congress. Course participants were practicing surgeons seeking to advance surgical skills in thoracoscopic tracheoesophageal fistula (tTEF) repair, thoracoscopic lobectomy (tLobe), and laparoscopic duodenal atresia (lapDA) repair. Anonymous surveys regarding clinical practices and pre- and post-training perceived “comfort levels” for each procedure were completed by participants. Descriptive analyses were performed.
Results: Of 18 course participants, 17 completed pre- and post-course surveys. Pre-course, the majority of participants had no prior experience with tLobe (59%) or lapDA (53%), and many had no experience with tTEF repair (35%). Similarly, the majority were “not comfortable” with minimally invasive tTEF repair (59%), tLobe (65%), and lapDA repair (71%). On post-course survey, the majority of surgeons were “likely to perform” these operations within 6 months. Of the 6+ participants with no prior experience, 67%, 70%, and 56% were “somewhat or very likely” to perform tTEF, tLobe, and lapDA repair within 6 months. Similarly, of the 10+ participants self-reportedly “not comfortable” with the MIS procedures, 70%, 73%, and 58% were “somewhat or very likely” to perform these procedures within 6 months.
Conclusion: In conclusion, an exposure training course led to immediate perception of increased skills and confidence. While these data may seem to support “exposure” courses, basic tenets of expert performance that demands deliberate practice in a distributed schedule, with ongoing formative and summative feedback, are typically not provided in exposure courses such as these. Future course design should transition to a Mastery Learning framework in which regular skills assessments, milestones, and unlimited education time are prioritized, prior to implementation of the new skills.