Laparoscopic training: Results of a Belgian survey in trainees

The assurance of adequate training in laparoscopic surgery still is a signi ficant problem. This report aims to provide data and to formulate suggestio ns, based on the results of a questionnaire completed by 53 trainees, on a literature review and on discussions within the committee on training of th e Belgian Group for Endoscopic Surgery (BGES). About 2/3 trainees think that their theoretical competence in laparoscopy i s satisfactory or excellent. In contrast, 2/3 consider that their practical training is inadequate; only 53% of the sixth year trainees felt confident about their practical competence. The vast majority (72 %) of senior train ees (5th and 6th year) performed less than 50 laparoscopic cholecystectomie s or appendicectomies as first surgeon. Very few of them had the opportunit y to perform advanced procedures, e.g. fundoplication or colon resection. L aparoscopic appendicectomy is the most common operation done by young train ees (3-4(th) year) : 56 % performed more than 10 procedures. In the majority of surgical centres, the trainee has few opportunities to p erform supervised laparoscopic surgery because of the limited experience of the surgical staff, the learning curve of tutors, and the limited number o f laparoscopic operations in some centres. Several solutions are proposed: training courses with laparoscopic procedures on animals, set up of quota ( also for tutors), pelvi-trainer, recommended participation in theoretical c ourses (trainee session), more free time for attendance at scientific meeti ngs and for reading surgical books and journals Up to now, no formal process for certification of surgical competence in la paroscopy has been promoted. Moreover, not only the organisation and monito ring, but also the cost of training must be managed, and responsabilities m ust be taken by all persons and instances involved: teachers, teaching cent res, professional board, government.