Optimal teaching environment for laparoscopic splenectomy

Background: Traditional surgical teaching depends on graduated acquisition of skill learned in residency. The introduction of minimal access technique s after residency training has created a new paradigm dependent on animate course experiences and limited preceptor training. The outcome of performan ce of a new skill "learned" in these settings has not been assessed. The pu rpose of this study was to test the benefit of an animate course compared w ith a precepted operating room experience in learning to perform a laparosc opic splenectomy. Methods: All attending surgeons who had taken a I-day course to learn lapar oscopic splenectomy (n = 37) rind those who had undergone an intraoperative preceptorship (in their hospital)by the lead author (n = 15) were polled t o ascertain their previous experience with laparoscopy and with laparoscopi c splenectomy since the intervention. The course included lectures, operati ve videos, and an animal lab. Statistical differences were measured using a t test. Results: Thirty-two of the 37 (86.5%) taking the course and all 15 of the p recepted surgeons responded. There was no difference between the groups reg arding prior laparoscopic experience(P = 0.73), laparoscopic training durin g residency (P = 0.74), academic or private practice (P = 0.48), or follow- up since the intervention (P = 0.36). The participants graded the courses ( 1 to 5, 5 = excellent) at an average of 4.72. Fourteen of 15 precepted surg eons have performed laparoscopic splenectomy as compared with 2 of 32 takin g courses (nonprecepted surgeons; P < 0.0001). The number:of laparoscopic s plenectomies performed totaled 112 for precepted surgeons and 4 for nonprec epted surgeons (P = 0.0003). The nonprecepted surgeons performed significan tly more open splenectomies than laparoscopic (95 versus 13 respectively, P = 0.02). Reasons quoted not to proceed with laparoscopic splenectomy inclu ded waiting for the perfect patient, concern of hilar management, and Splen ic size. Conclusion: Surgeons precepted in their own operating room performed a lapa roscopic splenectomy more readily than those gaining experience from a cour se-only (93% versus 6%, respectively) despite no difference in their preint ervention experience and having the opportunity to do so. The expectation o f the eventual performance of advanced laparoscopic techniques depends on a precepted experience. (C) 2001 Excerpta Medica, Inc. All rights reserved.