Consensus views on the optimum training curriculum for advanced minimally invasive surgery: A delphi study.

INTRODUCTION There has been a wide uptake in the use of Minimal Invasive Surgery (MIS) globally across different surgical specialties. Whilst evidence exists for a structured training curriculum for basic laparoscopic surgery, there is little agreement on a complete framework for an advanced MIS training curriculum, defining the essential elements of the curriculum including the optimal assessment methods. The aim of this study is to obtain a consensus on the essential elements of a training curriculum for advanced MIS. MATERIALS AND METHODS A Delphi study was carried out involving 57 international experts in advanced MIS across different surgical specialties. A three round survey was conducted to reach consensus on the essential domains of a curriculum. This included defining the learners, trainers and training centres; curriculum content and competency based assessment. RESULTS Unanimous agreement was reached for the completion of basic laparoscopic training before entry into advanced training. A trainer should have reached competency in advanced MIS and attended a 'Train the trainer' course. The curriculum should be delivered as modular training, including a multi-modal approach with a structured clinical proctorship programme. Formative assessment was considered as an integral part of learning and should be performed using objective work based assessment tools such as global assessment scale (GAS) forms. Accreditation in advanced MIS can be achieved by objective assessment of technical performance of unedited videos in addition to key clinical performance outcomes. CONCLUSION A consensus on the framework of an advanced MIS training curriculum has been achieved defining the essential elements of entry criteria, selection of trainers and training units and curriculum content. Multimodal learning, clinical proctorship programme and competency based assessment are integral parts of the curriculum.

[1]  T S Ikonen,et al.  Virtual Reality Simulator Training of Laparoscopic Cholecystectomies — A Systematic Review , 2012, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[2]  M. Mizumoto,et al.  Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm , 2015, Case reports in surgery.

[3]  A Cuschieri,et al.  The performance of master surgeons on standard aptitude testing. , 2001, American journal of surgery.

[4]  B. Samstein,et al.  Laparoscopic Living Donor Left Lateral Sectionectomy: A New Standard Practice for Donor Hepatectomy. , 2015, Annals of surgery.

[5]  J. Rosenberg,et al.  Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track , 2012, Minimally invasive surgery.

[6]  Adam Dubrowski,et al.  Teaching Surgical Skills: What Kind of Practice Makes Perfect?: A Randomized, Controlled Trial , 2006, Annals of surgery.

[7]  J. Yu,et al.  Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer , 2014, Journal of Gastrointestinal Surgery.

[8]  Rajesh Aggarwal,et al.  Framework for systematic training and assessment of technical skills. , 2007, Journal of the American College of Surgeons.

[9]  S. Furness,et al.  Laparoscopy versus laparotomy for benign ovarian tumour. , 2009, The Cochrane database of systematic reviews.

[10]  N. Francis,et al.  First international training and assessment consensus workshop on transanal total mesorectal excision (taTME) , 2016, Techniques in Coloproctology.

[11]  B. Champagne,et al.  Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing? , 2011, Surgical Endoscopy.

[12]  K. Gurusamy,et al.  Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. , 2015, The Cochrane database of systematic reviews.

[13]  James A. Giles.  Surgical training and the European Working Time Directive: The role of informal workplace learning. , 2010, International journal of surgery.

[14]  G. Hanna,et al.  Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees , 2013, Surgical Endoscopy.

[15]  Daniel B. Jones,et al.  Validation of the VBLaST: A Virtual Peg Transfer Task in Gynecologic Surgeons. , 2015, Journal of minimally invasive gynecology.

[16]  M. Ayyaz,et al.  Use of box simulators for improving intraoperative laparoscopic skills - an essential tool for the surgeon in training. , 2015, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[17]  B. Mol,et al.  Surgical approach to hysterectomy for benign gynaecological disease. , 2015, The Cochrane database of systematic reviews.

[18]  P. Dasgupta,et al.  Training in minimally invasive surgery in urology: European Association of Urology/International Consultation of Urological Diseases consultation , 2016, BJU international.

[19]  Xuesong Li,et al.  Ring Suture Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Hilar Cancer: A New Renorrhaphy Technique. , 2016, Journal of endourology.

[20]  Norman Crolee Dalkey,et al.  An experimental study of group opinion , 1969 .

[21]  G. Hanna,et al.  Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program , 2011, Surgical Endoscopy.

[22]  P. Mathevet,et al.  Laparoscopic hysterectomy after concurrent radiochemotherapy in locally advanced cervical cancer compared to laparotomy: A multi institutional prospective pilot study of cost, surgical outcome and quality of life. , 2016, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[23]  E. Huri,et al.  The novel laparoscopic training 3D model in urology with surgical anatomic remarks: Fresh-frozen cadaveric tissue. , 2016, Turkish journal of urology.

[24]  E. Yiannakopoulou,et al.  Virtual reality simulators and training in laparoscopic surgery. , 2015, International journal of surgery.

[25]  Teodor P Grantcharov,et al.  A consensus-based framework for design, validation, and implementation of simulation-based training curricula in surgery. , 2012, Journal of the American College of Surgeons.

[26]  A. Cuschieri,et al.  What do master surgeons think of surgical competence and revalidation? , 2001, American journal of surgery.

[27]  R. Aggarwal,et al.  Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator , 2006, Surgical Endoscopy And Other Interventional Techniques.

[28]  Paolo Caione,et al.  A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey , 2016, World Journal of Urology.

[29]  A. Darzi,et al.  Systematic Review on Mentoring and Simulation in Laparoscopic Colorectal Surgery , 2010, Annals of surgery.

[30]  C. Webb,et al.  The Delphi technique: a methodological discussion. , 1994, Journal of advanced nursing.

[31]  R. Ward.  THE BRITISH ASSOCIATION OF UROLOGICAL SURGEONS , 1946 .

[32]  C. Delaney,et al.  Evaluation of the Learning Curve in Laparoscopic Colorectal Surgery: Comparison of Right-Sided and Left-Sided Resections , 2005, Annals of surgery.

[33]  G. Hanna,et al.  The National Training Programme for Laparoscopic Colorectal Surgery in England: a new training paradigm , 2011, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[34]  J. Fukushima,et al.  Laparoscopic Extrafascial Hysterectomy (Completion Surgery) After Primary Chemoradiation in Patients With Locally Advanced Cervical Cancer: Technical Aspects and Operative Outcomes , 2014, International Journal of Gynecologic Cancer.

[35]  E. Kiely,et al.  A technique for excision of abdominal and pelvic neuroblastomas. , 2007, Annals of the Royal College of Surgeons of England.

[36]  K. Yamashita,et al.  Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer , 2016, Surgical Endoscopy.

[37]  R. Velthoven,et al.  Methods for laparoscopic training using animal models , 2006, Current urology reports.

[38]  Hyung-Jin Kim,et al.  Laparoscopic Surgery for Transverse Colon Cancer: Short- and Long-Term Outcomes in Comparison with Conventional Open Surgery. , 2015, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[39]  Vanessa N Palter,et al.  Comprehensive training curricula for minimally invasive surgery. , 2011, Journal of graduate medical education.