The impact of MIS on patient care over the past decade has been little short of revolutionary. Patient preference for a laparoscopic procedure (proc.) has driven technique adoption rates and subsequently altered surgeons' (surg.) pattern of practice. The most obvious learning context into which training of these new techniques should be introduced is a surgical residency. Residency programs have encountered many of the same difficulties of learning new techniques and becoming competent in them, identified by practicing surg. There are often new skill sets to learn and steep learning curves to ascend in mastering MIS proc. There exists no uniform or nationally recognized MIS curriculum. In this study our purpose was to glean a consensus from leading experts in MIS nationally, regarding which proc. should be incorporated into residency training and case numbers (nos.) necessary to achieve competence in them. This was compared to the no. of cases actually performed as reported by the Residency Review Committee (RRC).
Methods: A detailed survey was sent nationally to all surgical residencies (academic and private) known to have a program in MIS and/or leader in the field. The response rate was approximately 40%. RRC data were obtained from the resident statistics summary report for 1998-1999 for comparison.
Results: As can be seen from a sample of the proc listed below experts consistently judged that residents need to perform proc. many more times than the RRC data indicate they do.
Conclusion: It is anticipated that the number and proportion of MIS proc. performed by surg. will continue to rise. Currently, ASRP do not meet the suggested MIS case volume required for competency. Residency programs need to be restructured to incorporate more exposure to MIS. There is a need to recruit more expert faculty to train residents for the realities of surgical practice in the future.
Expert (min-max) RRC (max)
Lap Ing. Hernia 37.5 (12-200) 6.9 (61)
Lap Cholecystectomy 37 (10-100) 78.6 (223)
Lap Anti-Reflux 22.3 (5-50) 3.8 (40)
Lap Splenectomy 13.7 (5-30) 0.8 (11)
Lap Appendectomy 10.1 (2-25) 7 (56)