Implementation and Evaluation of a Comprehensive Proficiency-Based Curriculum in an Advanced Minimally Invasive Procedure: A Multi-Institutional Canadian Experience

Boris Zevin MD PhD, Guy Sheahan MBBS, Shady Ashamalla MD MSc, Nicolas J.Dedy MD PhD, Diederick Jalink MD, Teodor Grantcharov MD PhD

Surgery for Obesity and Related Diseases


Introduction A comprehensive proficiency-based curriculum for an advanced minimally invasive procedure was previously developed and shown to be more educationally effective than conventional surgery training.

Objective To implement and evaluate this proficiency-based curriculum in two academic general surgery residency programs in Canada.

Setting Two academic general surgery residency programs at University Hospitals in Ontario, Canada.

Methods An 8-week proficiency-based curriculum consisted of a didactic component (lectures, small group sessions, assigned readings) and a simulation-based component (proficiency-based training in laparoscopic enteroenterostomy and a simulated OR crisis scenario). It was offered to PGY 2-5 general surgery residents in two academic programs in Canada. Pre- and post-curriculum procedure-specific knowledge and psychomotor skills were assessed using a 25-item knowledge test and a procedure-specific assessment scale. Post-curriculum non-technical skills were assessed using the NOTSS scale. Participants’ perceptions about the curriculum were assessed using a questionnaire. Direct costs for curriculum implementation were recorded.

Results Twenty-five residents participated in the curriculum across two programs. Completion of the curriculum resulted in significant improvement in technical skills (45(37.5-65) vs 88(85-93); p<0.01) and demonstration of “acceptable” situation awareness (3(3-4)), decision making (3(3-4)), teamwork and communication (3(2-4)), and leadership (3(3-4)) skills. There was no improvement in procedure-specific knowledge (48(40-64) vs 58(48-60); p=0.39). Participants perceived all components of the curriculum as educationally valuable and 96% agreed and/or strongly agreed that this curriculum should continue to be a part of academic curriculum. The average cost of curriculum implementation was $613.05 CAD per participant. Lack of faculty supervision was the main barrier to implementation with only 65% of participants agreeing and/or strongly agreeing that quantity of faculty supervision was optimal.

Conclusions A comprehensive proficiency-based curriculum for an advanced minimally invasive procedure was successfully implemented and evaluated at two academic general surgery residency programs in Canada. Adequate faculty preceptor resources are essential for widespread implementation.

Key words Proficiency-based training curriculumadvanced minimally invasive surgerybariatric surgery