Transparent operative training in visceral surgery : Analysis at a German university medical center

Abstract

Practical operative training in the discipline of visceral surgery is currently under discussion. Aside from surveys, data on this topic in Germany are sparse. The aim of the study was an objective collation of surgical residents' practical training in the operating room in our department. All surgical cases from 2015 were prospectively included. Procedures were stratified into resident and non-resident operations and complex cases with sub-steps which could potentially be performed by residents. We analyzed whether an operation or surgical sub-steps were performed by a resident. If this was not achieved, the reasons were analyzed. An anonymous online survey was conducted among employees in the surgery department regarding surgical training. Out of 2896 surgical cases 1141 (39.4 %) were classified as potential resident training operations, which were actually performed by a resident in 743 cases (65.1 %). The survey showed an underestimation of this proportion, where sub-steps were assisted in 30.3 % (n= 265) of 876 potential cases. This proportion significantly increased during the observation period (p< 0.001); however, it was highly overestimated by residents as well as fellows and senior consultants. Often organizational reasons were responsible when resident operations or sub-steps were not performed by a trainee (13.1 % and 30.0 %, respectively). The monocentric analysis per se resulted in an improvement in practical surgical training. In the training environment, assisting with sub-steps provides a great potential. Multicenter studies are needed.