Thursday, July 2, 2015

A simulator-based resident curriculum for laparoscopic common bile duct exploration

Ezra Teitelbaum, MD, MEd
Northwestern University

Background: Laparoscopic common bile duct exploration (LCBDE) remains an underutilized treatment for choledocholithiasis, likely in part due to a lack of exposure to the procedure during surgical residency. In this study, we implemented a resident LCBDE curriculum using a previously validated procedural simulator.

Methods: Senior surgery residents underwent a curriculum consisting of deliberate practice using the LCBDE simulator. Residents performed a simulated transcystic and transcholedochal LCBDE before and after undergoing the curriculum, which were rated by 3 faculty. Passing scores were determined using an Angoff method.

Results: 10 residents participated. For transcystic LCBDE, all 10 residents failed the pre-test. Assessment scores improved after the curriculum (20.3 ±3.8 vs. 41.1 ±2.4; scale 0-45, p<.001), and all 10 residents passed the post-test. For transcholedochal LCBDE, all 10 residents failed the pre-test. Transcholedochal scores improved after the curriculum (26.6 ±6.2 vs. 46.4 ±3.7; scale 0-53, p<.001). Eight residents passed the initial post-test. Two failed because they sutured the t-tube into the choledochotomy closure. Both underwent remedial training and passed a re-test. Resident confidence in performing LCBDE clinically improved for both transcystic and transcholedocal approaches.

Conclusions: This curriculum improved surgical residents’ ability to perform both transcystic and transcholedochal LCBDE on a procedural simulator.