Proposals for Training Residents With a Concentration in Laparoscopic and Endoscopic Surgery
Outlines for Education published on: 10/2003
by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
PROPOSALS FOR TRAINING RESIDENTS WITH A CONCENTRATION IN LAPAROSCOPIC AND ENDOSCOPIC SURGERY
INTRODUCTION:
These recommendations represent proposals for alterations in the training of general surgical residents interested in careers in laparoscopic and endoscopic gastrointestinal surgery. They are feasible within current American Board of Surgery and Residency Review Committee approved guidelines.
GOAL:
Obtain a concentrated experience in laparoscopic and endoscopic surgery for the future general surgeon wishing to emphasize these elements of gastrointestinal surgery in his or her practice.
PROGRAM RECOMMENDATIONS:
1. Program director interested in promoting training that allows for an area of "concentration" by the surgical resident.
2. Program with an adequate number of major gastrointestinal abdominal operations performed using a laparoscopic approach.
3. Program with an active surgical endoscopy service, where the resident will have a significant hands-on experience.
4. Chair of the department supportive of such training concentration.
LOGISTICS:
1. Concentration can be accomplished if there is simply an adequate case load available for one resident annually to concentrate in the area of laparoscopic gastrointestinal surgery, while not rotating on one or perhaps two other rotations otherwise normally taken.
2. In smaller programs where two chief residents finish annually and work in the same hospital, re-distribution of cases based on type can be accomplished.
3. In programs where workforce dictates that a fixed number of rotations be covered by a fixed number of residents, then it is necessary to have two areas of general surgery (laparoscopic gastrointestinal and one other) with an abundance of cases such that a "trade" between residents is possible. It would then be necessary to have a mutual interest in two trainees to interchange a three-month block of time on those two services, either in the 4th or 5th year. Such a trade would need to conform to:1. Current RRC requirements for Chief resident rotations
2. Still satisfying minimum numbers in both areas for the two trainees (unless the Board is willing to change this policy).
4. A dedicated rotation or significant experience as part of a rotation in flexible endoscopy. This could occur in the junior (preferable) or senior years.
5. Skills training in basic and advanced laparoscopy at times early (ideally year 1) and intermediate (ideally years 2 or 3) respectively during residency.
RESULTS:
The goal for a trainee interested in a concentration in laparoscopic and endoscopic surgery would be:
1. An early and significant exposure to basic laparoscopic skills and performing basic laparoscopic operations (cholecystectomy, appendectomy, diagnostic laparoscopy).
2. Achieve a level of 70% (by RRC numbers) or greater national average case load in basic laparoscopic operations.
3. An experience in flexible gastrointestinal endoscopy above the median case volume for currently trained residents in general surgery.
4. Serving a total of nine to twelve months during the final two years on rotation(s) concentrating in laparoscopic gastrointestinal surgery.
5. An operative experience as surgeon on 50 advanced laparoscopic procedures.
This document was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) March, 1998. It was prepared by the Resident Education Committee and revised in 2003. The Board of Governors approved this document in October 2003.