Development of an International Standardized Curriculum for Laparoscopic Sleeve Gastrectomy Teaching Utilizing Modified Delphi Methodology.

BACKGROUND: The performance of laparoscopic sleeve gastrectomy has increased markedly to become the single-most performed bariatric surgical procedure globally. To date, a means of standardized trainee teaching has not been developed. The aim of this study was to design a laparoscopic curriculum for trainees of bariatric surgery utilizing modified Delphi consensus methodology. METHODS: A panel of surgeons was assembled to devise an academic framework of technical, non-technical and cognitive skills utilized in the performance of laparoscopic sleeve gastrectomy. The panel invited 18 bariatric surgeons experienced in laparoscopic gastrectomy from 11 countries to rate the items for inclusion in the curriculum to a predefined level of agreement. RESULTS: A consensus of experts was achieved for 24 of the 30 proposed elements for inclusion within the first round of the curriculum Delphi panel. All components pertaining to anatomical knowledge, peri-operative considerations and non-technical items were accepted. A second round further examined six statements, of which three were accepted. Agreement of the panel was reached for 27 of the cognitive, technical and non-technical components after two rounds. Three statements found no consensus. CONCLUSIONS: Utilizing modified Delphi methodology, a curriculum outlining the most important components of teaching the procedure of laparoscopic sleeve gastrectomy, has been determined by a consensus of international experts in bariatric surgery. The curriculum is suggested as a standard in proficiency-based training of this procedure. It forms a generic template which facilitates individual jurisdictions to perform content validation, adapting the curriculum to local requirements in teaching the next generation of bariatric surgeons.

Video-Rated Performance Assessment of Simulated Laparoscopic Sleeve Gastrectomy: Validation of a Sleeve Gastrectomy Rating Scale.

PURPOSE: The global rise in obesity has been accompanied by widespread uptake of the procedure of laparoscopic sleeve gastrectomy. Despite this, the key components for performance assessment have not been standardized for this procedure. The aim of this study was to develop and demonstrate the validity of a Sleeve Objective Structured Assessment of Technical Skill (SOSATS) scale for learning the procedure of laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: The SOSATS evaluation tool was based upon critical steps of the LSG procedure. Both the SOSATS and the Global Rating Scale (GRS) component of the Objective Structured Assessment of Technical Skill (OSATS) tools were utilized in a prospective single-blinded observational study design of 26 video recordings of surgeons performing sleeve gastrectomies using a novel simulation. The surgeons were allocated into "novice" or "experienced" groups dependent on case-volume criteria. Surgical performance was assessed using both the GRS and SOSATS scales by blinded assessors of the video recordings. RESULTS: Face and content validity were demonstrated for key components of the simulated model. An overall positive correlation was established inferring concurrent validity between the accepted OSATS Global Rating Scale against the SOSATS procedural scale. Construct validity was established for a number of areas of the SOSATS scale. CONCLUSION: The SOSATS scale is shown to exhibit construct and concurrent validity in the simulated setting for the procedure of sleeve gastrectomy. Utilizing this scale to review surgical performance is potentially feasible and reliable but would require further research prior to use in high-stakes assessment processes such as credentialing.

Complex coronary sinus fistula in a 58-year-old female.

Coronary artery aneurysms and arterio-venous fistulae are uncommon malformations. We report the case of a 58-year-old woman with a large aneurysmal fistula arising from the left coronary tree and involving the entire coronary sinus venous system, resulting in significant left-to-right shunt. We discuss the management of aneurysmal fistulae of the coronary arteries, and the merits of prophylaxis for thrombotic complications of large aneurysms. We recommend consideration of warfarinisation in addition to aspirin of such patients post-operatively.

Prevocational medical training and the Australian Curriculum Framework for Junior Doctors: a junior doctor perspective.

The current system of prevocational training does not meet the needs of junior doctors because of a high administrative workload, insufficient funding for education, and a lack of centralised guidance for trainees, teachers and hospitals. The Australian Curriculum Framework for Junior Doctors is designed to identify the training objectives for the prevocational years. The Framework has the potential to improve the quality of training of junior doctors, but this depends on how well it is implemented and resourced. It is imperative that any group responsible for implementing or assessing the Framework have a representative junior doctor, among others, on its decision-making committee. Stringent accreditation of training institutions is vital to the effective implementation of the Framework. The Framework should be used to promote teaching and learning, not as a barrier to vocational training or as a check-list to complete.