The Laparoscopic Surgical Skills programme

Prof.dr. Jack Jakimowicz

Setting the standard for laparoscopic skills

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Background

• WHO & national healthcare authorities demand:• Proper preclinical training

• Accreditation by means of objective skills assessment

• Ensuring retention of skills by introducing reaccreditation

• Several initiatives by individual institutes & national associations to meet demands healthcare authorities

• Currently available tools & curricula: mainly for basic skills and/or component taskslack of tools to train/assess judgment, decision making, situational awareness

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Creating a European standard

• EAES initiative• Centralise & standardise development of

• Curriculum

• Assessment tools

• Accredited courses• Approach

• combining existing knowledge & expertise

• prevent unnecessary duplication

• reach goal sooner

• save costs

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Laparoscopic Surgical Skills programme

Objective: develop, validate, and implement

• LSS curriculum • LSS assessment• LSS accredited courses• LSS diploma

to (re)credential medical specialists to perform laparoscopic surgery, licensed by EAES

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Project management

Project leaders: Prof. dr. Jack Jakimowicz, Prof. dr. George Hanna Prof. dr. Abe Fingerhut

Project Coordination: Dr.ir. Sonja Buzink

Operations, Logistics and Finance: Excellence in Society and Congress

(ESC BV)

Development, validation and project coordination by

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Project management

• Implementation & collaborating institutes

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The LSS approach

• Beyond basic laparoscopic skills• Focus on performance of procedure• Comprehensive approach

• technical skills + cognitive skills + judgment + non-technical skills• Standardisation according to stratified experience levels• Close link to clinical practise• Transferability of skills to clinical practise

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LSS curriculum

• Stratified experience levels• Grade I: basic skills & procedures (3 sub-levels)

• Grade II: advanced procedural skills• Criterion-based pre-clinical assessment combined with

clinical performance assessment

Level 1 Level 3Level 2Grade 1

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LSS curriculum

Grade 1 Level 1:•basic knowledge •basic psychomotor tasks •index procedures: cholecystectomy, diagnostic laparoscopy, appendicectomy

Grade 1 Level 2: •refresh basic skills & knowledge•suturing skills for procedures (square, surgeons, tumble)•tissue approximation techniques and anastomotic devices•techniques of haemostasis•index procedures: difficult cholecystectomy, incisional hernia repair, perforated duodenal ulcer, common bile duct (CBD) exploration

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LSS curriculum

Grade 1 Level 3:•refresh basic skills & knowledge, suturing•suturing (running, different planes)•advanced dissection•stapled anastomosis techniques•energised dissectors and vessel sealing techniques•index procedures: anti-reflux procedures (Nissen fundoplication), incisional hernia repair, common bile duct (CBD) exploration, splenectomy, inguinal hernia repair

Grade 2:•Courses based on procedures, e.g.: colon surgery, bariatric surgery, inguinal hernia repair, solid organs•team training (CRM)

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Target group

•Surgical trainees and fellows general surgery, urology, gynaecology, paediatric surgery, other specialty laparoscopy

•Certified practicing surgeonsgeneral surgeons, urologists, gynaecologists, paediatric surgeons, other physicians performing laparoscopy

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clinical performance assessment preceding level passed * *

knowledge test

simulator assessment

scenario-based assessment

clinical performance assessment

* For Grade 1 Level 2 and above

Admission requirements

All eligible can enrol for LSS G1L1

Admission to LSS assessment/accredited course: knowledge test clinical performance assessment previous level

Admission to clinical performance assessment: simulator assessment scenario-based assessment

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LSS diploma

Apply for LSS diploma simulator assessment scenario-based assessment clinical performance assessment

•Certificate providing recognition by EAES•Formal accreditation throughout EU difficult•Need for recognition by

• national healthcare authorities

• local surgical associations

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LSS assessment

• Integral examination within LSS accredited course• Separate examination at LSS accredited test centre

Examination• Web-based knowledge test• Hands-on simulator assessment • Scenario-based assessment (application of knowledge and judgment

skills)

• Clinical performance assessment

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Knowledge test

Online E-learning module•Course documents•Exercise materials

Assessment •Online•Multiple choice questions

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Simulator assessment

• Demonstrate hands-on skilfulness• Performance of basic & procedural tasks

• Multiple repetitions reliably performed at or above benchmark level• Simulation modality matching with assessment task

• Grade 1 Level 1: Simbionix LapMentor simulator• Peg transfer

• Placing a ligating loop

• 2 different laparoscopic cholecystectomy procedures

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Scenario-based assessment

• Assess knowledge & judgment skills regarding index procedures

• Several lifelike scenarios presented • Videos, photos, situation descriptions

• Solve problems that occur

• Answer questions at specific critical moments

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• Detailed video analysis two index procedures• Full length

• Unedited• Expert review

• Two expert raters, fully blinded

(LSS office anonymises videos prior to review)

• Structured documentation

• Scoring by Competency Assessment

Tool (CAT)

• Observational Clinical Human Reliability

Assessment (OCHRA) for failed

cases/ difficult decisions

Clinical performance assessment

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LSS accredited courses

• LSS assessment embedded in course

LSS assessment:

LSS course outline:

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LSS accredited courses

• Goal-oriented & criterion-based• Deliberate practise• Combining different training modalities

• Proper simulation tool for each training task

• Balanced mix of theory application and hands-on training• Feedback on performance

• Formative feedback by expert supervision course faculty

• Objective summative feedback generated by simulation tools

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LSS accredited courses

• Admission requirements• Be eligible

• Knowledge test successfully passed

• Passed clinical performance assessment previous level (Grade 1 Level 2

and above)

• Pre-course simulator training ‘at home’• Acquiring/maintaining basic psychomotor skills

• Any type of (validated) simulation tool

(box trainer, virtual reality, augmented reality)

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Dexterity test

• Course focus on acquiring procedural laparoscopic skills• To get the most out of course possessing basic skills is essential

• Dexterity test• Verification of basic psychomotor skills

• Baseline assessment to give insight to participant and trainers

• Encouragement to prepare properly for the course

• Performance benchmarks offered as guidelines

• Cannot fail• Assessment tasks

• Navigation with a 30° laparoscope

• Peg transfer

• Pattern cutting

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In-course simulator training

• Multi-modality• Combination of simulation tools, best fitting to training tasks

(box trainer / VR simulator / AR simulator / animal model / …)

• Enlarge transferability of skills

• Improve engagement in training• Instrument manipulation (laparoscope navigation, tissue manipulation,

knot tying)

• Procedural tasks (component tasks & full procedures)

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Expert discussions

• Interactive and open discussions• Critical topics

• Case studies• Deepening of understanding of theory • Training of judgment skills

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Results first pilot course

• Post-course survey (10-point scale)

What is your overall impression of the course? 7.7

How do you rate the extent of variation between theory and hands-on training during the course?

8.0

To what extent do you expect to apply the course content in practice?

8.3

How do you rate the quality of the course documentation (theory)?

6.9

How do you rate the quality of the expert discussions? 7.3

How do you rate the quality of the hands-on training? 7.8

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Dynamic curriculum

• Programme based on current knowledge & expertise• Identify gaps & bridge those with

• additional research

• development of new training/assessment tools

• validate new tools• Continuous research & development

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LSS accredited course

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Level 1 Level 3Level 2Grade 1

LSS certification

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Accreditation requirements

Accreditation to offer•LSS accredited courses•LSS assessments

Requirements for training centre•Course director LSS accredited trainer•Course structure must match LSS course outline

• LSS course documents as handbook

• LSS discussion slides to guide expert discussions

• Adding material is permitted, removing material is not allowed•Freedom in simulation tools used for training (need to be validated tools)

•Use of LSS simulator assessment tools (provided by LSS in case not available)

•LSS office issues the LSS diploma

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Accreditation process

1. Complete application form including description of course

programme

2. First (pilot) course co-organised with LSS representatives

3. Prospective course director takes part as expert in LSS course elsewhere

4. Prospective course director completes assessor training for clinical performance assessment

5. After accreditation annual visitations of LSS representatives

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Thank you!

For more information please contact us:

LSS FOUNDATIONP.O. Box 335, 5500 AH Veldhoven, The Netherlands

+31 40 235 0594info@esc-societycongress.com