Surgical instruction for general practitioners: How, who and how often?

Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Journal of Plastic Reconstructive & Aesthetic Surgery (Impact Factor: 1.42). 06/2009; 63(7):1156-62. DOI: 10.1016/j.bjps.2009.05.023
Source: PubMed


Educational programmes, designed to meet the training needs of General Practitioners (GPs) performing minor surgical procedures, have previously been shown to increase their surgical workload. The change in the level of competence following these programmes has not been assessed. The aims of this study were two-fold: to evaluate the vertical mattress suture for construct validity and to assess the impact of plastic surgery training on the surgical skill of GPs. Thirty non-consultant hospital doctors and 27 self-selected GPs were included. Using a modified objective structured assessment of technical skills (OSATS) scoring system, construct validity of the vertical mattress suture was confirmed. The median total OSATS score was 16 points (26.7%) in the novice group (medical registrars), 38.5 points (64.2%) in the intermediate group (surgical SHOs) and 59 points (98.3%) in the expert group (surgical registrars, p<0.001, Kruskal-Wallis test). Objective assessment in the GP group immediately following practical instruction revealed a median overall improvement of 31.7% (19 points) in total OSATS scores (p<0.001, Friedman non-parametric test, F). At six months follow-up all course participants had improved compared to their baseline. A median overall improvement of 13 points (21.7%) was noted (p<0.001, F). However, the majority (80%, n=20) had deteriorated from the standard set immediately after the course with a median overall reduction in total OSATS scores of six points (10%, p=0.001, F). Plastic surgery training is immediately efficacious in improving the technical proficiency of GPs. Through objective assessment of a standardised suture task we demonstrated a low rate of educational decay of 10% over a six-month period.

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    • "Considering that surgical training on living patients (traditional learning) violates ethical and medical-legal aspects, that training on live animals and fresh human cadaver increases the risk of infections, involves high costs and limited access, requires specialized installations, and also contravenes ethical legal aspects, and that using virtual reality simulators involves high costs and restricted access [7] [8], the simulation-based basic surgical teaching on inanimate bench models is becoming widely used [9]. However, to date, it has not been established a teaching program that allows surgical skills to be completely acquired [4] [5], and new opportunities in simulation-based surgical education need to be explored to positively impact quality and safety in surgical care [10]. Among all the surgical specialties, plastic surgery now occupies a negligible component of many undergraduate curricula, and there is much discussion in the worldwide literature regarding if there is a place for plastic surgery in the undergraduate curriculum [11] [12] [13] [14]. "
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    ABSTRACT: Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching programs already established is proposed.
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