Can a structured training paradigm address the inconsistency in inguinal hernia operations performed worldwide?
In this prospective, observational study, 81 surgeon trainees at 16 hospitals in 5 countries underwent systematic training in Lichtenstein hernioplasty, a subset of whom became certified regional trainers. During the training series, improvements in operative performance were statistically significant for all countries and sites.
Regional competency-based training provides a standard method to address the global burden of surgical disease.
Sustainable, capacity-building educational collaborations are essential to address the global burden of surgical disease.
To assess an international, competency-based training paradigm for hernia surgery in underserved countries.
Design, Setting, and Participants
In this prospective, observational study performed from November 1, 2013, through October 31, 2015, at 16 hospitals in Brazil, Ecuador, Haiti, Paraguay, and the Dominican Republic, surgeons completed initial training programs in hernia repair, underwent interval proficiency assessments, and were appointed regional trainers. Competency-based evaluations of technical proficiency were performed using the Operative Performance Rating Scale (OPRS). Maintenance of proficiency was evaluated by video assessments 6 months after training. Certified trainees received incentives to document independent surgical outcomes after training.
Main Outcomes and Measures
An OPRS score of 3.0 (scale of 1 [poor] to 5 [excellent]) indicated proficiency. Secondary outcomes included initial vs final scores by country, scores among surgeons trained by the regional trainers (second-order trainees), interval scores 6 months after training, and postoperative complications.
A total of 20 surgeon trainers, 81 local surgeons, and 364 patients (343 adult, 21 pediatric) participated in the study (mean [SD] age, 47.5 [16.3] years; age range, 16-83 years). All 81 surgeons successfully completed the program, and all 364 patients received successful operations. Mean (SD) OPRS scores improved from 4.06 (0.87) before the initial training program to 4.52 (0.57) after training (P < .001). No significant variation was found by country in final scores. On trainee certification, 20 became regional trainers. The mean (SD) OPRS score among 53 second-order trainees was 4.34 (0.68). After 6-month intervals, the mean (SD) OPRS score among participating surgeons was 4.34 (0.55). The overall operative complication rate during training series was 1.1%.
Conclusions and Relevance
Competency-based training helps address the global burden of surgical disease. The OPRS establishes an international standard of technical assessment. Additional studies of long-term surgeon trainer proficiency, community-specific quality initiatives, and expansion to other operations are warranted.
Justin P. Wagner, Alexander D. Schroeder, Juan C. Espinoza, Jonathan R. Hiatt, John D. Mellinger, Robert A. Cusick, Robert J. Fitzgibbons, Giampiero Campanelli, Marta Cavalli, Sergio Roll, Rodrigo A. Silva, Wolfgang Reinpold, Louis-Franck Télémaque, Brent D. Matthews, Charles J. Filipi, David C. Chen. Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty. JAMA Surg. 2017;152(1):66–73. doi:10.1001/jamasurg.2016.3323