MSS857: TOO FEW CASES, TOO LITTLE CONFIDENCE: A NEEDS ASSESSMENT OF PILONIDAL FLAP TRAINING IN MILITARY SURGERY
Melissa M Burns, MD1; Megan Breckheimer, MD1; Daniel Ferman, MD2; Adam Biggs, PhD3; Holly Meyer, MS, PhD3; Christopher Dyke, MD, FASMBS1; 1Walter Reed National Military Medical Center; 2Portsmouth Naval Medical Center; 3Uniformed Services University
Background: Pilonidal disease disproportionately impacts military members compared to the civilian population. It is seen in 0.49% of service members, whereas 0.026% of the civilian population suffers from this disease–making it 18.8x more common in the military. Accordingly, military surgeons have ample reason to understand and explore possible treatments for pilonidal disease. While less invasive techniques like the GIPS procedure are often successful, the recurrence rate is as high as 7%. Thus, knowing how to perform at least one flap closure is imperative for the general surgeon. This need is further compounded by the additional challenges imposed upon military surgeons who perform procedures overseas in austere environments. Exposure to these procedures both in and out of the operating room is limited, which may affect resident confidence in treating the disease with flap closures.
Objective: A needs assessment was conducted to assess general surgery residents' confidence in treating pilonidal disease with a variety of flap closures. It evaluated whether simulation-based training could increase resident confidence in performing the flaps.
Methods: General surgery residents in multiple military general surgery residency programs were asked to participate in an anonymous survey. Information collected included demographics, experience with different types of flaps for pilonidal disease, and confidence in performing each type of flap. A 5-point Likert scale was used to gauge resident confidence in performing each flap option. Free-text responses captured perceived barriers to confidence and suggestions for improving training.
Results: Eleven general surgery residents responded to the survey, with all post-grad years represented. Three residents had exposure to the Bascom Procedure, two to the Limberg flap, and one resident each had exposure to the Karydaskis procedure and Z-plasty. The remaining residents had zero exposure to these flaps. The mean confidence in performing a Bascom procedure was the highest at 1.64 (1= not at all confident, 5 = extremely confident), with the Karydaskis procedure at 1.45. The Limberg and Z-plasty both had the lowest mean confidence at 1.27. Lack of exposure emerged as the most common barrier to feeling comfortable performing a pilonidal flap. The majority of residents also believed that a simulation course would increase their confidence in treating the disease.
Conclusion: General Surgery residents reported overall low confidence in performing flap closures for pilonidal disease. The main barrier to feeling confident was low operative volume, leading to decreased exposure. Implementing a simulation-based curriculum would increase resident confidence and autonomy in performing the procedure.