MSS862: RESIDENT CONFIDENCE IN INTRAOPERATIVE CHOLANGIOGRAPHY: THE CASE FOR SUPPLEMENTAL SIMULATION-BASED TRAINING
Megan C Breckheimer, MD1; Melissa M Burns, MD1; Daniel H Ferman, MD2; Adam T Biggs, PhD3; Holly S Meyer, PhD3; Christopher E Dyke, MD1; 1Walter Reed National Military Medical Center; 2Naval Medical Center Portsmouth; 3Uniformed Services University of the Health Sciences
Objectives: All general surgery residents must learn to perform intraoperative cholangiography (IOC) independently as a part of the American Board of Surgery’s Gallbladder Disease Entrustable Professional Activities. However, studies have shown that the total number of IOCs performed in the US are declining. As a result general surgery resident autonomy and readiness for independent practice have also been decreasing. Proficiency performing IOC is particularly important for military surgeons as they could be stationed places without advanced imaging or interventional alternatives. Accordingly, there is ample need to supplement surgical training through simulation, but the specific demands and gaps remain unclear. This needs assessment evaluated general surgery residents’ confidence in performing IOC and explored how supplemental training opportunities could enhance individual confidence and competence.
Methods: An anonymous survey was administered to general surgery residents at multiple military general surgery residency programs. The survey collected demographics, experience with IOC, and knowledge of IOC. A 5-point Likert scale assessed confidence in performing IOC and teaching IOC. Short-answer responses explored perceived barriers to confidence and potential strategies to improve training.
Results: Twelve general surgery residents responded to the survey (2 PGY1, 3 PGY2, 2 PGY3, 1 PGY4, 1 PGY5, 2 chief residents). The mean confidence score for performing IOC was 2.17 (1 = not at all confident, 5 = completely confident). 75% of participants cited lack of exposure/operative volume as the primary barrier, followed by lack of autonomy. The mean confidence score for teaching IOC to a junior resident was 1.82 (1 = not at all confident, 5 = completely confident). No participants had prior IOC simulation experience. The most frequently suggested strategies for improvement were structured education on instruments and techniques, as well as hands-on simulation.
Conclusion: General surgery residents reported low confidence in performing and teaching IOC, primarily due to low case volume and limited autonomy. Residents strongly endorsed formal didactics and hands-on simulation as strategies to enhance competence. These findings support our ongoing development and implementation of an IOC simulation model and structured curriculum to ensure that graduates achieve competency and confidence in IOC, ultimately improving patient safety and quality of care.