Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty

Justin P. Wagner, Alexander D. Schroeder, Juan C. Espinoza, Jonathan R. Hiatt, John D. Mellinger, Robert A. Cusick, Robert Joseph Fitzgibbons, Giampiero Campanelli, Marta Cavalli, Sergio Roll, Rodrigo A. Silva, Wolfgang Reinpold, Louis Franck Télémaque, Brent D. Matthews, Charles Filipi, David C. Chen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

IMPORTANCE Sustainable, capacity-building educational collaborations are essential to address the global burden of surgical disease. OBJECTIVE 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. RESULTS 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. JAMA Surg.

Original languageEnglish (US)
Pages (from-to)66-73
Number of pages8
JournalJAMA Surgery
Volume152
Issue number1
DOIs
StatePublished - Jan 1 2017

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Groin
Herniorrhaphy
Paraguay
Dominican Republic
Haiti
Ecuador
Capacity Building
Education
Certification
Hernia
Surgeons
Observational Studies
Brazil
Motivation
Maintenance
Prospective Studies
Pediatrics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Wagner, J. P., Schroeder, A. D., Espinoza, J. C., Hiatt, J. R., Mellinger, J. D., Cusick, R. A., ... Chen, D. C. (2017). Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty. JAMA Surgery, 152(1), 66-73. https://doi.org/10.1001/jamasurg.2016.3323

Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty. / Wagner, Justin P.; Schroeder, Alexander D.; Espinoza, Juan C.; Hiatt, Jonathan R.; Mellinger, John D.; Cusick, Robert A.; Fitzgibbons, Robert Joseph; Campanelli, Giampiero; Cavalli, Marta; Roll, Sergio; Silva, Rodrigo A.; Reinpold, Wolfgang; Télémaque, Louis Franck; Matthews, Brent D.; Filipi, Charles; Chen, David C.

In: JAMA Surgery, Vol. 152, No. 1, 01.01.2017, p. 66-73.

Research output: Contribution to journalArticle

Wagner, JP, Schroeder, AD, Espinoza, JC, Hiatt, JR, Mellinger, JD, Cusick, RA, Fitzgibbons, RJ, Campanelli, G, Cavalli, M, Roll, S, Silva, RA, Reinpold, W, Télémaque, LF, Matthews, BD, Filipi, C & Chen, DC 2017, 'Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty', JAMA Surgery, vol. 152, no. 1, pp. 66-73. https://doi.org/10.1001/jamasurg.2016.3323
Wagner JP, Schroeder AD, Espinoza JC, Hiatt JR, Mellinger JD, Cusick RA et al. Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty. JAMA Surgery. 2017 Jan 1;152(1):66-73. https://doi.org/10.1001/jamasurg.2016.3323
Wagner, Justin P. ; Schroeder, Alexander D. ; Espinoza, Juan C. ; Hiatt, Jonathan R. ; Mellinger, John D. ; Cusick, Robert A. ; Fitzgibbons, Robert Joseph ; Campanelli, Giampiero ; Cavalli, Marta ; Roll, Sergio ; Silva, Rodrigo A. ; Reinpold, Wolfgang ; Télémaque, Louis Franck ; Matthews, Brent D. ; Filipi, Charles ; Chen, David C. / Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty. In: JAMA Surgery. 2017 ; Vol. 152, No. 1. pp. 66-73.
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N2 - IMPORTANCE Sustainable, capacity-building educational collaborations are essential to address the global burden of surgical disease. OBJECTIVE 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. RESULTS 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. JAMA Surg.

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