Long-term Retention After Structured Curriculum On Attainment Of Critical View Of Safety During Laparoscopic Cholecystectomy For Surgeons
*Harry J Wong, *Yohei Kojima, *Bailey Su, *Mikhail Attaar, *Hoover Wu, *Michelle Campbell, *Kristine Kuchta, John Linn, *Stephen Haggerty, *Woody Denham, Michael Ujiki
NorthShore University HealthSystem, Evanston, IL
Obtaining a clear Critical View of Safety (CVS) prevents misidentification of the bile duct and bile duct injury during laparoscopic cholecystectomy (LC), which can be improved with a structured Safe CVS Curriculum. In this study, we aimed to determine whether the improvement in obtaining CVS post-curriculum is retained long-term.
A Safe CVS Curriculum was previously implemented for all surgeons who perform LC at a regional health system. Recordings of LC cases were collected for each surgeon before and after the curriculum, de-identified and randomly ordered, before being graded by two blinded expert surgeons using a 6-point CVS assessment tool. At least 2 operative recordings from each surgeon were then collected one year after completion of the curriculum. The Wilcoxon signed-rank test and multivariable mixed modeling were used for score comparisons.
A total of 12 surgeons (5 general, 4 acute care, 3 minimally invasive) with average experience of 17.9±6.3 years in practice participated in the study. The majority (83%) had performed >700 LCs and four surgeons (33%) reported two or more bile duct injuries in their career. Controlling for gallbladder pathology, CVS scores improved from 1.7±0.4 to 4.0±0.4 (p<0.001) immediately after completion of the curriculum. However, there was a small decrease in CVS score after one year (3.2±0.3 from 4.0±0.4, p=0.055) while still significantly higher compared to pre-curriculum (3.2±0.3 vs 1.7±0.4, p<0.001). Similar trends were noted in the individual criteria of the CVS assessment except for “cystic plate clearance,” where retention scores were similar to immediately post-curriculum (0.9±0.6 vs 1.0±0.5, p=0.47). Acute care surgeons had lower CVS retention scores compared to general surgeons (1.8±0.5 vs 3.3±0.4, p=0.01) and minimally invasive surgeons (1.8±0.5 vs 3.8±0.5, p<0.01).
A structured curriculum on achieving CVS helped improve practicing surgeons’ frequency and quality of obtaining the Critical View of Safety during LC. However, this improvement decreased after one year, suggesting some decay in knowledge retention over time. Therefore, continued educational interventions on CVS and safe LC may be needed to enhance long-term retention.
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