Hands-on lap course has 'high impact' on practices

Amsterdam, Netherlands-Participants in an AUA-sponsored laparoscopic videotape mentoring course, offered as part of a skills-based learning course, report an increase in their laparoscopic caseload and in the performance of clinical laparoscopic suturing.

The course included a total of 68 urologists, ages 31 to 61 years (mean, 46.6 years), who participated in one of four laparoscopy improvement courses that were offered to postgraduate urologists between August 2002 and March 2004.

The 2-day course included didactic lecture sessions, performing standardized tasks under expert videotape analysis, participating in a porcine lab, and an extended pelvic trainer laboratory session.

Participating urologists performed standardized tasks in a dry lab, including rope passing, ring placement, laparoscopic suturing, and knot tying on a pelvic trainer after expert laparoscopists demonstrated and described the techniques.

None of the participants had performed significant laparoscopic suturing clinically prior to the course. They were videotaped and timed in performing standardized tasks.

Participants received copies of the videotaped skill performances and an audiotape of the assessment when they left the course. Course instructors sent follow-up surveys to assess the course's impact on the participants' clinical practices. Mean follow-up time was 15.2 months (range, 7 to 25 months).

Survey questions addressed the number of laparoscopic cases performed since the course and whether laparoscopic practices had expanded. Other, more specific questions included whether any clinical laparoscopic suturing was performed after the course, whether the video mentoring during the course was helpful, and whether any participants purchased and used a pelvic trainer following the course.

High impact on practices

Fifty-four (79%) of the participating urologists responded to the survey. Of the respondents, 76% (41) reported that their laparoscopic practice had expanded after taking the course, with 34% performing at least two cases per month.

After taking the course, only 35% of the respondents needed an intraoperative mentor. More than 60% of respondents (33) sutured laparoscopically, with 35% having sutured a bleeding vessel. Of these, only two had attempted laparoscopic suturing prior to the course.

Eighty-three percent of the respondents said the course's video mentoring was helpful. Of those who purchased a pelvic trainer, 90% reported practicing on it regularly.

"Many urologists without fellowship training perform laparoscopy, but do not advance beyond hand-assisted, extirpative laparoscopy," said Gyan Pareek, MD, a former endourology fellow at the University of Wisconsin, Madison, under Stephen Y. Nakada, MD, the course director. "This is a course for the non-fellowship-trained by the fellowship-trained.

"Although some investigators have questioned the long-term impact these courses have on the participants' practices and surveys reveal that urologists who acquire skills from courses fail to maintain these techniques in their daily practice, the re-sults of our evaluation show a high impact of this course on the participants' practices," said Dr. Pareek, now an assistant professor of surgery, division of urology, Brown Medical School, Providence, RI.

Dr. Pareek explained that postgraduate courses have recently become widely available as an alternative means for urologists to incorporate minimally invasive techniques into their practices. He noted that skills-driven learning led to increased rehearsal, clinical skills, and experience.

The curriculum and faculty for all four courses were the same. The didactic portion covered history, techniques, and potential intraoperative and postoperative complications. Didactic sessions (45-minute lectures) stressed techniques of dissection and step-by-step instructions for suturing. All of the faculty members taught the same suturing technique. The course also covered the proper functioning of all laparoscopic equipment and devices.