The Laparoscopic Surgical Skills programme

Prof.dr. Jack Jakimowicz

Setting the standard for laparoscopic skills

Background
WHO & national healthcare authorities demand:
Proper preclinical training Accreditation by means of objective skills assessment Ensuring retention of skills by introducing reaccreditation

Several initiatives by individual institutes & national associations to meet demands healthcare authorities Currently available tools & curricula: mainly for basic skills and/or component tasks lack of tools to train/assess judgment, decision making, situational awareness

LSS Foundation

Creating a European standard

EAES initiative Centralise & standardise development of
Curriculum Assessment tools Accredited courses

Approach
combining existing knowledge & expertise prevent unnecessary duplication reach goal sooner save costs

LSS Foundation

Laparoscopic Surgical Skills programme

Objective: develop, validate, and implement LSS LSS LSS LSS curriculum assessment accredited courses diploma

to (re)credential medical specialists to perform laparoscopic surgery, licensed by EAES

LSS Foundation

Project management
Development, validation and project coordination by

Project leaders:

Prof. dr. Jack Jakimowicz, Prof. dr. George Hanna Prof. dr. Abe Fingerhut

Project Coordination: Dr.ir. Sonja Buzink Operations, Logistics and Finance: Excellence in Society and Congress (ESC BV) LSS Foundation

Project management
Implementation & collaborating institutes

LSS Foundation

The LSS approach

Beyond basic laparoscopic skills Focus on performance of procedure Comprehensive approach
technical skills + cognitive skills + judgment + non-technical skills

Standardisation according to stratified experience levels Close link to clinical practise Transferability of skills to clinical practise

LSS Foundation

LSS curriculum
Stratified experience levels
Grade I: basic skills & procedures (3 sub-levels) Grade II: advanced procedural skills

Criterion-based pre-clinical assessment combined with clinical performance assessment

Grade 1 Level 1

Level 2

Level 3

LSS Foundation

LSS curriculum
Grade 1 Level 1: basic knowledge basic psychomotor tasks index procedures: cholecystectomy, diagnostic laparoscopy, appendicectomy Grade 1 Level 2: refresh basic skills & knowledge suturing skills for procedures (square, surgeons, tumble) tissue approximation techniques and anastomotic devices techniques of haemostasis index procedures: difficult cholecystectomy, incisional hernia repair, perforated duodenal ulcer, common bile duct (CBD) exploration

LSS Foundation

LSS curriculum
Grade 1 Level 3: refresh basic skills & knowledge, suturing suturing (running, different planes) advanced dissection stapled anastomosis techniques energised dissectors and vessel sealing techniques index procedures: anti-reflux procedures (Nissen fundoplication), incisional hernia repair, common bile duct (CBD) exploration, splenectomy, inguinal hernia repair Grade 2: Courses based on procedures, e.g.: colon surgery, bariatric surgery, inguinal hernia repair, solid organs team training (CRM)

LSS Foundation

Target group
Surgical trainees and fellows
general surgery, urology, gynaecology, paediatric surgery, other specialty laparoscopy

Certified practicing surgeons

general surgeons, urologists, gynaecologists, paediatric surgeons, other physicians performing laparoscopy

LSS Foundation

Admission requirements
All eligible can enrol for LSS G1L1 Admission to LSS assessment/accredited course: knowledge test clinical performance assessment previous level Admission to clinical performance assessment: simulator assessment scenario-based assessment
admission to

scenario-based assessment or simulator assessment

clinical performance assessment

admission requirements

clinical performance assessment preceding level passed knowledge test simulator assessment scenario-based assessment clinical performance assessment

LSS Foundation

* For Grade 1 Level 2 and above

obtain LSS diploma

LSS accredited course

LSS diploma
Apply for LSS diploma simulator assessment scenario-based assessment clinical performance assessment

Certificate providing recognition by EAES Formal accreditation throughout EU difficult Need for recognition by
national healthcare authorities local surgical associations

LSS Foundation

LSS assessment
Integral examination within LSS accredited course Separate examination at LSS accredited test centre Examination Web-based knowledge test Hands-on simulator assessment Scenario-based assessment (application of knowledge and judgment skills) Clinical performance assessment

LSS Foundation

Knowledge test
Online E-learning module Course documents Exercise materials Assessment Online Multiple choice questions

LSS Foundation

Simulator assessment
Demonstrate hands-on skilfulness
Performance of basic & procedural tasks Multiple repetitions reliably performed at or above benchmark level

Simulation modality matching with assessment task Grade 1 Level 1: Simbionix LapMentor simulator
Peg transfer Placing a ligating loop 2 different laparoscopic cholecystectomy procedures

LSS Foundation

Scenario-based assessment
Assess knowledge & judgment skills regarding index procedures Several lifelike scenarios presented
Videos, photos, situation descriptions Solve problems that occur Answer questions at specific critical moments

LSS Foundation

Clinical performance assessment

Detailed video analysis two index procedures
Full length Unedited

Expert review
Two expert raters, fully blinded
(LSS office anonymises videos prior to review)

Structured documentation Scoring by Competency Assessment Tool (CAT) Observational Clinical Human Reliability Assessment (OCHRA) for failed cases/ difficult decisions

LSS Foundation

LSS accredited courses

LSS assessment embedded in course LSS assessment:

LSS course outline:

LSS Foundation

LSS accredited courses

Goal-oriented & criterion-based Deliberate practise Combining different training modalities
Proper simulation tool for each training task Balanced mix of theory application and hands-on training

Feedback on performance
Formative feedback by expert supervision course faculty Objective summative feedback generated by simulation tools

LSS Foundation

LSS accredited courses

Admission requirements
Be eligible Knowledge test successfully passed Passed clinical performance assessment previous level
(Grade 1 Level 2 and above)

Pre-course simulator training at home

Acquiring/maintaining basic psychomotor skills Any type of (validated) simulation tool
(box trainer, virtual reality, augmented reality)

LSS Foundation

Dexterity test
Course focus on acquiring procedural laparoscopic skills
To get the most out of course possessing basic skills is essential

Dexterity test
Verification of basic psychomotor skills Baseline assessment to give insight to participant and trainers Encouragement to prepare properly for the course Performance benchmarks offered as guidelines Cannot fail

Assessment tasks
Navigation with a 30 laparoscope Peg transfer Pattern cutting

LSS Foundation

In-course simulator training

Multi-modality
Combination of simulation tools, best fitting to training tasks
(box trainer / VR simulator / AR simulator / animal model / )

Enlarge transferability of skills Improve engagement in training

Instrument manipulation (laparoscope navigation, tissue manipulation, knot tying) Procedural tasks (component tasks & full procedures)

LSS Foundation

Expert discussions
Interactive and open discussions
Critical topics Case studies

Deepening of understanding of theory Training of judgment skills

LSS Foundation

Results first pilot course

Post-course survey (10-point scale)
What is your overall impression of the course? How do you rate the extent of variation between theory and hands-on training during the course? To what extent do you expect to apply the course content in practice? How do you rate the quality of the course documentation (theory)? How do you rate the quality of the expert discussions? How do you rate the quality of the hands-on training? 7.7 8.0 8.3 6.9 7.3 7.8

LSS Foundation

Dynamic curriculum
Programme based on current knowledge & expertise Identify gaps & bridge those with
additional research development of new training/assessment tools validate new tools

Continuous research & development

LSS Foundation

LSS accredited course

LSS Foundation

LSS certification

Grade 1 Level 1

Level 2

Level 3

LSS Foundation

Accreditation requirements
Accreditation to offer LSS accredited courses LSS assessments Requirements for training centre Course director LSS accredited trainer Course structure must match LSS course outline
LSS course documents as handbook LSS discussion slides to guide expert discussions Adding material is permitted, removing material is not allowed

Freedom in simulation tools used for training (need to be validated tools) Use of LSS simulator assessment tools (provided by LSS in case not available) LSS office issues the LSS diploma

LSS Foundation

Accreditation process
1. Complete application form including description of course programme 2. First (pilot) course co-organised with LSS representatives 3. Prospective course director takes part as expert in LSS course elsewhere 4. Prospective course director completes assessor training for clinical performance assessment 5. After accreditation annual visitations of LSS representatives

LSS Foundation

Thank you!
For more information please contact us:

LSS FOUNDATION P.O. Box 335, 5500 AH Veldhoven, The Netherlands +31 40 235 0594 info@esc-societycongress.com

LSS Foundation