Optimal Pouch Training: Investigating Operative and Nonoperative Needs Study.

Abstract

Background: Ileal pouch anal anastomosis is an important part of colorectal surgery training. However, decreasing case numbers create fewer chances to teach the knowledge and skills to trainees.

Objective: This purpose of this study is to define the components and format of an adjunctive curriculum for teaching colon and rectal surgery residents ileal pouch anal anastomosis. More specifically, it aims to create expert consensus on the essential and unique elements of a curriculum, determine which alternative strategies will be an acceptable, and to identify methods of assessment to evaluate the effectiveness of the curriculum.

Design: This was a modified Delphi Consensus study. Semi-structured interviews with thematic analysis were used to develop the initial round of the survey.

Setting/participants: Faculty who were at North American Accreditation Council for Graduate Medical Education colorectal residencies were invited to participate in the electronic surveys, and participants from each round were invited to subsequent rounds.

Outcome measures: Three rounds of surveys were used to select high priority items for inclusion in the curriculum, educational strategies, and assessments. This was followed by a consensus conference to clarify prioritization and acceptable options for teaching and assessment. Participants from the third round of surveys as well as Program Directors from colorectal residencies were invited to the consensus conference.

Results: Twelve semi-structured interviews defined the educational needs of colorectal residents, the appropriateness of alternative educational strategies, and concerns about case minimums as an assessment of readiness for practice for this procedure. The needs were divided into preoperative, intraoperative, and postoperative phases with knowledge and skills in each. The resulting survey was completed by 85 colorectal surgeons in Round 1, 43 in Round 2, and 38 in Round 3. These results were subsequently summarized by a team of 9 participants in a final consensus conference where the participants made suggestions on the recommended educational strategies for each educational need.

Limitations: Inclusion of colorectal surgeons involved in training programs only; bias in respondents; participation rate.

Conclusions: This shared understanding of educational needs for colorectal residents that includes knowledge, judgement, and technical skills is the first step toward developing a curriculum to teach ileal pouch anal anastomosis. A collaborative effort to create the necessary curriculum is underway. See Video Abstract.