Appendectomy in the Training Program of General Surgery: Entrustable Professional Activity?

Aim: The training of medical specialists is a decisive issue for the quality of medical practice. Autonomization in simple procedures and applying the peer education concept seem promising, particularly for general surgery. With this work, we wanted to assess whether there are differences between appendectomy operations performed by differently composed teams with the active involvement of resident doctors at a university centre.

Methods: We retrospectively analyzed the laparotomies and laparoscopic appendicectomies carried out at the Udine Surgery Clinic over a period of 10 years. The interventions were divided into groups according to the experience of the surgical team that performed them: G1 (consultant), G2 (senior resident + consultant), G3 (junior resident + consultant), and G4 (junior resident + senior resident).

Results: 510 appendectomy procedures were considered for the present analysis. 214 (42.0%) were performed by G1, 139 (27.3%) by G2, 79 (15.5%) by G3 and 78 (15.3%) by G4 group. No difference between the groups was shown in terms of complications, reinterventions, readmissions, length of stay, and duration of surgery. A statistically significant difference was shown in the age of the observed population with respect to the degree of experience of the surgical teams: younger patients were mainly operated on by more experienced teams, and in particular, pediatric laparoscopic appendectomy was performed mainly by consultants.

Conclusions: Appendectomy surgery can be performed by teams with varying levels of experience and is an example of an activity that can be used in Peer Education. It allows for the empowerment of younger residents and the autonomization of older residents in maintaining a medically, ethically, and legally correct standard of safe clinical practice.