Inguinal hernia repair: see one, do one, teach one?
Clinical management of inguinal hernias has been the subject of recent debate, and guidelines have been produced by The Royal College of Surgeons of England. There is evidence that the results of hernia repair by trainees are inferior to those of more experienced surgeons, but there are no published data on the amount of training and supervision currently experienced by junior surgeons. Thirty-two questionnaires were returned by trainees (21 senior house officers and 11 registrars) from hospitals in the south of England, giving details of teaching and supervision for 3,013 hernia repairs recorded in their log books. Trainees had assisted at 2-90 (median 8) repairs before operating themselves, and had then been supervised during 2-46 (median 9) repairs before being allowed to operate unsupervised. They had assisted subsequently at a further 0-100 (median 9) repairs, and had received supervision during a further 0-42 (median 6) repairs after their first unsupervised repair. The majority (79 per cent) felt adequately trained at the time of their first unsupervised repair. Senior house officers had significantly more experience than registrars in the Shouldice and Lichtenstein techniques, suggesting that these methods have gained ground recently in surgical training. These results show substantial variation in the amount of training and supervision given for inguinal hernia repair. In general, however, trainees experienced a good progression through assisting, supervision, and subsequent reinforcement by further work with senior surgeons after being allowed to operate unsupervised.
D000328:Adult; D004503:Education, Medical, Graduate / Q000592:standards*; D004739:England; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*