title: A rural, community-based program can train surgical residents in advanced laparoscopy.
abstract: BACKGROUND
  Advanced laparoscopy requires mastery of complex surgical skills. A steep learning curve, lack of an adequate number of cases, and a shortage of experienced staff are reasons cited as barriers to the acquisition of these skills by surgical residents. We hypothesize that advanced laparoscopy can be taught during residency without additional fellowship training.
  
  
  METHODS
  ast surgical residents who completed training at our rural, community-based, 140-bed hospital from 1992 to 2000 were contacted by mailed surveys and a followup telephone interview. Advanced laparoscopy was defined as cases other than cholecystectomy, appendectomy, and diagnostic laparoscopy. Five attending surgeons routinely perform advanced laparoscopy.
  
  
  RESULTS
  The response rate to the survey was 93.3% with 15 of 18 graduates currently practicing general surgery and 100% of the surgeons performing advanced laparoscopy. Laparoscopic herniorrhaphy, splenectomy, colectomy, Nissen fundoplication, and adrenalectomy were performed by 12 (85.7%), 10 (71.4%), 11 (78.6%), 13 (92.9%), and 9 (64.3%) surgeons, respectively. Eight (57.1%) surgeons reported confidence to perform advanced laparoscopy immediately after residency. All graduating chief residents from the last 3 years expressed this confidence. On average each of two chief residents from the past 3 academic years graduated with 99 basic and 50 advanced laparoscopic cases.
  
  
  CONCLUSIONS
  A rural, community-based program can train residents to perform advanced laparoscopy. Increasing the volume of advanced cases handled by resident correlates with increasing confidence in graduates.
authors.affiliation: Department of Surgery, Mary Imogene Bassett Hospital, Cooperstown, NY 13326, USA.
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Reynolds
authors.forename: Leonidas
authors.initials: L
authors.lastname: Goudas
authors.forename: Randall S
authors.initials: RS
authors.lastname: Zuckerman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Gold
authors.forename: Steven
authors.initials: S
authors.lastname: Heneghan
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D002983:Clinical Competence; D003082:Colectomy; D018662:Fundoplication; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D013156:Splenectomy