title: A simulator-based resident curriculum for laparoscopic common bile duct exploration.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration (LCBDE) remains an underused treatment for choledocholithiasis, likely in part because of a lack of exposure to the procedure during surgery residency. In this study, we implemented a resident LCBDE curriculum using a previously validated procedural simulator.
  
  
  METHODS
  Senior surgery residents underwent a curriculum consisting of deliberate practice using the LCBDE simulator. Residents performed a simulated transcystic and transcholedochal LCBDE before and after completing the curriculum, which were rated by three faculty. Passing scores were determined using an Angoff method.
  
  
  RESULTS
  Ten residents participated. For transcystic LCBDE, all 10 residents failed the pretest. Assessment scores improved after the curriculum (20 ± 4 vs 41 ± 2; scale 0-45, P < .01), and all 10 residents passed the posttest. For transcholedochal LCBDE, all 10 residents failed the pretest. Transcholedochal scores improved after the curriculum (27 ± 6 vs 46 ± 4; scale 0-53, P < .01). Eight residents passed the initial posttest and two failed because they sutured the t-tube into the choledochotomy closure. Both underwent remedial training and passed a retest. Resident confidence in performing LCBDE clinically improved for both transcystic and transcholedochal approaches.
  
  
  CONCLUSIONS
  This curriculum improved the ability of surgery residents to perform both transcystic and transcholedochal LCBDE on a procedural simulator.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Ezra N
authors.initials: EN
authors.lastname: Teitelbaum
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Byron F
authors.initials: BF
authors.lastname: Santos
authors.affiliation: Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Rooney
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Pratik
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Nagle
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: ehungnes@nmh.org.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hungness
mesh_terms: D042883:Choledocholithiasis / Q000601:surgery*; D002983:Clinical Competence; D003135:Common Bile Duct / Q000601:surgery*; D003198:Computer Simulation; D003479:Curriculum; D006801:Humans; D007087:Illinois; D007396:Internship and Residency / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D008824:Michigan; D017145:Models, Educational