title: Training in Laparoscopic Gastric Cancer Surgery in the Western World: Current Educational Practices, Challenges, and Potential Opportunities at a Large University Centre.
abstract: OBJECTIVE
  The purpose of this study was to explore and understand how surgeons distribute tasks during a laparoscopic gastrectomy for gastric cancer in an academic teaching environment.
  
  
  METHODS
  An anonymous, cross-sectional, census survey was used to poll trainees' and staff members' opinions pertaining to laparoscopic gastrectomy.
  
  
  METHODS
  Academic and community tertiary teaching hospitals, affiliated with the University of Toronto.
  
  
  METHODS
  All surgeons, within the Department of General Surgery at the University of Toronto, who practice laparoscopic gastrectomy for gastric cancer, were invited to participate. All general surgery residents, postgraduate year 1-5, minimally invasive surgery and surgical oncology fellows at the University of Toronto were invited to participate. Overall response rate was 74.35% (n = 87/117).
  
  
  RESULTS
  The results suggested that trainees do not routinely perform the major operative steps. Trainees agreed with faculty in this regard; however, there was a statistically significant difference in opinions, related to the degree of the perceived active operating of the trainees. There was also a difference in opinion, between trainees and faculty, regarding the common reasons for takeover.
  
  
  CONCLUSIONS
  The present survey highlights that current level of active exposure of surgical trainees to laparoscopic gastric surgery might be insufficient. A lack of role clarity may further hinder an optimal educational experience during these cases. Adopting a stepwise approach, with task deconstruction, could optimize training. Additional training modalities may be required to ensure technical proficiency is acquired before independent practice.
authors.affiliation: Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: andras.fecso@mail.utoronto.ca.
authors.forename: Andras B
authors.initials: AB
authors.lastname: Fecso
authors.affiliation: Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Bonrath
authors.affiliation: Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D005260:Female; D005743:Gastrectomy / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D009864:Ontario; D013274:Stomach Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; evaluation; gastrectomy; laparoscopic surgery; surgical trainee; surveys; training