The Pareto Analysis for Establishing Content Criteria in Surgical Training.
BACKGROUND
Current surgical training is still highly dependent on expensive operating room (OR) experience. Although there have been many attempts to transfer more training to the skills laboratory, little research is focused on which technical behaviors can lead to the highest profit when they are trained outside the OR. The Pareto principle states that in any population that contributes to a common effect, a few account for the bulk of the effect. This principle has been widely used in business management to increase company profits. This study uses the Pareto principle for establishing content criteria for more efficient surgical training.


METHODS
A retrospective study was conducted to assess verbal guidance provided by 9 supervising surgeons to 12 trainees performing 64 laparoscopic cholecystectomies in the OR. The verbal corrections were documented, tallied, and clustered according to the aimed change in novice behavior. The corrections were rank ordered, and a cumulative distribution curve was used to calculate which corrections accounted for 80% of the total number of verbal corrections.


RESULTS
In total, 253 different verbal corrections were uttered 1587 times and were categorized into 40 different clusters of aimed changes in novice behaviors. The 35 highest-ranking verbal corrections (14%) and the 11 highest-ranking clusters (28%) accounted for 80% of the total number of given verbal corrections.


CONCLUSIONS
Following the Pareto principle, we were able to identify the aspects of trainee behavior that account for most corrections given by supervisors during a laparoscopic cholecystectomy on humans. This strategy can be used for the development of new training programs to prepare the trainee in advance for the challenges encountered in the clinical setting in an OR.
Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands. Electronic address: k.h.kramp@gmail.com.
Kelvin H
KH
Kramp
Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
Marc J
MJ
van Det
Department of Epidemiology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands.
Nic J G M
NJ
Veeger
Department of Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; Post Graduate School of Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Jean-Pierre E N
JP
Pierie
D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004526:Efficiency; D006801:Humans; D007396:Internship and Residency; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014741:Video Recording
Interpersonal and Communication Skills; Medical Knowledge; Practice-Based Learning and Improvement; content validity; laparoscopic cholecystectomy; pareto principle; surgical training