title: Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses.
abstract: BACKGROUND
  Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees.
  
  
  METHODS
  After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data.
  
  
  RESULTS
  Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely.
  
  
  CONCLUSIONS
  Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.|2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Gause
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.|2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Grace
authors.initials: G
authors.lastname: Hsiung
authors.affiliation: 2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.|3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Ben
authors.initials: B
authors.lastname: Schwab
authors.affiliation: 4 Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta , Atlanta, Georgia .|5 Division of Pediatric Surgery, Department of Surgery, Emory University , Children's Hospital of Atlanta, Atlanta, Georgia .
authors.forename: Matthew
authors.initials: M
authors.lastname: Clifton
authors.affiliation: 6 Division of Pediatric Surgery, Department of Surgery, Women and Children's Hospital of Buffalo , Buffalo, New York.|7 Department of Surgery, State University of New York at Buffalo , Buffalo, New York.
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.|2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.|3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Barsness
mesh_terms: D001980:Bronchi; D002983:Clinical Competence; D003135:Common Bile Duct / Q000601:surgery; D004380:Duodenal Obstruction / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000601:surgery; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency / Q000379:methods; D007409:Intestinal Atresia; D010535:Laparoscopy / Q000193:education; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D010372:Pediatrics / Q000193:education*; D010930:Plague; D012189:Retrospective Studies; D020377:Self Efficacy; D000066908:Simulation Training; D013043:Specialties, Surgical / Q000193:education*; D014138:Tracheoesophageal Fistula / Q000601:surgery