title: Increasing resident utilization and recognition of the critical view of safety during laparoscopic cholecystectomy: a pilot study from an academic medical center.
abstract: Laparoscopic cholecystectomy (LC) is a commonly performed surgical procedure; however, it is associated with an increased rate of bile duct injury (BDI) when compared to the open approach. The critical view of safety (CVS) provides a secure method of ductal identification to help avoid BDI. CVS is not universally utilized by practicing surgeons and/or taught to surgical residents. We aimed to pilot a safe cholecystectomy curriculum to demonstrate that educational interventions could improve resident adherence to and recognition of the CVS during LC.
  
  
  
  Forty-three general surgery residents at Thomas Jefferson University Hospital were prospectively studied. Fifty-one consecutive LC cases were recorded during the pre-intervention period, while the residents were blinded to the outcome measured (CVS score). As an intervention, a comprehensive lecture on safe cholecystectomy was given to all residents. Fifty consecutive LC cases were recorded post-intervention, while the residents were empowered to "time-out" and document the CVS with a doublet photograph. Two independent surgeons scored the videos and photographs using a 6-point scale. Residents were surveyed pre- and post-intervention to determine objective knowledge and self-reported comfort using a 5-point Likert scale.
  
  
  
  In the 18-week study period, 101 consecutive LCs were adequately captured and included (51 pre-intervention, 50 post-intervention). Patient demographics and clinical data were similar. The mean CVS score improved from 2.3 to 4.3 (p < 0.001). The number of videos with CVS score >4 increased from 15.7 to 52 % (p < 0.001). There was strong inter-observer agreement between reviewers. The pre- and post-intervention questionnaire response rates were 90.7 and 83.7 %, respectively. A greater number of residents correctly identified all criteria of the CVS post-intervention (41-93 %, p < 0.001) and offered appropriate bailout techniques (77-94 %, p < 0.001). Residents strongly agreed that the CVS education should be included in general surgery residency curriculum (mean Likert score = 4.71, SD = 0.54). Residents also agreed that they are more comfortable with their LC skills after the intervention (4.27, σ = 0.83).
  
  
  
  The combination of focused education along with intraoperative time-out significantly improved CVS scores and knowledge during LC in our institution.
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Crystal B
authors: CB
authors: Chen
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Francesco
authors: F
authors: Palazzo
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Stephen M
authors: SM
authors: Doane
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Jordan M
authors: JM
authors: Winter
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Harish
authors: H
authors: Lavu
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Karen A
authors: KA
authors: Chojnacki
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Ernest L
authors: EL
authors: Rosato
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors: Charles J
authors: CJ
authors: Yeo
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Sidney Kimmel Medical College, Thomas Jefferson University, 1100 Walnut Street, 5th Floor, Philadelphia, PA, 19107, USA. michael.pucci@jefferson.edu.
authors: Michael J
authors: 0000-0003-4679-7927
authors: MJ
authors: Pucci
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014741:Video Recording
keywords: Critical view of safety; Laparoscopic cholecystectomy; Resident education