title: What are the Training Gaps for Acquiring Laparoscopic Suturing Skills?
abstract: BACKGROUND
  Advanced laparoscopic suturing is considered a challenging skill to acquire. The aim of this study was to investigate the learning process for advanced laparoscopic suturing in the operating room to understand the obstacles trainees face when trying to master the skill.
  
  
  METHODS
  A qualitative methodology using semistructured interviews and field observations was used. Data were analyzed using a Grounded Theory approach. Participants were general surgery residents and surgeons with advanced minimally invasive surgery (MIS) experience.
  
  
  RESULTS
  Ten MIS surgeons across different institutions and 15 local general surgery residents were interviewed. The semistructured interviews and field observations of 9 advanced MIS operations (27h) yielded the following 6 themes around the acquisition of laparoscopic suturing skills for residents: complexity, training misalignment, variability of opportunities, inconsistency of techniques, lack of feedback, and differing expectations.
  
  
  CONCLUSIONS
  There are several unmet training needs around laparoscopic suturing skills. Training for advanced laparoscopic skills requires more emphasis on coaching and the development of advanced models. This study heralded the need to incorporate advanced laparoscopic skills into the surgical simulation curriculum.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ghada
authors.initials: G
authors.lastname: Enani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: McKendy
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Elif
authors.initials: E
authors.lastname: Bilgic
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: ghada.enani@gmail.com.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D036301:Qualitative Research; D013536:Suture Techniques / Q000193:education*
keywords: Medical Knowledge; Practice-Based Learning and Improvement; advanced laparoscopy; laparoscopic suturing; resident; surgical education; surgical simulation