Surgical skills competitions at ACS chapter meetings can increase resident engagement

The American College of Surgeons (ACS) Governors’ Committee on Chapter Relations (now the Chapter Activities Domestic Workgroup) provided best practices guidelines for getting Resident Members involved in chapter activities in 2012.¹ The committee highlighted Resident Member involvement as a key goal to help familiarize residents with the College, provide resources for participation in the College, and offer leadership and organizational skills development.

In an effort to generate enthusiasm and increase resident involvement at the annual meeting, the Massachusetts Chapter of the ACS introduced a statewide surgical skills competition as part of its annual chapter meeting in 2011. Because of widespread experience with surgical simulation tasks and the established correlation between simulator performance and operative skills, the chapter determined these skills could be tested in a competitive environment.^2-4 This plan built upon the “Top Gun” competitions presented at meetings of the American Association for Thoracic Surgery and the Society of American Gastrointestinal and Endoscopic Surgeons.^4,5

The competition

Massachusetts surgical training programs were asked to nominate a team composed of an intern and a junior and a senior resident. An institutional faculty member was asked to serve as team leader, and other faculty members also were asked to judge the competition.

The competition was conducted in two stages. In the first stage, all participants performed four tasks, including two open tasks (soda can tie and tie under tension) and two Fundamentals of Laparoscopic Surgery (FLS)-based tasks (pattern cutting and intracorporeal suture tie).^6-8 The three teams with the best total scores, including penalties for errors, continued to the second stage, where participants from each institution performed a single task as a team. The second stage included tasks such as a bowel anastomosis; notably, the nature and objective of this final step varied from year to year. The highest performing team in this round was declared the winner of the competition and was awarded a trophy.

The introduction of this event did not directly affect the cost of the meeting because some industry sponsors provided supplies, such as instruments and box trainers. On the revenue side, the residents’ registration was free, and as a result the chapter experienced no direct financial gain.

A success story

An average of 90 percent of the state’s training programs have participated (9/10, 8/10, and 9/9, in 2012, 2013, and 2014, respectively) in the competition. Resident attendance at the annual meeting increased significantly—from an average of 44 residents per year before the introduction of the event (2008–2010) to 82 residents per year for the years after the competition was introduced (2011–2013) (p<0.05) (see Figure 1). In contrast, attendance by non-resident members decreased by 13 percent, from an average of 72 to 62 attendees; as a result, the overall attendance only increased by 24 percent, from an average of 116 to 144 participants. Costs and location of the meeting remained unchanged; however, industry interest in supporting the annual meeting increased.

Figure 1. Attendance at the Massachusetts Chapter meeting

Most residency programs in the state were enthusiastic participants, with some teams traveling nearly 100 miles to the event. Review of the attendance records showed that the introduction of the surgical skills competition increased resident attendance at the Massachusetts Chapter annual meeting nearly twofold, and this increase was maintained over a three-year period, during which the regular member attendance decreased modestly. This finding suggests that the increase in resident attendance likely was correlated to the competition, as no other major programmatic changes were made to the meeting and cost and location were consistent throughout these years.

A model for other chapters

Incorporation of such competitions into ACS chapter meetings can increase resident involvement at the local level. The authors of this column acknowledge that having 10 training programs in relative geographical proximity puts Massachusetts in a unique position, and factors such as distance and limited number of residency programs may create hurdles in some states.

Furthermore, the authors believe that these competitions can be useful in surgical training at the institutional level. Many programs reported significant internal competition among residents who were determined to make their institution’s team, with members spending a significant amount of time practicing simulated surgical tasks for the competition, which they may not have done otherwise.

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References

1. American College of Surgeons Governors Committee on Chapter Relations. Getting residents involved: The key to chapter success! 2012. Available at: facs.org/~/media/files/about%20acs/chapters/gettingresidentsinvolved.ashx. Accessed March 28, 2016.
2. Varban OA, Ardestani A, Peyre S, Smink DS. Assessing the effectiveness of surgical skills laboratories: A national survey. Simul Healthc. 2013;8(2):91-97.
3. McCluney AL, Vassiliou MC, Kaneva PA, et al. FLS simulator performance predicts intraoperative laparoscopic skill. Surg Endosc. 2007;21(11):1991-1995.
4. Enter DH, Lee R, Fann JI, et al. “Top Gun” competition: Motivation and practice narrows the technical skill gap among new cardiothoracic surgery residents. Ann Thorac Surg. 2015;99(3):870-875; discussion 875-876.
5. Rosser JC Jr., Rosser LE, Savalgi RS. Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. Arch Surg. 1998;133(6):657-661.
6. Scott DJ, Goova MT, Tesfay ST. A cost-effective proficiency-based knot-tying and suturing curriculum for residency programs. J Surg Res. 2007;141(1):7-15.
7. Goova MT, Hollett LA, Tesfay ST, et al. Implementation, construct validity, and benefit of a proficiency-based knot-tying and suturing curriculum. J Surg Educ. 2008;65(4):309-315.
8. Peters JH, Fried GM, Swanstrom LL, et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery. 2004;135(1):21-27.