Do more years in training equal to more advanced skills? Trends in operative performance of surgical residents during advanced laparoscopic training course

Background: As surgery residents gain experience during their training, their operative skills are expected to improve. However, it’s unclear whether this applies to both basic and advanced procedures. The objective of this study was to examine the trend in operative performance of senior general surgery residents during an advanced laparoscopic course in live porcine lab and to compare faculty assessments with residents’ self-assessments. Methods: Senior general surgery residents (PGY 3 to 5) performed 3 advanced laparoscopic procedures (Nissen fundoplication, low anterior colon resection (LAR) and splenectomy) in anesthetized pigs. The assessment tools with proven validity evidence were used to assess their operative performance. A linear mixed effects model with a random intercept accounting for within-subject correlation was used to assess score trends by resident level and compare faculty and residents’ self-assessments. Results: Between 2015 and 2023, 93 residents participated and completed 129 Nissen fundoplication, 116 LAR, and 115 splenectomies. The data revealed that senior residents' self-assessment for all procedures was higher than the faculty assessment. With regards to splenectomy and LAR, there was a significant linear relationship between skill level and PGY year from both faculty and residents (Splenectomy-F: 0.29, S: 0.35, p = 0.0002, p = 0.0001, respectively; LAR- F: 0.24, S: 0.22, p = 0.014, p = 0.027, respectively). However, there was no significant improvement demonstrated between the increased years of training and performance during Nissen fundoplication. Even when the scores from both faculty and resident’s self-assessments increased with PGY level, this trend was not statistically significant (F: 0.12, p = 0.29; S: 0.15, P = 0.14). Conclusions: This study found that resident performance improved with PGY level for laparoscopic LAR and splenectomy but not for Nissen fundoplication, which requires advanced suturing. Additionally, residents consistently rated their skills higher than faculty assessments. These findings highlight the importance of focusing on training in advanced skills, particularly advanced laparoscopic surgery, to address potential gaps in surgical education.