Surgical training trends in the Americas: A cross-continental assessment of minimally invasive surgery and open surgery among surgical trainees
Benjamin P. Cassidy
Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
Contribution: Formal analysis, Investigation, Methodology, Writing - original draft
Search for more papers by this authorC. Sierra Stingl
Division of Plastic & Reconstructive Surgery, Stanford University, Stanford Medicine, Palo Alto, California, USA
Contribution: Methodology, Writing - review & editing
Search for more papers by this authorNapoleón Méndez
Departamento de Emergencia de Cirugía, Hospital General San Juan de Dios, Guatemala City, Guatemala
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorGustavo M. Machain
Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Hospital de Clínicas, Segunda Cátedra de Clínica Quirúrgica, San Lorenzo, Paraguay
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorFelipe Vega-Rivera
Departamento de Cirugía, Hospital Angeles Lomas, Estado de México, México
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorMarcelo A. F. Ribeiro Jr.
Division of Trauma, Critical Care, and Acute Care Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorHernan Sacoto
Cirugía de Trauma y Emergencias, Hospital Vicente Corral Moscoso, Universidad del Azuay, Cuenca, Ecuador
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorPablo Ottolino
Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorSusan K. Beitia
Ministerio de Salud, Panamá, Panamá
Universidad de Panamá, Panamá, Panamá
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorMartha Quiodettis
Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
Contribution: Resources, Writing - review & editing
Search for more papers by this authorEdgar B. Rodas
Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
Contribution: Conceptualization, Methodology, Supervision, Writing - review & editing
Search for more papers by this authorCorresponding Author
Mike M. Mallah
Division of General and Acute Care Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Global Surgery Program, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Correspondence
Mike M. Mallah, Department of Surgery Clinical Sciences, Medical University of South Carolina, Building Suite 420, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
Email: [email protected]
Contribution: Conceptualization, Methodology, Supervision, Writing - original draft
Search for more papers by this authorBenjamin P. Cassidy
Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
Contribution: Formal analysis, Investigation, Methodology, Writing - original draft
Search for more papers by this authorC. Sierra Stingl
Division of Plastic & Reconstructive Surgery, Stanford University, Stanford Medicine, Palo Alto, California, USA
Contribution: Methodology, Writing - review & editing
Search for more papers by this authorNapoleón Méndez
Departamento de Emergencia de Cirugía, Hospital General San Juan de Dios, Guatemala City, Guatemala
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorGustavo M. Machain
Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Hospital de Clínicas, Segunda Cátedra de Clínica Quirúrgica, San Lorenzo, Paraguay
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorFelipe Vega-Rivera
Departamento de Cirugía, Hospital Angeles Lomas, Estado de México, México
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorMarcelo A. F. Ribeiro Jr.
Division of Trauma, Critical Care, and Acute Care Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorHernan Sacoto
Cirugía de Trauma y Emergencias, Hospital Vicente Corral Moscoso, Universidad del Azuay, Cuenca, Ecuador
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorPablo Ottolino
Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorSusan K. Beitia
Ministerio de Salud, Panamá, Panamá
Universidad de Panamá, Panamá, Panamá
Contribution: Resources, Validation, Writing - review & editing
Search for more papers by this authorMartha Quiodettis
Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
Contribution: Resources, Writing - review & editing
Search for more papers by this authorEdgar B. Rodas
Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
Contribution: Conceptualization, Methodology, Supervision, Writing - review & editing
Search for more papers by this authorCorresponding Author
Mike M. Mallah
Division of General and Acute Care Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Global Surgery Program, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Correspondence
Mike M. Mallah, Department of Surgery Clinical Sciences, Medical University of South Carolina, Building Suite 420, 96 Jonathan Lucas St, Charleston, SC 29425, USA.
Email: [email protected]
Contribution: Conceptualization, Methodology, Supervision, Writing - original draft
Search for more papers by this authorAbstract
Introduction
Minimally invasive surgery (MIS) has become standard of care in many high-income countries, but its adoption in low- and middle-income countries (LICs/MICs) has been impeded by resource- and training-related barriers. We hypothesized that trainees in MICs perform MIS procedures less often, and that as procedure complexity increases, the rate of MIS decreases.
Methods
A 22-question survey, distributed to representative leaders across Latin America, collected country-specific graduating trainee case requirements and volumes for four index procedures (cholecystectomy, appendectomy, inguinal hernia repair, colectomy) using MIS or open surgery (OS). USA data was obtained from the Accreditation Council for Graduate Medical Education. Kruskal–Wallis and Mann–Whitney U tests were performed to determine whether the rate of MIS differed across all countries, procedure complexity classes, and high income countries (HICs)/MICs.
Results
Seven experts (70% response rate) completed the survey, representing: Brazil, Chile, Ecuador, Guatemala, Mexico, Panama, and Paraguay. The percentage of MIS completed by trainees varied with mean and interquartile ranges as follows: cholecystectomy (60% ± 54%), appendectomy (41% ± 69%), inguinal hernia repair (19% ± 23%), colectomy (16% ± 29%). There was a significant difference in mean MIS experience across the eight countries (H = 17.6, p = 0.014) and between most complex and least complex procedures (p = 0.039). No difference was found between MICs and HICs (p = 0.786).
Conclusions
We found a significant difference of general surgery trainee exposure to MIS versus OS across the Americas, but the difference was not significantly associated with World Bank Income Groups. Different trainee experiences with MIS and OS may highlight an opportunity for international and bidirectional collaboration.
CONFLICT OF INTEREST STATEMENT
The authors declare that they have no conflict of interest.
Supporting Information
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