Core Competency in Laparoendoscopic Surgery

BACKGROUND: Concern about patient safety and physician competence was highlighted by the Institute of Medicine report, revealing the prevalence of fatal medical errors. There is also awareness that technical difficulties specific to laparoendoscopic surgery can cause medical errors. Reported herein is a review of the evidence pertaining to objective assessment of core competency components in laparoendoscopic surgery: cognitive skills, technical skills, surgical performance, and judgment. METHODS: PubMed and MedLine searches were performed to identify articles with combinations of the following key words: core competency, competency, laparoscopy, training, assessment, and curriculum. Further articles were obtained by searching reference lists of identified papers and through personal communication. CONCLUSIONS: The available evidence suggests that it is currently possible to objectively assess core competency components in laparoendoscopic surgery: knowledge and clinical judgment with well-established tests and innate technical abilities with computer-based simulators with embedded metrics. Simulation training is conducted to a proficiency criterion regardless of the number of repetitions or practice hours. Reports indicate that skills learned on a simulator transfer to the operating room. However, to date, objective assessment of surgical performance can be obtained only through review of unedited video tapes of surgical procedures by disinterested experts as recently demonstrated by our Japanese colleagues in urology.