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have observed, a surgical procedure could be
divided into a number of mandatory steps.
Using these steps as a checklist, it would be easy
to confirm whether all steps were completed,
either live through examiner dictation to a scribe
in the operating room or through video replay.
The actions taken to complete the steps are
described as neither good nor bad; only indicated
is that the mandatory steps were completed.
To qualify as an examiner it is suggested
that steps A, B, C, and D have been passed,
but for practical reasons, local variations
would be permissible. In some cases,
experienced surgical assistants have been
used to check such surgical videos.
In this context, written surgical reports are
likely to be replaced by videos in the not-too-distant future. Such a development supports
the staircase model with systematic video
examinations, which could increase both the
patient’s safety and trainer and trainee confidence.
The staircase model needs to be scientifically
validated in different ways, and could be used
as a tool for scientific studies comparing the
development of surgical skills among residents
trained in a traditional way (time-based) or after
this model (competency-based). The possible timesaving effect of the suggested training model
might be studied, as well as other aspects.
The described stepwise surgical training model
can be used for any kind of surgery. One crucial
factor is mandatory practical examinations
of the obtained surgical skills, to be allowed
to pass on to the next level. The model is the
result of 30 years of observation of lacking
structures in this domain and of the costs to
society for avoidable surgical complications. ♦
SEP 2017 BULLETIN American College of Surgeons