Laparoscopic training: results of a Belgian survey in trainees. Belgian Group for Endoscopic Surgery (BGES).

The assurance of adequate training in laparoscopic surgery still is a significant problem. This report aims to provide data and to formulate suggestions, based on the results of a questionnaire completed by 53 trainees, on a literature review and on discussions within the committee on training of the Belgian Group for Endoscopic Surgery (BGES). About 2/3 trainees think that their theoretical competence in laparoscopy is satisfactory or excellent. In contrast, 2/3 consider that their practical training is inadequate; only 53% of the sixth year trainees felt confident about their practical competence. The vast majority (72%) of senior trainees (5th and 6th year) performed less than 50 laparoscopic cholecystectomies or appendicectomies as first surgeon. Very few of them had the opportunity to perform advanced procedures, e.g. fundoplication or colon resection. Laparoscopic appendicectomy is the most common operation done by young trainees (3-4th year): 56% performed more than 10 procedures. In the majority of surgical centres, the trainee has few opportunities to perform supervised laparoscopic surgery because of the limited experience of the surgical staff, the learning curve of tutors, and the limited number of laparoscopic operations in some centres. Several solutions are proposed: training courses with laparoscopic procedures on animals, set up of quota (also for tutors), pelvi-trainer, recommended participation in theoretical courses (trainee session), more free time for attendance at scientific meetings and for reading surgical books and journals. Up to now, no formal process for certification of surgical competence in laparoscopy has been promoted. Moreover, not only the organisation and monitoring, but also the cost of training must be managed, and responsabilities must be taken by all persons and instances involved: teachers, teaching centres, professional board, government.