Ben Schwab1, Ezra N Teitelbaum2, Jeffrey H Barsuk3, Nathaniel J Soper1, Eric S Hungness4. 1. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 2. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 3. Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 4. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: Eric.Hungness@nm.org.
Abstract
BACKGROUND: Laparoscopic common bile duct exploration is an underutilized treatment for choledocholithiasis. We sought to evaluate the impact of a simulation-based mastery-learning curriculum for surgical residents on laparoscopic common bile duct exploration utilization and to compare outcomes for patients treated with laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography (ERCP). METHODS: The number of laparoscopic common bile duct explorations performed before and after curriculum implementation was reviewed and outcomes were compared between patients with choledocholithiasis managed with laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography. Based on cost savings from increased utilization of laparoscopic common bile duct exploration, the annual return on investment associated with the curriculum was calculated. RESULTS: Twenty-two residents completed the curriculum. In the pre-curriculum period, an average of 1.7 laparoscopic common bile duct explorations was performed yearly, which increased to 8.4 cases per year after curriculum implementation (P < .05). Identified were 155 patients with choledocholithiasis: 31 underwent laparoscopic common bile duct exploration plus laparoscopic cholecystectomy and 124 underwent endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. The laparoscopic common bile duct exploration and laparoscopic cholecystectomy group had a reduced duration of stay (2.5 ± 1.8 days versus 4.3 ± 2.2 days, P < .0001) and costs ($12,987 ± $3,286 versus $15,022 ± $4,613, P = .01) compared with endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Rates of readmission and reoperation were equivalent between groups. Cost savings were more than $38,000, resulting in a 3.8 to 1 return on investment from curriculum implementation. CONCLUSION: A simulation-based mastery-learning curriculum increased institutional utilization of laparoscopic common bile duct exploration and adoption of the curriculum resulted in positive return on investment.
BACKGROUND: Laparoscopic common bile duct exploration is an underutilized treatment for choledocholithiasis. We sought to evaluate the impact of a simulation-based mastery-learning curriculum for surgical residents on laparoscopic common bile duct exploration utilization and to compare outcomes for patients treated with laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography (ERCP). METHODS: The number of laparoscopic common bile duct explorations performed before and after curriculum implementation was reviewed and outcomes were compared between patients with choledocholithiasis managed with laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography. Based on cost savings from increased utilization of laparoscopic common bile duct exploration, the annual return on investment associated with the curriculum was calculated. RESULTS: Twenty-two residents completed the curriculum. In the pre-curriculum period, an average of 1.7 laparoscopic common bile duct explorations was performed yearly, which increased to 8.4 cases per year after curriculum implementation (P < .05). Identified were 155 patients with choledocholithiasis: 31 underwent laparoscopic common bile duct exploration plus laparoscopic cholecystectomy and 124 underwent endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. The laparoscopic common bile duct exploration and laparoscopic cholecystectomy group had a reduced duration of stay (2.5 ± 1.8 days versus 4.3 ± 2.2 days, P < .0001) and costs ($12,987 ± $3,286 versus $15,022 ± $4,613, P = .01) compared with endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Rates of readmission and reoperation were equivalent between groups. Cost savings were more than $38,000, resulting in a 3.8 to 1 return on investment from curriculum implementation. CONCLUSION: A simulation-based mastery-learning curriculum increased institutional utilization of laparoscopic common bile duct exploration and adoption of the curriculum resulted in positive return on investment.
Authors: Rosa Jorba; Mihai C Pavel; Erik Llàcer-Millán; Laia Estalella; Mar Achalandabaso; Elisabet Julià-Verdaguer; Esther Nve; Erlinda D Padilla-Zegarra; Josep M Badia; Donal B O'Connor; Robert Memba Journal: Surg Endosc Date: 2020-09-23 Impact factor: 4.584
Authors: Jeffrey H Barsuk; Jane E Wilcox; Elaine R Cohen; Rebecca S Harap; Kerry B Shanklin; Kathleen L Grady; Jane S Kim; Gretchen P Nonog; Lauren E Schulze; Alison M Jirak; Diane B Wayne; Kenzie A Cameron Journal: Circ Cardiovasc Qual Outcomes Date: 2019-10-11
Authors: Jeffrey H Barsuk; Rebecca S Harap; Elaine R Cohen; Kenzie A Cameron; Kathleen L Grady; Jane E Wilcox; Kerry B Shanklin; Diane B Wayne Journal: Clin Simul Nurs Date: 2018-11-27 Impact factor: 2.391
Authors: Vimal K Narula; Eleanor C Fung; D Wayne Overby; William Richardson; Dimitrios Stefanidis Journal: Surg Endosc Date: 2020-02-24 Impact factor: 4.584
Authors: Yara Mikhaeil-Demo; Eric Holmboe; Elizabeth E Gerard; Diane B Wayne; Elaine R Cohen; Kenji Yamazaki; Jessica W Templer; Danny Bega; George W Culler; Amar B Bhatt; Neelofer Shafi; Jeffrey H Barsuk Journal: J Grad Med Educ Date: 2021-04-16
Authors: Jeffrey H Barsuk; Elaine R Cohen; Kenzie A Cameron; Kathleen L Grady; Jane E Wilcox; Kerry B Shanklin; Rebecca S Harap; Gretchen P Nonog; Diane B Wayne Journal: Clin Simul Nurs Date: 2021-02-15 Impact factor: 2.391
Authors: James O Brewer; Lalin Navaratne; Stephen W Marchington; David Martínez Cecilia; Jose Quiñones Sampedro; Luis Muñoz Bellvis; Alberto Martínez Isla Journal: Langenbecks Arch Surg Date: 2021-02-17 Impact factor: 3.445
Authors: Jeffrey H Barsuk; Elaine R Cohen; Rebecca S Harap; Kathleen L Grady; Jane E Wilcox; Kerry B Shanklin; Diane B Wayne; Kenzie A Cameron Journal: J Cardiovasc Nurs Date: 2020 Jan-Feb Impact factor: 2.468
Authors: Jane E Wilcox; Rebecca S Harap; Valentina Stosor; Elaine R Cohen; Kathleen L Grady; Kenzie A Cameron; Denise M Scholtens; Diane B Wayne; Kerry B Shanklin; Gretchen P Nonog; Lauren E Schulze; Alison M Jirak; Grace C Magliola; Jeffrey H Barsuk Journal: J Cardiovasc Nurs Date: 2022 May-Jun 01 Impact factor: 2.468