Operative Experience vs. Competence: A Curriculum Concordance and Learning Curve Analysis

Objective Certification of completion of training in general surgery requires proof of competence of index operations by means of 3, level-4 consultant-validated procedural-based assessments. The aim of this study was to examine the relationship between index operative experience and competence. Design Higher surgical trainee procedural-based assessments were compared with e-logbooks to determine the relationship between index operative experience and achievement of a third level 4 competence (L4C) related to the indicative procedures of emergency laparotomy (EL, target 100), Hartmann procedure (5), appendicectomy (80), segmental colectomy (20), laparoscopic cholecystectomy (50), and inguinal hernia (80). Setting All trainees are from a single UK Deanery. Participants Consecutive 69 national training number higher surgical trainees were appointed to a single UK Deanery between 2007 and 2014. Results EL L4C was achieved at a median of 76 (15-136) cases, Hartmann procedure L4C at 17 (7-27) cases (p = 0.009 vs. EL), appendicectomy L4C at 107 (20-206) cases, segmental colectomy L4C at 52 (15-131) cases, laparoscopic cholecystectomy L4C at 72 (40-197) cases, and inguinal hernia L4C at 64 (17-132) cases. Conclusions The learning curve and caseload required to demonstrate L4C related to specific procedure varied over 4-fold, from 0.76 to 3.4 times the national indicative target number guidance. Certification of completion of training operative logbook number targets should be reconsidered to better reflect the competencies demanded by the curriculum.