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European Surgery

, Volume 49, Issue 2, pp 76–83 | Cite as

What are the needs for education in hernia surgery for the future?

  • R. LorenzEmail author
  • B. Stechemesser
  • W. Reinpold
  • F. Mayer
  • F. Köckerling
  • W. Schröder
  • R. Fortelny
original article

Summary

Introduction

Hernia surgery has undergone rapid development in the past decades. The ever greater array of surgical techniques and materials together with the demand for individualized treatment concepts thus present a special challenge not only to qualified surgeons but also when devising education programs for trainee surgeons. To that effect, continuing education and training concepts must be reviewed and possibly new concepts formulated. This study now reports on the findings from a survey on continuing education and training in hernia surgery, while presenting and evaluating the existing concepts.

Materials and Methods

In 2014 the German Hernia Society (DHG) in cooperation with the Federal Association of German Surgeons (BDC) conducted a broad-based online survey among surgeons on the future of continuing education in hernia surgery. Since 2011 basic courses in hernia surgery have been in place in Germany, and since 2014 in Austria too. In the meantime, further Hernia School levels have also been introduced. We compared the learning effects identified for participants of the two Hernia compact courses in Salzburg in 2014 and 2016. Besides, special questionnaires were designed to explore new and topical issues.

Results

In total, 1296 surgeons in Germany took part in the BDC / DHG online survey on the future of continuing education in hernia surgery. The vast majority (more than 80%) of respondents deemed the establishment of a systematic, step-by-step and structured continuing education program to be useful or very useful. Evaluation of the basic training courses already conducted revealed that both the theoretical knowledge and practical experience of participants improved thanks to these courses.

Conclusion

From the perspective of surgeons there is an urgent need for a systematic, structured and step-by-step concept for continuing education hernia surgery. This should include, in addition to theoretical and practical aspects, eLearning, video tutorials, and simulation models. Since to date there is a lack of empirical data, continuous evaluation of the training courses is an important component for further development of such courses. This can markedly enhance the theoretical knowledge and practical experience of participants. Besides, systematic survey of participants helps to continuously tailor the curriculum to future needs.

Keywords

Hernia Hernia School Education and Training Learning curve 

Notes

Compliance with ethical guidelines

Conflict of interest

R. Lorenz, B. Stechemesser, W. Reinpold, F. Mayer, F. Köckerling, W. Schröder, and R. Fortelny declare that they have no competing interests.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

References

  1. 1.
    Reinpold W. Aktuelle Leistenhernienchirurgie. Hamb Arztebl. 2015;69(01):28–31.Google Scholar
  2. 2.
    Köckerling F, Berger D, Jost JO. What is a certified hernia center? The example of the German Hernia Society and German Society of General and Visceral Surgery. Front Surg. 2014;1(1):Art. 26. doi: 10.3389/fsurg.2014.00026.CrossRefGoogle Scholar
  3. 3.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefGoogle Scholar
  4. 4.
    Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Koeckerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Tomoney M, Weyhe D, Chowbey P. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [Internationals Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773–843.CrossRefGoogle Scholar
  5. 5.
    Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP. Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2014;18(2):151–63.CrossRefGoogle Scholar
  6. 6.
    Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RL, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc. 2015;29(2):289–321.CrossRefGoogle Scholar
  7. 7.
    Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W. How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg. 2015;2:24.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Aquina CT, Kelly KN, Probest CP, Iannuzzi JC, Noyes K, Langstein HN, Monson JR, Fleming FJ. Surgeon volume plays a significant role in outcomes and cost following open Incisional hernia repair. J Gastrointest Surg. 2015;19(1):100–10.CrossRefGoogle Scholar
  9. 9.
    Aquina CT, Probst CP, Kelly KN, Iannuzzi JC, Noyes K, Fleming FJ. Monson JRT the pitfalls of inguinal herniorrhaphy: surgeon volume matter. Surgery. 2015;158(3):736–46.CrossRefGoogle Scholar
  10. 10.
    Al Jamal YN, Zendejas B, Gas BL, Ali SM, Heller SF, Kendrick ML, Farley DR. Annual surgeon volume and patient outcomes following laparoscopic totally extraperitoneal inguinal hernia repairs. J Laparoendosc Adv Surg Tech A. 2016;26(2):92–8.CrossRefGoogle Scholar
  11. 11.
    Carlsen CG, Lindorff-Larsen K, Funch-Jensen P, Lund L, Morcke AM, Ipsen M, Charles P. Is current surgical training efficient? A national survey. J Surg Educ. 2014;71(3):367–74.CrossRefGoogle Scholar
  12. 12.
    Park AE, Zahiri HR, Pugh CM, Vassiliou M, Voeller G. Raising the quality of hernia care: Is there a need? Surg Endosc. 2015;29(8):2061–71.CrossRefGoogle Scholar
  13. 13.
    Kavic MS. Teaching and Training Surgery to the next Generation of Surgeon. JSLS. 2011;15:279–81.CrossRefGoogle Scholar
  14. 14.
    Hope WW, O’Dwyer B, Adams A, Hooks WB 3rd, Kotwall CA, Clancy TV. An evaluation of hernia education in surgical residency programs. Hernia. 2014;18(4):535–42.CrossRefGoogle Scholar
  15. 15.
    Zendejas B, et al. Simulation based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg. 2011;254(3):502–9.CrossRefGoogle Scholar
  16. 16.
    Miserez M, Arregui M, Bisgaard T, Huyghe M, Van Bruwaene S, Peeters E, Penninckx F. A structured resident training program in endoscopic surgery in general and in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair in particular. Surg Laparosc Endosc Percutan Tech. 2009;19(4):e125–e129.CrossRefGoogle Scholar
  17. 17.
    Bökeler U, Schwarz J, Bittner R, Zacheja S, Smaxwil C. Teaching and training in laparoscopic inguinal hernia repair (TAPP): impact of the learning curve on patient outcome. Surg Endosc. 2013;27(8):2886–93.CrossRefGoogle Scholar
  18. 18.
    Johnson TG, Hooks WB 3rd, Adams A, Hope WW. Safety and efficacy of laparoscopic access in a surgical training program. Surg Laparosc Endosc Percutan Tech. 2016;26(1):17–20.CrossRefGoogle Scholar
  19. 19.
    Abdelsattar JM, Pandian TK, Finnesgard EJ, El Khatib MM, Rowse PG, Buckarma EN, Gas BL, Heller SF, Farley DR. Do you see what I see? How we use video as an adjunct to general surgery resident education. J Surg Educ. 2015;72(6):e145–e150.CrossRefGoogle Scholar
  20. 20.
    Zahiri HR, Park AE, Pugh CM, Vassiliou M, Voeller G. “See one, do one, teach one”: inadequacies of current methods to train surgeons in hernia repair. Surg Endosc. 2015;29(10):2867–72.CrossRefGoogle Scholar
  21. 21.
    Villegas L, Schneider BE, Callery MP, Jones DB. Laparoscopic skills Training. Surg Endosc. 2003;17:1879–88.CrossRefGoogle Scholar
  22. 22.
    AlJamal YN, Ali SM, Ruparel RK, Brahmbhatt RD, Yadav S, Farley DR. The rationale for combining an online audiovisual curriculum with simulation to better educate general surgery trainees. Surgery. 2014;156(3):723–8.CrossRefGoogle Scholar
  23. 23.
    Khatib M, Hald N, Brenton H, Barakat MF, Sarker SK, Standfield N, Ziprin P, Kneebone R, Bello F. Validation of open inguinal hernia repair simulation model: a randomized controlled educational trial. Am J Surg. 2014;208(2):295–301.CrossRefGoogle Scholar
  24. 24.
    Kurashima Y, Feldman LS, Kaneva PA, Fried GM, Bergman S, Demyttenaere SV, Li C, Vassiliou MC. Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc. 2014;28(3):783–8.CrossRefGoogle Scholar
  25. 25.
    Rowse PG, Ruparel RK, Abdelsattar JM, AlJamal YN, Dy BM, Farley DR. TEP and Lichtenstein anatomy: Does simulation accelerate acquisition among interns? Hernia. 2016;20(3):211–6.CrossRefGoogle Scholar
  26. 26.
    Pugh CM, Arafat FO, Kwan C, Cohen ER, Kurashima Y, Vassiliou MC, Fried GM. Development and evaluation of a simulation-based medical education course: beyond lectures and credit hours. Am J Surg. 2015;210(4):603–9.CrossRefGoogle Scholar
  27. 27.
    Lorenz R, Stechemesser B, Reinpold W. Ausbildung in der Hernia surgery: Hernia compact – junge Chirurgie als 3‑tägiger Weiterbildungskurs. In: Schumpelick V, Arlt G, Conze J, Junge K, editors. Hernien, 5th edn. Stuttgart: Thieme; 2014.Google Scholar
  28. 28.
    Stechemesser B, Jacob DA, Schug-Paß C, Köckerling F. Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia. 2012;16(3):269–76.CrossRefGoogle Scholar
  29. 29.
    Palumbo P, Turano R, Gallinaro LS, Bertagni A, Montesano G, Forte A, Angelici AM. Inguinal hernia repair in a teaching course for surgeons. A training program. G Chir. 2001;22(10):321–4.PubMedGoogle Scholar
  30. 30.
    Lorenz R, Stechemesser B, Reinpold W, Fortelny R, Mayer F, Schröder W, Köckerling F. Development of a structured curriculum concept for continuing education and training in hernia surgery: German Hernia School. Hernia. 2016; doi: 10.1007/s10029-016-1566-7.CrossRefPubMedGoogle Scholar
  31. 31.
    Lazzarini-Mendes CJ, Pacheco AM Júnior, Destro BB, Tamaro C, Nogueira FA, Chen D, Reinpold W, Bruscagin V, Roll S, Silva RA. Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015. Rev Col Bras Cir. 2016;43(5):382–91. doi: 10.1590/0100-69912016005018.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.3CHIRURGEN Hernia CenterBerlinGermany
  2. 2.Hernia Center ColognePAN-HospitalCologneGermany
  3. 3.Department of Surgery and Hernia CenterWilhelmsburg Hospital Gross-SandHamburgGermany
  4. 4.Department of SurgeryParacelsus Medical UniversitySalzburgAustria
  5. 5.Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical SchoolVivantes HospitalBerlinGermany
  6. 6.BDC-AcademyProfessional Association of German SurgeonsBerlinGermany
  7. 7.Department of General, Visceral and Oncologic SurgeryWilhelminenhospitalViennaAustria
  8. 8.Sigmund Freud University ViennaViennaAustria

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