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Ann R Coll Surg Engl. 2009 May; 91(4): 352–353.
PMCID: PMC2749421

Lack of Laparoscopic Training at the Junior Level

The article by Owais and colleagues rightly addressed the potential negative effect of the implementation of the European Working Time Directive (EWTD) on training opportunities for junior doctors. A significant reduction in the number of open appendicectomies performed by the SHOs has been demonstrated. Although the SHOs did not perform any of the laparoscopic cases, their proportion of overall appendicectomies remained the same.

We believe that the results of this study are alarming. The further increase of the laparoscopic procedures is predictable and already in progress. Against the background of the described 60% reduction in the proportion of the cases being performed by the SHOs, it is worrying that no practical step has been taken towards an early implementation of laparoscopic training at the junior level.

Although the learning curve for laparoscopic procedures seems to be longer, there is no evidence that previous exposure to basic open surgical operations enhances the learning period. However, there is strong evidence that a proficiency-based, virtual-reality training curriculum shortens the learning curve on real laparoscopic procedures when compared with traditional training methods.1

Therefore, we not only strongly suggest improvement of the postgraduate simulated training programmes of basic and advanced laparoscopic skills, but also encourage the implementation of practical basic laparoscopic training in the daily clinical practice of junior doctors pursuing a surgical career.


1. Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg. 2007;246:771–9. [PubMed]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England