Knut Magne Augestad

Background: Developing surgical skills among residents requires time and resources, often in conflict with the goals of efficiency and hospital economics in surgical practice. Optimizing resident training may prevent a decline in quality. Skilled surgeons are vital to effective and safe surgical performance, yet the training trajectory for surgical residents is often inefficient, particularly in the era of minimally invasive surgery. A framework that efficiently disseminates surgical skills is essential to cultivate skilled future surgeons within an acceptable time frame. Surgical telementoring (ST) aligns well with minimally invasive surgery because the mentee operating in the field shares the telementor’s perspective. Despite growing experience with telemedicine, data on educational outcomes remain limited. Objective: We aim to conduct a pilot randomized controlled trial (RCT). Data collection will inform a future full-scale RCT evaluating whether real-time ST, combined with structured postoperative coaching, is superior to traditional on-site mentoring in developing laparoscopic cholecystectomy skills among surgical residents. Methods: Eligible residents will be randomly assigned in a 1:1 ratio to either the intervention group (real-time ST and postoperative coaching) or the control group (traditional intraoperative hands-on teaching). This research adheres to the extended SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statements for pilot RCTs and follows the intention-to-treat principle. Residents in both groups will perform 5 consecutive procedures under standardized intraoperative conditions. The primary outcomes are the Global Operative Assessment of Laparoscopic Skills (GOALS) score and the Non-Technical Skills for Surgeons (NOTSS). We hypothesize that the intervention group will show a 3- to 5-point improvement in the GOALS score compared with the control group. To achieve 0.8 statistical power, a P value <.05, and a 20% dropout rate in a definitive RCT, 12 residents per group are required. We present a pilot RCT with 5 residents per group. Challenges encountered during the trial will be reported, and amendments will be proposed to assess the need for a future definitive RCT. Results: The primary outcomes will be technical and nontechnical surgical skills, measured by the GOALS and NOTSS scores, respectively. Patient-reported experience measures and satisfaction scores of eligible mentees and mentors will be analyzed as secondary outcomes. The ST system configuration at the 2 inclusion centers was completed in December 2023. Ethics approval and the most recent update report to ClinicalTrials.gov were obtained on October 23, 2023, and December 8, 2024, respectively. Recruitment of residents to the study commenced in spring 2024. Recruitment is expected to be completed in May 2026, with data analysis in November 2026 and manuscript submission of results in January 2027. Conclusions: The SURGTEACH (Surgical Telementoring in Acquisition of Surgical Skills of Laparoscopic Cholecystectomy) trial is the first pilot RCT evaluating ST for educational outcomes. This research may provide high-quality evidence to improve surgical education, particularly in rural hospitals.

BACKGROUND Developing surgical skills among residents requires time and resources, often in conflict with the goals of efficiency and hospital economics in surgical practice. It is necessary to optimize resident training to prevent a decline in quality. Skilled surgeons are vital for effective and safe performance, yet the training path for surgical residents is often inefficient, especially in the minimally invasive surgery era. Establishing a framework that efficiently disseminates surgical skills is essential to cultivate skilled future surgeons within an acceptable timeframe. Surgical telementoring (ST) aligns well with minimally invasive surgery since the operating mentee shares the same perspective of the operating field as the telementor. Despite growing experience with telemedicine, data on educational outcomes is still under evaluation. OBJECTIVE The efficiency and safety of ST as a skill development tool will be evaluated for selected residents performing laparoscopic cholecystectomy (LC). Technical and non-technical surgical skills of included surgical registrars will be evaluated in addition to the satisfaction scores of patients, registrars, and mentors. METHODS In this pilot randomized controlled trial (RCT), eligible residents will be assigned in a 1:1 ratio to either the intervention group (real-time ST and postoperative coaching) or the control group (traditional intraoperative hands-on teaching). This research adheres to the extended CONSORT statements for pilot RCTs and follows the intention-to-treat principle (ITT). The residents in both groups will perform five consecutive procedures under standardized intraoperative conditions. The primary outcomes are the global assessment tool for evaluating Laparoscopic Skills (GOALS-score) and a score assessing non-technical surgical skills (NOTSS-score). We hypothesize skill enhancement in the intervention group by 3–5 points on the GOALS score compared to the control group. Secondary outcomes will be satisfaction scores of patients, included registrars and mentors in both groups. For the definite RCT to attain 0.8 statistical power, a p-value of less than 0.05, and a 20% dropout rate, 12 residents per group are needed. However, the trial's novelty requires a pilot study to clarify the premises of a future definite RCT. RESULTS Before the trial begins, all telementors and on-site consulting surgeons will participate in a LapCo TT course (LapCo train the trainer course). The configuration of the telementoring system was finalized in December 2023. All residents, consulting surgeons, and telementors were instructed on how to set up and use the telementoring system. The recruitment commenced in spring 2024. Due to licensing issues, the MedPrescence equipment was replaced by Proximie in the summer of 2025 after the recruitment of 4 residents in the study. The telementors underwent a course for acquaintance with the new telementoring software system before the remaining inclusions commenced in August 2025, scheduled for three months. This will enable data analysis in the fall of 2025, and findings should be submitted for publication in an international peer-reviewed journal by spring 2026. CONCLUSIONS The SURGTEACH trial is the first known trial that evaluates surgical telementoring as an educational method in a pilot-RCT assessing both technical and nontechnical surgical skills. Globally and domestically, there are constraints on the number of surgeons available and a strain on the surgical education system. The Norwegian healthcare system needs help adequately training enough surgeons, mainly due to geographical obstacles and limitations in the educational system. Therefore, there is a need for a fundamental change in surgical education, and surgical telementoring has the potential to overcome these obstacles. This study has the potential to provide substantial evidence that may be used to enhance surgical education, particularly in rural healthcare facilities. CLINICALTRIAL Trial registration: ClinicalTrial.gov NCT06421584

Objectives This study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway. Design A nationwide retrospective observational study. Setting All 52 hospitals in Norway performing elective and acute abdominal surgery. Participants All 598 736 patients undergoing emergency and elective abdominal surgery from 2011 to 2021. Primary outcome measure Primary outcome was failure to rescue within 30 days (FTR30), defined as in-hospital or out-of-hospital death within 30 days of a surgical patient who developed at least one complication within 30 days of the surgery (FTR30). Other outcome variables were surgical complications and hospital FTR30 variation. Statistical analysis was conducted separately for general surgery and abdominal surgery. Results The 30-day postoperative complication rate was 30.7 (183 560 of 598 736 surgeries). Of general surgical complications (n=25 775), circulatory collapse (n=6127, 23%), cardiac arrhythmia (n=5646, 21%) and surgical infections (n=4334, 16 %) were most common and 1507 (5.8 %) patients were reoperated within 30 days. One thousand seven hundred and forty patients had FTR30 (6.7 %). The severity of complications was strongly associated with FTR30. In multivariate analysis of general surgery, adjusted for patient characteristics, only the year of surgery was associated with FTR30, with an estimated linear trend of −0.31 percentage units per year (95% CI (−0.48 to –0.15)). The driving distance from local hospitals to the nearest referral intensive care unit was not associated with FTR30. Over the last decade, FTR30 rates have varied significantly among similar hospitals. Conclusions Hospital factors cannot explain Norwegian hospitals’ significant FTR variance when adjusting for patient characteristics. The national FTR30 measure has dropped around 30% without a corresponding fall in surgical complications. No association was seen between rural hospital location and FTR30. Policy-makers must address microsystem issues causing high FTR30 in hospitals.

Background A stoma has severe impact on the patient's quality of life (QoL). Postoperative home community follow‐up by teleconsultation (TC) and stoma nurses may reduce the burden of travel and improve QoL. Methods A university hospital and five district medical centres participated. Patients with a stoma were randomized to follow‐up by either TC (intervention) or hospital (control). Stoma nurses performed the clinical examination at the TC studio, aided remotely by hospital nurses and surgeons. The primary endpoint was the EQ‐5D™ index score; secondary endpoints were the Stoma Quality‐of‐Life Scale, the OutPatient Experiences Questionnaire, and use of hospital resources. Results A total of 110 patients were randomized to hospital (58 patients) or TC (52) follow‐up; 64 patients (hospital 38, TC 26) were followed for more than 12 months and 246 consultations (hospital 151, TC 95) were performed. There were no differences in QoL: EQ‐5D™ index score (P = 0·301) and EQ‐5D™ visual analogue scale (VAS) score (P = 0·775); Work/Social Function (P = 0·822); Sexuality/Body Image (P = 0·253) and Stoma Function (P = 0·074). Hospital follow‐up performed better for organization of care (staff collaboration, P = 0·004; met same persons, P = 0·003) and communication (surgeon understandable, P < 0·001; surgeon caring P = 0·003). TC did not increase the number of hospital consultations (P = 0·684) and reduced the number of journeys of more than 8 h (P = 0·007). Conclusion Telemedicine follow‐up by stoma nurses did not improve the QoL of patients, but decreased the readmission rate and burden of travel. Registration number NCT01600508 ( https://www.clinicaltrials.gov).

In the era of competency-based surgical education, VBC has gained increased attention and may enhance the efficacy of surgical education. The objective of this systematic review was to summarize the existing evidence of video-based coaching (VBC) and compare VBC to traditional master-apprentice-based surgical education.