Long-term Retention after Structured Curriculum on Attainment of Critical View of Safety During Laparoscopic Cholecystectomy for Surgeons.

Background: Obtaining a clear Critical View of Safety helps prevent bile duct injuries during laparoscopic cholecystectomy, which can be improved with a structured Safe Critical View of Safety curriculum. We aimed to determine whether the improvement in obtaining Critical View of Safety postcurriculum is retained long-term. Methods: A safe Critical View of Safety curriculum was previously implemented for all surgeons who perform laparoscopic cholecystectomy at a regional health system. Recordings of laparoscopic chole-cystectomy cases were collected 1 year after completion of the curriculum, deidentified and randomly ordered, and then graded by 2 blinded expert surgeons using a 6-point Critical View of Safety assessment tool. Results: A total of 12 surgeons with average experience of 17.9 +/- 6.3 years in practice participated in the study. The majority (83%) had performed >700 laparoscopic cholecystectomies, and 4 surgeons (33%) reported 2 or more bile duct injuries in their career. Controlling for gallbladder pathology, Critical View of Safety scores improved from 1.7 +/- 0.4 to 4.0 +/- 0.4 (P < .001) immediately after completion of the cur-riculum. However, there was a small decrease in Critical View of Safety score after 1 year (3.2 +/- 0.3 from 4.0 +/- 0.4, P = .055), while still significantly higher compared to precurriculum (3.2 +/- 0.3 vs 1.7 +/- 0.4, P < .001). Acute care surgeons had lower Critical View of Safety retention scores compared to general sur-geons (1.8 +/- 0.5 vs 3.3 +/- 0.4, P = .01) and minimally invasive surgeons (1.8 +/- 0.5 vs 3.8 +/- 0.5, P < .01). Conclusion: A structured curriculum helped improve practicing surgeons' attainment of obtaining the Critical View of Safety during laparoscopic cholecystectomy. However, this improvement decreased after 1 year, suggesting some decay in knowledge retention over time. Therefore, continued educational in-terventions on Critical View of Safety and safe laparoscopic cholecystectomy may be needed to enhance long-term retention. (c) 2021 Elsevier Inc. All rights reserved.