What Surgical Skills Rural Surgeons Need to Master

Background
As new technology is developed and scientific evidence demonstrates strategies to improve the quality of care, it is essential that surgeons keep current with their skills. Rural surgeons need efficient and targeted continuing medical education that matches their broader scope of practice. Developing such a program begins with an assessment of the learning needs of the rural surgeon. The aim of this study was to assess the learning needs considered most important to surgeons practicing in rural areas.

Study Design
A needs assessment questionnaire was administered to surgeons practicing in rural areas. An additional gap analysis questionnaire was administered to registrants of a skills course for rural surgeons.

Results
Seventy-one needs assessment questionnaires were completed. The self-reported procedures most commonly performed included laparoscopic cholecystectomy (n=44), hernia repair (n=42), endoscopy (n=43), breast surgery (n=23), appendectomy (n=20) and colon resection (n=18). Respondents indicated that they would most like to learn more skills related to laparoscopic colon resection (n=16), laparoscopic antireflux procedures (n=6), laparoscopic common bile duct exploration/ERCP (n=5 colonoscopy/advanced techniques and esophagogastroscopy (n=4) and breast surgery (n=4). Ultrasound, hand surgery, and leadership and communication were additional topics rated as useful by the respondents. Skills course participants indicated varying levels of experience and confidence with breast ultrasound, ultrasound for central line insertion, hand injury and facial soft tissue injury.

Conclusions
Our results demonstrate that surgeons practicing in rural areas have a strong interest in acquiring additional skills in a variety of general and subspecialty surgical procedures. The information obtained in this study may be used to guide curriculum development of further post graduate skills courses targeted to rural surgeons.

Amy L. Halverson, MD, FACS, Tyler G. Hughes, MD, FACS, David C. Borgstrom, MD, FACS, Ajit K. Sachdeva, MD, FACS, Debra A. DaRosa, PhD, David B. Hoyt, MD, FACS
Received 27 April 2013; received in revised form 25 May 2013; accepted 28 June 2013. published online 08 July 2013. Journal of the American College of Surgeons

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