Aims

The aim of this thesis was to investigate, for supervised training in laparoscopic colorectal surgery (LCS); clinical safety, proficiency gain, training quality and programme structure. The specific objectives were (1) define national learning curves for LCS and analyse the clinical safety of supervised LCS training (2) assess the performance of supervised LCS trainees and define their proficiency gain (3) evaluate the impact of training quality and programme structure.

Methods
Objective 1: National data was used to create national proficiency gain curves and define the national clinical outcomes for LCS. Clinical data and proficiency gain curves from the National Training Programme (NTP) and laparoscopic fellowships were compared against this. Objective 2: The formative Global Assessment Scale (GAS) scores were used to assess the performance and define the competency proficiency gain for supervised LCS training. Summative Competency Assessment Tool (CAT) scores were used to assess trainee performance on completion of training. Objective 3: Mini-Structured Training Trainer Assessment Report (mini-STTAR) scores were used to measure training quality and the impact of the Lapco-TT course. A survey study was used to evaluate the structural and organisational quality of the NTP.

Results
There has been a national learning curve for mortality associated with the introduction of LCS. Supervised training in LCS flattened the clinical learning curve and prevented unnecessary patient harm. The supervised competency proficiency gain curve for LCS was around 30 cases. Increased training volume improved technical performance in objective summative competency assessment, which in turn improved clinical outcomes. The quality of the training, structure and organisation was high and Lapco-TT course augmented training.

Conclusion
The introduction of novel surgical techniques is associated with patient harm. LCS was learnt safely, efficiently and effectively within the NTP. The NTP model, including the structure, organisation, competency assessment and audit provides a template for future training programmes.