Background: We describe initial success in designing and implementing an objective evaluation for opening and closing a simulated abdomen.
Methods: (1) An assessment for laparotomy was created using peer-reviewed literature, texts, and the input of academic surgeons nationally; (2) the assessment was evaluated for construct validity, comparing the videotaped performance of laparotomy by surgical experts and novices on a viscoelastic model; and (3) the basics of open laparotomy training (BOLT) curriculum was piloted with junior residents to evaluate efficacy at improving performance.
Results: Experts performed better than novices opening (.94 vs .51; P < .001), closing (.85 vs .16; P < .001), and overall performance (.88 vs .27; P < .001). Novices caused bowel injury more frequently (5 vs 1; P < .05) and took longer to open the abdomen (6:06 vs 3:43; P = .01). After completing the BOLT curriculum, novices improved for opening (1.00 vs .50; P = .014), closing (.80 vs .10; P = .014), and overall score (.87 vs .23; P = .014).
Conclusions: We demonstrate construct validity of an evaluation tool for simulated laparotomy, and pilot efforts with the BOLT curriculum have shown promise.
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