Training healthcare providers for optimal management of hemorrhoidal disease

Optimal management of hemorrhoidal disease, or of all anorectal problems for that matter, demands a thorough understanding of the anatomy and physiology of the anal canal and rectum. With this as a foundation, the healthcare provider recognizes the various symptoms produced by hemorrhoids and implements appropriate management strategies. Training then requires imparting cognitive skills such as knowledge of anorectal anatomy, pertinent history taking, and understanding of management options. Equally important for the provider is acquisition of certain technical skills required for diagnosis, useful for office procedures, and necessary for the variety of operative options available for the definitive management of hemorrhoidal disease. The intent of this chapter is to assist the surgeon educator who has the important charge of training those providers who care for patients with hemorrhoidal disease. Consideration is given to the type of provider and their specific needs and includes primary care physician, emergency medicine physician, surgical resident, and practicing surgeon. Practical methods for both cognitive and technical skill transfer are reviewed. The potential role for the surgical skills laboratory is offered. Finally, the question of assessing the "trained" provider's level of competency for optimally managing patients with hemorrhoids will be addressed.