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How internal (i.e. surgeon\u2019s experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience\u2009&lt;\u20094\u00a0years) operating under supervision. Trainers evaluated trainees\u2019 overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A \u201cChallenging\u201d procedure was defined as a combination of either\/or \u201cperforation\u201d and \u201cdifficult\u201d. Trainees who had performed\u2009&gt;\u200930 appendectomies were defined as \u201cexperienced\u201d. The trainees were asked if they had used simulation or web-based tools the week prior to surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>142 procedure evaluation forms were included of which 19 (13%) were \u201cperforated\u201d, 14 (10%) \u201cdifficult\u201d and 24 (17%) \u201cChallenging\u201d. Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0\u201375.6). Experienced trainees performed \u201cproficient\u201d more often than non-experienced (OR 34.5, 95% CI 6.8\u2013176.5). \u201cDifficult\u201d procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0\u20130.9). In \u201cChallenging\u201d procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1\u20130.9). The procedures assessed as \u201cdifficult\u201d had significantly longer operating time with a median (IQR) of 90 (75\u2013100) min compared to 59 (25\u2013120)\u00a0min for the non-difficult (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a \u201cdifficult\u201d procedure had most overall impact on proficiency evaluation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00464-024-11007-2","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T20:21:54Z","timestamp":1720470114000},"page":"4939-4946","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Internal and external factors affecting the performance score of surgical trainees doing laparoscopic appendectomy: a prospective, observational cohort study in a structured training programme"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3307-0262","authenticated-orcid":false,"given":"Benedicte","family":"Skjold-\u00d8degaard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hege Langli","family":"Ersdal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Assmus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjetil","family":"S\u00f8reide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,8]]},"reference":[{"issue":"8","key":"11007_CR1","doi-asserted-by":"publisher","first-page":"3450","DOI":"10.1007\/s00464-018-6064-9","volume":"32","author":"TM Drake","year":"2018","unstructured":"Drake TM et al (2018) Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. 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