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Surgical training is aimed towards entrusted professional activity to obtain operative independence. Laparoscopic appendicectomy is performed early in training but except for simulators, real-life evaluation towards proficiency is scarce. The aim of this study was to model how each consecutive step may impact on the overall proficiency score for surgical trainees performing laparoscopic appendicectomy.

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A multilevel, step-based model to evaluate progress in procedure efficiency for laparoscopic appendicectomy in surgical training: structured evaluation using ‘ebb-and-flow’ and ‘string-of-pearls’ concepts