Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent approaches

Abstract

Aim: Current financial and work hour constraints make proctored on-site laparoscopic simulation training challenging. An independent learning approach utilizing proficiency-based training is a potential solution. The purpose of this study was to determine if an independent approach using a portable, laparoscopic training device within one’s home environment could effectively train novices in laparoscopic procedural skills.

Methods: After baseline testing, laparoscopic novices (n = 16) were randomized to one of two study groups. The on-site group (n = 7) received unlimited access to the workplace laparoscopic trainers and the home group (n = 9) received portable laparoscopic trainers for home. Both groups underwent self-directed, proficiency-based training for three months then were retested. Results were compared with parametric and non-parametric statistical tests.

Results: Baseline characteristics were similar between groups. The practice rate (56%) and practice time (range, 0.18 to 2.6 h) were poor in both groups during the training period. At post-test, the number of participants who demonstrated an improvement (86% on-site, 78% home) on the peg task was not different between groups. The successful completion of the suturing task post-test had significantly improved compared with pre-test in both groups (71% vs. 29% on-site; 44% vs. 22% home, P < 0.001). Although the majority of participants reported it was difficult to practice on a regular basis (86% on-site, 89% home), 56% of the home group participants agreed that the at-home trainer was a helpful teaching modality.

Conclusion: Learning of laparoscopic skills by novice trainees can be augmented by an independent learning approach using either home or on-site laparoscopic trainers. Although over half the candidates found it was useful to have the training device at home, none of the participants practiced more than an hour or two in the three month training period. Thus, the solution to conducting training does not lie in merely providing home training, but rather to understand the work-related stressors and reconfigure jobs.

Keywords

Laparoscopic surgery / training / medical education / proficiency / simulation / independent learning

References

[1] Madan AK,Taddeucci RJ.Goal-directed laparoscopic training leads to better laparoscopic skill acquisition..Surgery2008;144:345-50

[2] Gauger PG,Andreatta PB,Hillard ML,Kasten SJ,Cederna PS.Laparoscopic simulation training with proficiency targets improves practice and performance of novice surgeons..Am J Surg2010;199:72-80

[3] Rosenthal ME,Goova MT,Tesfay ST,Hartzler R.Proficiency-based fundamentals of laparoscopic surgery skills training results in durable performance improvement and a uniform certification pass rate..Surg Endosc2010;24:2453-7

[4] Scott DJ,Rege RV,Tesfay ST,Euhus DM,Thompson WM.Laparoscopic training on bench models: better and more cost effective than operating room experience?.J Am Coll Surg2000;191:272-83

[5] Gonzalez R,Smith CD.Does setting specific goals and providing feedback during training result in better acquisition of laparoscopic skills?.Am Surg2004;70:35-9

[6] Snyder CW,Tyra SL.Proficiency-based laparoscopic and endoscopic training with virtual reality simulators: a comparison of proctored and independent approaches..J Surg Educ2009;66:201-7

[7] Curet MJ.Resident work hour restrictions: where are we now?.J Am Coll Surg2008;207:767-76

[8] Damadi A,Saxe A.ACGME duty-hour restrictions decrease resident operative volume: a 5-year comparison at an ACGME-accredited university general surgery residency..J Surg Educ2007;64:256-9

[9] Pape HC.Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review..Patient Saf Surg2009;3:3 PMCID:PMC2654871

[10] Chang L,Hess DT,Babineau TJ.Integrating simulation into a surgical residency program: is voluntary participation effective?.Surg Endosc2007;21:418-21

[11] Brydges R,Safir O.How effective is self-guided learning of clinical technical skills? It's all about process..Med Educ2009;43:507-15

[12] Wulf G,Pfeiffer F.Self-controlled observational practice enhances learning..Res Q Exerc Sport2005;76:107-11

[13] Safir O,Hui Y,Carnahan H.Self-directed practice scheduling is equivalent to instructor guided practice when learning a complex surgical skill..Procedia Social Behavioral Sci2010;2:792-6

[14] Leff DR,Rana M,Purkayastha S,Darzi AW.Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare..Ann Surg2008;247:530-9

[15] Fundamentals of Laparoscopic Surgery. Available from: https://www.flsprogram.org/. [Last accessed on August 16, 2017]

[16] Korndorffer JRJr,Sierra R,Touchard CL.Simulator training for laparoscopic suturing using performance goals translates to the operating room..J Am Coll Surg2005;201:23-9

[17] Ritter EM.Design of a proficiency-based skills training curriculum for the fundamentals of laparoscopic surgery..Surg Innov2007;14:107-12

[18] Chung SY,Chon CH,Fuchs GJ.Laparoscopic skills training using a webcam trainer..J Urol2005;173:180-3

[19] Sharpe BA,Ogan K.Randomized comparison of standard laparoscopic trainer to novel, at-home, low-cost, camera-less laparoscopic trainer..Urology2005;66:50-4

[20] Ericsson KA.Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains..Acad Med2004;79:S70-81

[21] Jowett N,Xeroulis G,Dubrowski A.Surgical skill acquisition with self-directed practice using computer-based video training..Am J Surg2007;193:237-42

[22] Mann K,MacLeod A.Reflection and reflective practice in health professions education: a systematic review..Adv Health Sci Educ Theory Pract2009;14:595-621

[23] Summers AN,Simpson D.Acquisition of surgical skills: a randomized trial of didactic, videotape, and computer-based training..Surgery1999;126:330-6

[24] Xeroulis GJ,Moulton CA,Leblanc V.Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback..Surgery2007;141:442-9

[25] Ford JK.The application of cognitive constructs and principles to the instructional systems of model training: implications for needs assessment, design and transfer..In: Cooper CL, Robertson IT, eds. International Review of Industrial and Organizational Psychology.1995;Chichester, EnglandWiley1-48

[26] Rosser JC,Risucci DA,Rosser LE.Effectiveness of a CD-ROM multimedia tutorial in transferring cognitive knowledge essential for laparoscopic skill training..Am J Surg2000;179:320-4

[27] Takiguchi S,Yasui M,Fujiwara Y,Yano M.Cyber visual training as a new method for the mastery of endoscopic surgery..Surg Endosc2005;19:1204-10

[28] Stefanidis D,Heniford BT.Limited feedback and video tutorials optimize learning and resource utilization during laparoscopic simulator training..Surgery2007;142:202-6

[29] Cantillon P.Giving feedback in clinical settings..BMJ2008;337:a1961

[30] Kolkman W,Van den Hout WB,Jansen FW.Implementation of the laparoscopic simulator in a gynecological residency curriculum..Surg Endosc2007;21:1363-8