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BackgroundThe identification of developmental curve patterns generated by a simulation-based educational method and the variables that can accelerate the learning process will result in cost-effective training. This study describes the learning curves of a simulation-based instructional design (ID) that uses ex vivo animal models to teach laparoscopic latero-lateral small bowel anastomosis.MethodsTwenty general surgery residents were evaluated on their performance of laparoscopic latero-lateral jejuno-jejunal anastomoses (JJA) and gastro-jejunal anastomoses (GJA), using swine small bowel and stomach on an endotrainer. The ID included the following steps: (1) provision of references and videos demonstrating the surgical technique, (2) creation of an engaging context for learning, (3) critical review of the literature and video on the procedures, (4) demonstration of the critical steps, (5) hands-on practice, (6) in-action instructor’s feedback, (7) quality assessment, (8) debriefing at the end of the session, and (9) deliberate and repetitive practice. Time was recorded from the beginning to the completion of the procedure, along with the presence or absence of anastomotic leaks.ResultsThe participants needed to perform 23.8 ± 6.96 GJA (12–35) and 24.2 ± 6.96 JJA (9–43) to attain proficiency. The starting point of the learning curve was higher for the GJA than for the JJA, although the slope and plateau were parallel. Further, four types of learning curves were identified: (1) exponential, (2) rapid, (3) slow, and (4) no tendency. The type of pattern could be predicted after procedure number 8.ConclusionsThese findings may help to identify the learning curve of a trainee early in the developmental process, estimate the number of sessions required to reach a performance goal, determine a trainee’s readiness to practice the procedure on patients, and identify the subjects who lack the innate technical abilities. It may help motivated individuals to become reflective and self-regulated learners. Moreover, the standardization of the ID may help to measure the effectiveness of learning strategies and make comparisons with other educational strategies.

Traditionally surgeons learned surgical techniques by training them directly in the patient by imitating the actions of the surgeon with more experience. Today this methodology is difficult to apply, since there are multiple factors that hinder its use. The limited time of training systems, scarcity of resources, patient safety or the need to learn new techniques of minimally invasive surgery, make the training of surgeons require a different learning methodology. This study has designed a new methodology for the learning of surgical techniques that minimizes the impact of all the previous factors on the training of surgeons. Its effectiveness in the teaching of laparoscopic manual intestinal anastomosis is analyzed. It has been asked a group of 24 expert surgeons teaching in intestinal anastomoses, which are the steps that must include the teaching of the technique. The phases evaluated with the highest score were included in the methodology. Once the steps of the methodology were designed, 25 general surgeons were chosen and divided into three groups according to their level of experience (experts, trained and beginners). Each participant performed five training sessions following the new methodology. The technical quality of the anastomosis, the overall development of the operation, as well as the feedback developed between the participants and the instructor was analyzed. After analyzing the results it was observed that structured feedback between the instructor and the participant increases the involvement of the participant in the learning process and reduces the time needed to acquire the competence. With this methodology the inexperienced participants perform the fifth anastomosis with quality parameters close to those obtained by the expert participants. In addition, this methodology allows to individualize the learning according to the needs of each participant.How to cite this paper: