Learning curve patterns generated by a training method for laparoscopic small bowel anastomosis

Abstract

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.

Sleep Deprivation Adversely Impacts Resident Performance for Simulated Arthroscopy

“…Very few studies have quantitatively and objectively assessed the learning curve for shoulder arthroscopy. 17 , 18 This operation is reputed to be difficult, with a very steep learning curve; however, the plateau phase has not been well defined. The difficulty of a surgical exercise appears to be correlated with the time it takes for a trainee to reach the plateau.…”

Anesthesia Simulation Boot Camp—a Decade of Experience Enhancing Self-efficacy in First-year Residents

“…Supplementing the OR learning experience with simulation training provides the novice with opportunities to develop skills, behaviors, and confidence to effectively manage critical events safely, shifting the dangerous continued from previous page continued on next page Original Research early part of the learning curve away from patients. 1,27 Simulated clinical crises also allow residents to learn what adverse outcomes result from delayed diagnosis and treatment, without harming patients. 37 Our results are consistent with prior studies that support the effectiveness of simulation training in novice anesthesiology and critical care trainees.…”

“…Initial acquisition of procedural skills should be directed away from patients, shifting early training from traditional in-operating-room experiential learning toward simulation education that produces a more confident pretrained novice. 1,2 Simulation education also augments and standardizes exposure to emergency and rare-but-critical events that occur inconsistently.…”

Development, manufacture and initial assessment of validity of a 3-dimensional-printed bowel anastomosis simulation training model

“…One of the most common complications during any anastomosis procedure is leakage. 3 Complications due to poor stitching or stapling can lead to very severe complications, including death. 4 In a literature review analyzing information from 1980 to 2007, the rate of leakage after anastomosis ranged from 2.9% to 15.9%, depending on the procedure and experience of the surgeon, 5 which highlights the importance of training.…”

“…However, learners may not always have the opportunity to practise hand-sewn anastomosis in the operating room. 6 Resident work-hour restrictions 3 and emphasis on novel techniques such as stapling have decreased practical exposure to hand-sewn bowel anastomoses. 6 This decrease in exposure is unfavourable, as the handsewn small bowel anastomosis is one of the "most basic and fundamental skills burgeoning young surgeons must learn."…”