A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training

Tan, Swee Chin; Marlow, Nicholas; Field, John; Altree, Meryl; Babidge, Wendy; Hewett, Peter; Maddern, Guy J.

doi:10.1007/s00464-012-2326-0

Cited by 40 publications

(30 citation statements)

References 19 publications

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“…Systematic training with FLS models and, even with more economical improvised FLS surrogates, was found to shorten the time needed to gain proficiency in some techniques [27], [28]. The literature suggests that low-fidelity FLS-like models can prepare the trainee for other more expensive, high-fidelity, “wet-lab” modules, reducing the time and funds required for to train the future generation of surgeons [12].…”

Section: Discussionmentioning

confidence: 99%

“…However, it is an extremely expensive setting that cannot easily be offered repeatedly to a wide number of students. On the other hand, the “FLS” setting may be of low-fidelity, but it is relatively inexpensive, and as proven equally effective [12], [28], [35]. Dry-lab simulation is easily reproducible, can be applied to a wider audience with no restrictions, and ethics-wise it does not require any preparation.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, dry lab modules only use synthetic materials and technological equipment [11]. The setting of the environment is defined also by its fidelity level, with a range from low- to high-fidelity modules [12].…”

Section: Introductionmentioning

confidence: 99%

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Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?

Pantelidis

Sideris

Tsoulfas

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundEssentials Skills in the Management of Surgical Cases – ESMSC is an International Combined Applied Surgical Science and Wet Lab course addressed at the Undergraduate level. Laparoscopic Skills is a fundamental element of Surgical Education and various Simulation-Based Learning (SBL) models have been endorsed. This study aims to explore if there is any significant difference in delegates' performance depending on whether they completed In Vivo module prior to the equivalent in the laparoscopic simulator.Materials and methods37 Medical Students from various EU countries were divided in 2 groups, and both completed the “Fundamentals in Laparoscopic Surgery” module in the Dry-lab Laparoscopic Simulator as well as the same module “In Vivo” on a swine model. Group A (18 students, 48.6%) completed the “Fundamentals in Laparoscopic Surgery - FLS” module prior to the “In Vivo”, whereas group B completed the “In Vivo” module first. Direct Observation of Procedural Skills (DOPS) were used to assess delegates' performance.ResultsThe mean DOPS scores for the “FLS” and “In Vivo” models were 2.27 ± 0.902 and 2.03 ± 0.833, respectively, and the delegates' performance was not statistically significantly different between them (p = 0.128). There was no statistically significant difference in the scores among different gender, year of study, school and handedness groups. The alteration in the sequence between Dry-lab “FLS” and “In Vivo” modules did not affect the performance in neither the “FLS” nor the “In Vivo” models.ConclusionsThe inexpensive, but low-fidelity “FLS” model could serve an equal alternative Simulation-Based Learning model for the early undergraduate training. Our study demonstrated that high fidelity In Vivo simulation for laparoscopic skills does not affect significantly the improvement in the delegates' performance at the undergraduate level. Further studies should be conducted to identify at which stage of training should high fidelity simulation be introduced.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?

Pantelidis

Sideris

Tsoulfas

et al. 2017

Annals of Medicine &Amp; Surgery

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“…In a recent study, the performance on this simulator has not been shown to be correlated with the FLS scores (Hennessey & Hewett, 2014). Some comparative studies and reviews have shown also the benefit of the FLS trainer compared to LapSim for training basic laparoscopic skills (Fairhurst, Strickland, & Maddern, 2011; Tan, et al, 2012; Hennessey & Hewett, 2014), while another study has concluded that both systems are efficient for training laparoscopic skills with an advantage to the FLS box trainer in regard to its cost effectiveness (Orzech, Palter, Reznick, Aggarwal, & Grantcharov, 2012). Indeed, the annual cost of VR training for 5 residents was estimated to $80,000 USD while it was estimated to $12,000 for the FLS box training (Orzech, Palter, Reznick, Aggarwal, & Grantcharov, 2012).…”

Section: Related Workmentioning

confidence: 99%

Achieving interface and environment fidelity in the Virtual Basic Laparoscopic Surgical Trainer

Chellali

Mentis

Miller

et al. 2016

International Journal of Human-Computer Studies

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Virtual reality trainers are educational tools with great potential for laparoscopic surgery. They can provide basic skills training in a controlled environment and free of risks for patients. They can also offer objective performance assessment without the need for proctors. However, designing effective user interfaces that allow the acquisition of the appropriate technical skills on these systems remains a challenge. This paper aims to examine a process for achieving interface and environment fidelity during the development of the Virtual Basic Laparoscopic Surgical Trainer (VBLaST). Two iterations of the design process were conducted and evaluated. For that purpose, a total of 42 subjects participated in two experimental studies in which two versions of the VBLaST were compared to the accepted standard in the surgical community for training and assessing basic laparoscopic skills in North America, the FLS box-trainer. Participants performed 10 trials of the peg transfer task on each trainer. The assessment of task performance was based on the validated FLS scoring method. Moreover, a subjective evaluation questionnaire was used to assess the fidelity aspects of the VBLaST relative to the FLS trainer. Finally, a focus group session with expert surgeons was conducted as a comparative situated evaluation after the first design iteration. This session aimed to assess the fidelity aspects of the early VBLaST prototype as compared to the FLS trainer. The results indicate that user performance on the earlier version of the VBLaST resulting from the first design iteration was significantly lower than the performance on the standard FLS box-trainer. The comparative situated evaluation with domain experts permitted us to identify some issues related to the visual, haptic and interface fidelity on this early prototype. Results of the second experiment indicate that the performance on the second generation VBLaST was significantly improved as compared to the first generation and not significantly different from that of the standard FLS box-trainer. Furthermore, the subjects rated the fidelity features of the modified VBLaST version higher than the early version. These findings demonstrate the value of the comparative situated evaluation sessions entailing hands on reflection by domain experts to achieve the environment and interface fidelity and training objectives when designing a virtual reality laparoscopic trainer. This suggests that this method could be used successfully in the future to enhance the value of VR systems as an alternative to physical trainers for laparoscopic surgery skills. Some recommendations on how to use this method to achieve the environment and interface fidelity of a VR laparoscopic surgical trainer are identified.

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“…13 Since "high-fidelity" versus "low-fidelity" trainers do not seem to predict the degree of skill transfer, and low-fidelity models may be equivalent or better for novice trainees at times, it is difficult to predict which model might be best for training. 25,[49][50][51][52][53][54] This may, in part, be due to the difficulty in defining high-fidelity versus low-fidelity models, as structural fidelity such as physical resemblance may be higher in one model such as a human patient simulator, and functional fidelity such as tissue feel and forces required may be higher in the LT model. 22 It is still unknown how these various aspects of fidelity and how aspects of psychologic, emotional, and affective fidelity (having a living animal to resuscitate vs. having a live actor in the CutSuit) individually contribute to educational effectiveness and transfer of learning to the human model, especially in high-stress clinical environments.…”

Section: Cricmentioning

confidence: 99%

Training and Assessing Critical Airway, Breathing, and Hemorrhage Control Procedures for Trauma Care: Live Tissue Versus Synthetic Models

Hart

Rush

Rule

et al. 2017

Academic Emergency Medicine

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A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training

Cited by 40 publications

References 19 publications

Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?

Is In-Vivo laparoscopic simulation learning a step forward in the Undergraduate Surgical Education?

Achieving interface and environment fidelity in the Virtual Basic Laparoscopic Surgical Trainer

Training and Assessing Critical Airway, Breathing, and Hemorrhage Control Procedures for Trauma Care: Live Tissue Versus Synthetic Models

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