Incorporation of proficiency criteria for basic laparoscopic skills training: how does it work?

Abstract

Background It is desirable that surgical trainees are proficient in basic laparoscopic motor skills (eye-hand coordination). The present study evaluated the use of predefined proficiency criteria on a basic virtual reality (VR) simulator in preparation for a laparoscopic course on animal models. Methods Twenty-eight surgical trainees who enrolled for a basic laparoscopic course were trained on a basic (VR) simulator until their performance met predefined criteria. Two different criteria were defined, based on the performance of experienced laparoscopic surgeons on the simulator. In the first group (n = 10), the criteria were set at the 75th percentile of the laparoscopic surgeons' performance on the simulator and in the second group, at the 50th percentile (n = 18). Training time and number of attempts needed until the performance criteria were met were measured. Results In the first group, training time needed to pass the test ranged from 29 to 77 min (median: 63 min) with a range of 43-90 attempts (median 61 attempts). In the second group, training time ranged from 38 to 180 min (median 80 min) with a range of 55-233 attempts (median 95 attempts). Experience with assisting or performing laparoscopic procedures varied widely and was not correlated with the training time and number of attempts needed to pass the criteria. Conclusions The performance criteria for training laparoscopic motor skills on a (VR) simulator resulted in wide variation between surgical trainees in time and number of attempts needed to pass the criteria. This demands training courses with a flexible time span tailored to the individual level of the trainee.

Assessing Technical Competence in Surgical Trainees

“…The benchmarks are often set using virtual reality training systems or other simulated environments; however, they can also be established using other platforms such as recorded or live assessments completed intraoperatively or on standardized bench models. 84 One important consideration within this category lies in how these benchmarks are set. The majority of benchmarking assessments are completed using a virtual reality platform as summarized previously.…”

“…78,83 The majority of studies assessed the technical competence of categorical and/or preliminary surgical trainees performing a basic task (ie, knot tying) or generic procedure (ie, laparoscopic suturing) without a clear discipline focus or breakdown of participating residents. [88][89][90][91][92][93][94][95][96][97][98] The platforms utilized were live performances on virtual reality, 72,73,75,79,81,83,84,86,90,92,95,96,98 synthetic models (box trainers), 31,[76][77][78]80,82,85,89,91,94 simulators, 74,87 or a combination of synthetic models and a virtual reality platform. 97 Two studies utilized live assessments performed on standardized bench models.…”

“…The expert benchmark studies assessed competence in multiple disciplines including General Surgery, 31,[72][73][74][75][76][77][78][79][80][81][82][83][84] Gynecology, 78,83,85,86 Otolaryngology, 87 and Urology. 78,83 The majority of studies assessed the technical competence of categorical and/or preliminary surgical trainees performing a basic task (ie, knot tying) or generic procedure (ie, laparoscopic suturing) without a clear discipline focus or breakdown of participating residents.…”

European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills

“…All training programs described in earlier studies are using default settings or are based on personal choice [11][12][13][14][15][16][17][18][19]. The default settings tend to be unrealistic at the difficult level [11].…”

Criterion-Based (Proficiency) Training to Improve Surgical Performance

“…This disparity represents the wide range of aptitudes normally present in a resident population. It has been shown in multiple studies that the number needed to attain competency is variable within the resident population 19,20 owing to individual learning differences within the group. 21 Proficiency-based training seeks to eliminate this variability by ensuring that participants achieve validated criteria.…”