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

Abstract

How to cite this article: Bellows CF, Smith AA. Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent approaches. Mini-invasive Surg 2017;1:126-32. Quick Response Code: Original ArticleThis is an open access article licensed under the terms of Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the identical terms. For reprints contact: service@oaepublish.com Open AccessBellows et al. Mini-invasive Surg 2017;1:126-32 DOI: 10.20517/25741:126-32 DOI: 10.20517/ -12251:126-32 DOI: 10.20517/ .2017 Mini-invasive Surgery www.misjournal.net 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. Key words:Laparoscopic surgery, training, medical education, proficiency, simulation, independent learning ABSTRACT Article history:

Remote training in laparoscopy: a randomized trial comparing home-based self-regulated training to centralized instructor-regulated training

“…Accordingly, it has been emphasized that curricular requirements, goal setting, testing, and protected training time, i.e., training time incorporated into working-time, protected from clinical responsibilities [21], are essential factors for assuring trainees' commitment to training [22][23][24]. Studies of training programs with proficiency goals and pass/fail criteria found that access to independent home-based training resulted in comparable performance improvements and increased training distribution compared to control groups with access to independent training in simulation centers [25][26][27]. Unlike previous studies, the present study does not investigate independent training, but compares centralized instructor-led training to structured and supported home-based training in laparoscopy.…”

Prospective comparison of single encounter versus distributed laparoscopic training in novice learners

“…[ 3 4 ] Acquisition of such complex skills requires many hours of hands-on training, which becomes even more challenging in the face of reduced trainee working hours. [ 5 ] Work hour restrictions, pressure to increase theater throughput, and the ethical debate regarding inexperienced surgeons operating on patients meant that the traditional model of surgical training needed to be revised. [ 6 ] As a result, focus has shifted to the use of models and simulators, with the objective of better preparation of trainees for real-life operating room experience.…”