Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair (original) (raw)
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Journal of the American College of Surgeons, 2007
We have previously shown that reaching expert performance on an fundamentals of laparoscopic surgery (FLS)-type simulator model for laparoscopic suturing results in measurable improvement during an actual operation; trained novices, however, demonstrate inferior operative performance compared with experts. We hypothesized that simulator training under more difficult and realistic conditions would enhance the operative performance of novices. STUDY DESIGN: Medical students (n ϭ 32) participated in an IRB-approved, randomized, controlled trial. All participants were pretested in laparoscopic suturing on a previously validated porcine Nissen model and were randomized into three groups: group I (n ϭ 6) received no training, group II (n ϭ 13) trained on the FLS videotrainer model until a previously published proficiency score (512) was achieved on 2 consecutive and 10 additional attempts, group III (n ϭ 13) trained to the same goal but had to practice in a constrained space, with a shorter suture, starting with a dropped needle, and listening to operating room noise. Training workload was measured with the validated NASA-TLX (Task Load Index) questionnaire after each training session. All groups were posttested on the porcine model. Results were compared using ANOVA; p Ͻ 0.05 was considered significant.
State of the Evidence on Simulation-Based Training for Laparoscopic Surgery
Annals of Surgery, 2013
Objective: Summarize the outcomes and best practices of simulation training for laparoscopic surgery. Background: Simulation-based training for laparoscopic surgery has become a mainstay of surgical training. Much new evidence has accrued since previous reviews were published. Methods: We systematically searched the literature through May 2011 for studies evaluating simulation, in comparison with no intervention or an alternate training activity, for training health professionals in laparoscopic surgery. Outcomes were classified as satisfaction, skills (in a test setting) of time (to perform the task), process (eg, performance rating), product (eg, knot strength), and behaviors when caring for patients. We used random effects to pool effect sizes. Results: From 10,903 articles screened, we identified 219 eligible studies enrolling 7138 trainees, including 91 (42%) randomized trials. For comparisons with no intervention (n = 151 studies), pooled effect size (ES) favored simulation for outcomes of knowledge (1.18; N = 9 studies), skills time (1.13; N = 89), skills process (1.23; N = 114), skills product (1.09; N = 7), behavior time (1.15; N = 7), behavior process (1.22; N = 15), and patient effects (1.28; N = 1), all P < 0.05. When compared with nonsimulation instruction (n = 3 studies), results significantly favored simulation for outcomes of skills time (ES, 0.75) and skills process (ES, 0.54). Comparisons between different simulation interventions (n = 79 studies) clarified best practices. For example, in comparison with virtual reality, box trainers have similar effects for process skills outcomes and seem to be superior for outcomes of satisfaction and skills time. Conclusions: Simulation-based laparoscopic surgery training of health professionals has large benefits when compared with no intervention and is moderately more effective than nonsimulation instruction.
Simulation Based Training Improves Laparoscopic Surgical Skills in Trainee Surgeons
Pakistan Armed Forces Medical Journal, 2021
Objective: To assess the impact of laparoscopic simulation training on surgical skills of trainee surgeons. Study Design: Comparative prospective study. Place and Duration of Study: Jinnah Sindh Medical University Karachi, for one month October 2019. Methodology: Total thirty surgical trainees of FCPS year four (R4) were studied. The cases group (fifteen trainees) were given one month laparoscopy training on a LAP Simulator (LAPSim), surgical science Sweden) and the control group (fifteen trainees) were not trained. Their laparoscopic skills were then compared. Objective Structured Assessment of Technical Skills (OSATS) specific and general was used to assess their performance. Data was entered and analyzed using SPSS-23. Results: On LAP Sim Scoring, post-test scores were significantly better than pre-test for all skills in the trainedresidents (p<0.01 for all subscales) and total post-test score was also significantly better for trained surgeonsas compared to untrained (77.45 ± ...
Criterion-based training with surgical simulators: proficiency of experienced surgeons
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
In our effort to establish criterion-based skills training for surgeons, we assessed the performance of 17 experienced laparoscopic surgeons on basic technical surgical skills recorded electronically in 26 modules selected in 5 commercially available, computer-based simulators. Performance data were derived from selected surgeons randomly assigned to simulator stations, and practicing repetitively during one and one-half day sessions on 5 different simulators. We measured surgeon proficiency defined as efficient, error-free performance and developed proficiency score formulas for each module. Demographic and opinion data were also collected. Surgeons' performance demonstrated a sharp learning curve with the most performance improvement seen in early practice attempts. Median scores and performance levels at the 10th, 25th, 75th, and 90th percentiles are provided for each module. Construct validity was examined for 2 modules by comparing experienced surgeons' performance with...
Integrating Simulation in Surgery as a Teaching Tool and Credentialing Standard
Journal of Gastrointestinal Surgery, 2008
The time-honored training methods of surgery are rapidly being replaced with new teaching tools that are being integrated into residency and recredentialing standards. Numerous factors including societal, professional, and legal have all forced surgical training programs to seek alternative methods of training residents. Learning theories that have provided the basis for open surgical skills training have been modified and culminated in the theory of automaticity and the "pretrained" laparoscopic novice. A vast array of simulators exist for training, ranging from inanimate video trainers, human patient simulators, to more recently virtual reality (VR) computer-based trainers. Currently, inanimate trainers are deployed widely throughout surgical training programs and serve as the primary platform for laparoscopic skills training. As technology evolves, VR systems have become available, allowing for more complex skills training with realistic computer-generated anatomic structures. Using the theories of crisis management and crew resource management, simulation is moving from simple skills training to whole-team training in mock operating room environments. Looking to the near future, medical training will continue to evolve to meet the changing demands of society and professional responsibility to ensure patient safety. With the advent of accredited skills-training centers endorsed by the American College of Surgeons, simulation will be the catalyst for these continuing changes.
Simulation in surgical training: educational issues and practical implications
Medical Education, 2003
Background Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework.
Skill retention following proficiency-based laparoscopic simulator training
Surgery, 2005
Background. Proficiency-based curricula using both virtual reality (VR) and videotrainer (VT) simulators have proven to be efficient and maximally effective, but little is known about the retention of acquired skills. The purpose of this study was to assess skill retention after completion of a validated laparoscopic skills curriculum. Methods. Surgery residents (n = 14) with no previous VR or VT experience were enrolled in an Institutional Review Board-approved protocol and sequentially practiced 12 Minimally Invasive Surgical Trainer-VR and 5 VT tasks until proficiency levels were achieved. One VR (manipulate diathermy) and 1 VT (bean drop) tasks were selected for assessment at baseline, after training completion (posttest), and at retention. Results. All residents completed the curriculum. Posttest assessment occurred at 13.2 ± 11.8 days and retention assessment at 7.0 ± 4.0 months. After an early performance decrement at posttest (17%-45%), the acquired skill was maintained up to the end of the follow-up period. For VR, scores were 81.5 ± 23.5 at baseline, 33.3 ± 1.8 at proficiency, 48.4 ± 9.2 at posttest, and 48.4 ± 11.8 at retention. For VT, scores were 49.4 ± 12.5 at baseline, 22.0 ± 1.4 at proficiency, 25.6 ± 3.6 at posttest, and 26.4 ± 4.2 at retention. Skill retention was better for VT, compared with VR (P < .02). The extent of skill deterioration did not correlate with training duration or resident level. Conclusions. Although residents do not retain all acquired skills (more so for VR than for VT) according to simulator assessment, proficiency-based training on simulators results in durable skills. Additional studies are warranted to further optimize curriculum design, investigate simulator differences, and establish training methods that improve skill retention. (Surgery 2005;138:165-70.)
Establishing a simulation center for surgical skills: what to do and how to do it
Surgical Endoscopy, 2007
This article summarizes the hands-on course-Establishing a Simulation Center for Surgical Skills: What to Do and How to Do It-proposed and developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Technology Committee at the SAGES 2006 annual meeting in Dallas, Texas. The lecture portion was presented to approximately 60 attendees and included information on the ACS Initiative, curriculum development, teaching with simulation, validation, finances, and a technology update, as detailed in the following sections. A lab allowing handson use of 10 different physical and computerized simulators was provided to approximately 40 participants. The ACS Program for Accreditation of Education Institutes (Dr. Sachdeva) The ACS recently launched a program to accredit education institutes. The aims of the program are to advance surgical skills education and to enhance access to educational opportunities within and among institutions. Learner groups targeted by the program are surgeons in practice, surgery residents, medical students, members of the surgical team, and surgical patients. Educational underpinnings The critical role of structured teaching, learning, and assessment of surgical skills has been the subject of