Surgical Novice Response to Laparoscopic Surgery Training on Simulators Before and After Training

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Background: With the current stipulations of the 80-hour work week for residents, surgical programs are faced with dilemma of teaching surgical procedures to residents outside of the operating room. This along with the advancement of minimally invasive surgery and the public apprehension towards the “see one, do one, teach one” curriculum has lead to the introduction of simulation into surgical residency education curriculum. We looked at the ratings of usefulness training on laparoscopic surgical simulators by interns following a 2week period of daily training. We hypothesized that following the period of training novices would rate all modalities as a positive experience in accordance with their previously anticipated ratings. Methods:32 interns rotating through the general surgery department were included in the study (10 General Surgery, 4 Orthopedic, 2 Otolaryngology, 3 Urology, 7 Radiology, 3 Plastic Surgery, 1 Vascular Surgery and 2 Neurosurgery). Participants were given an initial survey prior to their participation to evaluate their prior experience as well as their anticipated reaction to the usefulness of the teaching simulations. They then performed a laparoscopic cholecystectomy on a prosected pig liver in a box trainer (control). Following this all participants underwent 5 days of FLS training for 1.5 hours daily on the box trainer. The following week half of the participants continued to train on the FLS box trainer while the other half were randomly selected by number to train for 1.5 hours daily on the Simbionix LapMentor™ virtual reality trainer. At the end of the study they performed a laparoscopic cholecystectomy on a live pig, followed by an additional prosected pig liver in a box trainer for comparison. At the end of the study they filled out a survey assessing their experience on all modalities based on a Likert scale using questions involving perceived skill development, feedback on performance, realism and ability to better perform a laparoscopic cholecystectomy on a human. Results: Following the study, results from 28 of the 32 participants were evaluated (4 surveys were not completed with participation numbers and could not be verified for comparison). It was observed that the anticipated usefulness on all measures were decreased in the post training surveys compared to the initial surveys with statistical significance occurring in 13 of the 20 measured categories (p < 0.05). The most notable significant decrease was with the skill development and feedback of the live pig (p < 0.002 for each). Notable decreases in rating from perceived verse evaluative assessment for the box trainer were also found in skill development (p < 0.008), feedback (p < 0.01) and ability to better perform a laparoscopic cholecystectomy on a human (p < 0.004). However, no statistically significant decreases were noted with the virtual reality simulator between the perceived advantage and actual assessment. Conclusion: Residents anticipated usefulness of different simulation strategies including box trainers, prosected pig livers and live pigs for laparoscopic surgical training is greater prior to training than their acknowledged usefulness following training on these simulators. Despite the overall decreased rating in usefulness for each simulation modalities, virtual reality simulators do not show a statistically significant decrease.

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Journal of Surgical Research, v. 158, issue 2, p. 251