Predictors of Technical Skill Acquisition Among Resident Trainees in a Laparoscopic Skills Education Program

The study by Van Hove et al. [1] attempts to address a very important aspect of surgical training, namely, the ability to reliably measure innate technical ability and to accurately predict technical skill acquisition among surgical trainees. Such ability would be invaluable for both selection of candidates into training programs and for helping to tailor training programs to individual trainee’s needs. It is well known that different people attain skills, both practical and otherwise, at different rates, leading to a move in recent years for progress through surgical training to be competency-based rather than simply time-based. The goal of the study was to identify student characteristics predictive of innate pretraining skill level and response to training over the course of a 4-week laparoscopic simulator skills course; the retention of these skills over time was also measured. Forty-six first-year surgical residents in a single training program were recruited over a 4-year period. Laparoscopic technical ability was assessed using the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills [2] at three different time periods: (1) prior to the training course (n = 46), (2) at the end of the course (n = 35), and (3) at a variable time [median (range) = 521 (63-804) days] after course completion (n = 18). Age, gender, handedness, subspecialty field, active practice of a musical instrument during high school, and current occasional participation in video game use were recorded for a subset of trainees who were available to complete a follow-up survey (n = 33). Scores at time 1 were not significantly related to age, gender, designated field, or musical instrument use. Residents who reported current occasional participation in video games had significantly higher scores at time 1 and time 3 than those who did not report such use. General surgery trainees had significantly higher scores at time 2 (but not at time 1 or 3) than those destined for other specialties. Females had significantly higher scores at time 3 (but not at time 1 or 2) than males. There was a significant negative correlation between trainee age and both the degree of improvement between time 1 and time 2 and the actual time 2 scores. The authors conclude that a laparoscopic technical curriculum can achieve basic proficiency, even when taught to a diverse group of trainees. Older residents may be slower to develop technical skills than their younger colleagues and choice of general surgery over other surgical subspecialties appears to predict a higher level of technical proficiency. The benefits of surgical simulation in teaching laparoscopic skills are discussed at length in the article and the authors clearly advocate the use of such systems in all surgical training programs. As documented by the authors in the Discussion section, the study has a number of methodologic limitations. There are deficiencies in subject retention. Forty-six trainees were recruited into the study and underwent testing at the beginning of the skills training course. The course lasted 4 weeks and yet only 35 completed the testing at the end of this period; a loss of 11 or almost 25%. A subset of 18 available trainees, less than 40% of the original cohort, underwent a third test ‘‘at least 9 weeks after training.’’ It is very difficult to reach any meaningful conclusions with such a large attrition rate. Trainees were tested for the third time between 63 and 804 days after the training program. This represents a huge A. Paisley (&) Department of Surgery, Royal Infirmary Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Scotland e-mail: Anna.Paisley@luht.scot.nhs.uk