The Pretrained Novice: Using Simulation-Based Training to Improve Learning in the Operating Room

Enabling trainees to acquire advanced technical skills before they begin the operating room experience benefits both trainee and patient. Whether medical students who had received exclusively simulation-based training could perform laparoscopic suturing and knot-tying as well as senior surgery residents was determined. Simulators were used to train 11 fourth-year medical students with no previous suturing experience to perform intracorporeal suturing and to successfully tie a free-hand intracorporeal knot. Students’ skills were assessed by the performance of the fundal suturing portion of a Nissen fundoplication in a porcine model. Their operative performance was evaluated for time, needle manipulations, and total errors. Results were compared to those of 11 senior-level surgery residents performing the same task. The study concluded that trainees could learn advanced technical skills such as laparoscopic suturing and knot tying by using simulation exclusively. The trainees and senior level surgery residents had a similar number of needle manipulations.

[1]  A. Voitk,et al.  The tail of the learning curve for laparoscopic cholecystectomy. , 2001, American journal of surgery.

[2]  R. M. Satava,et al.  Analysis of errors in laparoscopic surgical procedures , 2004, Surgical Endoscopy And Other Interventional Techniques.

[3]  Ara Darzi,et al.  The relationship between motion analysis and surgical technical assessments. , 2002, American journal of surgery.

[4]  D. Risucci.  Visual spatial perception and surgical competence. , 2002, American journal of surgery.

[5]  A. Darzi,et al.  Use of Suturing as a Measure of Technical Competence , 2003, Annals of plastic surgery.

[6]  Daniel B. Jones,et al.  Comparison of video trainer and virtual reality training systems on acquisition of laparoscopic skills , 2002, Surgical Endoscopy And Other Interventional Techniques.

[7]  R. Satava,et al.  Virtual Reality Simulation for the Operating Room: Proficiency-Based Training as a Paradigm Shift in Surgical Skills Training , 2005, Annals of surgery.

[8]  G. Fried,et al.  Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. , 2004, Surgery.

[9]  James R Korndorffer,et al.  Simulator training for laparoscopic suturing using performance goals translates to the operating room. , 2005, Journal of the American College of Surgeons.

[10]  B. Flor,et al.  Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve? , 2000, Surgical endoscopy.

[11]  Teodor P Grantcharov,et al.  Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. , 2003, American journal of surgery.

[12]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[13]  A. Gallagher,et al.  Objective Psychomotor Skills Assessment of Experienced, Junior, and Novice Laparoscopists with Virtual Reality , 2001, World Journal of Surgery.

[14]  A. G. Gallagher,et al.  Construct validation of the ProMIS simulator using a novel laparoscopic suturing task , 2005, Surgical Endoscopy And Other Interventional Techniques.

[15]  Hubertus Feussner,et al.  Ergonomic assessment of the static stress confronted by surgeons during laparoscopic cholecystectomy , 2004, Surgical Endoscopy And Other Interventional Techniques.

[16]  J. Rosser,et al.  Objective evaluation of a laparoscopic surgical skill program for residents and senior surgeons. , 1998, Archives of surgery.

[17]  F C Forrest,et al.  Use of a high-fidelity simulator to develop testing of the technical performance of novice anaesthetists. , 2002, British journal of anaesthesia.

[18]  Richard M Satava,et al.  Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures. , 2003, Journal of the American College of Surgeons.

[19]  R. M. Satava,et al.  Metrics for objective Assessment , 2003, Surgical Endoscopy And Other Interventional Techniques.

[20]  M. Schijven,et al.  Face-, expert, and referent validity of the Xitact LS500 Laparoscopy Simulator , 2002, Surgical Endoscopy And Other Interventional Techniques.

[21]  C. Bennett,et al.  The learning curve for laparoscopic cholecystectomy , 1995 .

[22]  James R Korndorffer,et al.  Skill retention following proficiency-based laparoscopic simulator training. , 2005, Surgery.

[23]  Gunnar Ahlberg,et al.  Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil? , 2005, American journal of surgery.

[24]  Richard M. Satava.  Metrics for Objective Assessment of Surgical Skills Workshop , 2001 .