A Prospective Evaluation of a Simulator-Based Laparoscopic Training Program for Gynecology Residents

• Published in: Journal of the American College of Surgeons Vol. 206; no. 2; pp. 343 - 348
• Main Authors: Kirby, Tyler O., MD, Numnum, T. Michael, MD, Kilgore, Larry C., MD, FACS, Straughn, J. Michael, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2008; Elsevier Science
• Subjects: Biological and medical sciences; Clinical Competence; Competency-Based Education - organization & administration; Digestive system. Abdomen; Endoscopy; General aspects; Gynecology - education; Humans; Internship and Residency; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Medical sciences; Models, Educational; Motor Skills; Obstetrics - education; Practice (Psychology); Prospective Studies; Reproducibility of Results; Surgery; Human; Prospective; Evaluation; Treatment; Surgery; Gynecology; Resident (student); Laparoscopy; Endoscopy; Simulator; Teaching
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2007.08.005

Background To determine prospectively if simulator-based laparoscopic training could improve laparoscopic skills of gynecology residents. Study Design Twenty-six gynecology residents were enrolled in a laparoscopy training curriculum involving didactics, self-paced learning modules, and graded simulator-based laparoscopic training modules. Six simulator tasks were developed to introduce incremental levels of difficulty. Residents were tested on bead/peg manipulation, passing of a specially designed “key,” cutting of lines and circles on a two-layer latex glove, and laparoscopic suturing followed by both intra- and extracorporeal knot tying. Times for each task and penalties for errors were assessed at baseline and after 3 months of training. Results Twenty-six residents completed initial baseline and 3-month evaluations. Average summary time (including 30-seconds penalties for each error) at baseline was 64 minutes and 36 minutes at 3-month evaluation (p < 0.001). For PGY1 baseline summary times averaged 83 minutes compared with 50 minutes at 3 months (p = 0.006). For PGY4 baseline summary times averaged 49 minutes compared with 28 minutes at 3 months (p = 0.05). All individual tasks demonstrated substantial improvement (p < 0.001) from baseline to 3-month evaluation. Baseline summary scores demonstrated correlation between PGY training year and overall score (p < 0.001) consistent with earlier ability and training. Three-month scores demonstrated equalization of skill level across PGY2 through PGY4. Conclusions A dedicated simulator-based laparoscopic training curriculum has the ability to improve basic laparoscopic skills in a gynecologic residency, as measured by timed and scored simulator tasks. Construct validity was demonstrated by measuring substantial improvement in performance with increasing residency training, and with practice.