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Bellows et al. Mini-invasive Surg 2017;1:126-32 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.12
www.misjournal.net
Original Article Open Access

Laparoscopic skills training of surgical

residents: a comparison of two proficiency-

based independent approaches

Charles F. Bellows , Alison A. Smith 2
1
1 Department of Surgery, Southwest Memorial Hospital, University of Colorado, Cortez, CO 81328, USA.
2 Department of Surgery, Tulane University, New Orleans, LA 70112, USA.
Correspondence to: Dr. Charles F. Bellows, Department of Surgery, Southwest Memorial Hospital, University of Colorado, Cortez, CO 81328, USA.
E-mail: cbellows@swhealth.org

How to cite this article: Bellows CF, Smith AA. Laparoscopic skills training of surgical residents: a comparison of two proficiency-based independent
approaches. Mini-invasive Surg 2017;1:126-32.

ABSTRACT
Article history: Aim: Current financial and work hour constraints make proctored on-site laparoscopic
Received: 23 Mar 2017 simulation training challenging. An independent learning approach utilizing proficiency-based
Accepted: 17 Jul 2017 training is a potential solution. The purpose of this study was to determine if an independent
Published: 30 Sep 2017 approach using a portable, laparoscopic training device within one’s home environment could
effectively train novices in laparoscopic procedural skills. Methods: After baseline testing,
Key words: laparoscopic novices (n = 16) were randomized to one of two study groups. The on-site group
Laparoscopic surgery, (n = 7) received unlimited access to the workplace laparoscopic trainers and the home group
training, (n = 9) received portable laparoscopic trainers for home. Both groups underwent self-directed,
medical education, proficiency-based training for three months then were retested. Results were compared
proficiency, with parametric and non-parametric statistical tests. Results: Baseline characteristics were
simulation, similar between groups. The practice rate (56%) and practice time (range, 0.18 to 2.6 h) were
independent learning poor in both groups during the training period. At post-test, the number of participants who
demonstrated an improvement (86% on-site, 78% home) on the peg task was not different
between groups. The successful completion of the suturing task post-test had significantly
improved compared with pre-test in both groups (71% vs. 29% on-site; 44% vs. 22% home,
P < 0.001). Although the majority of participants reported it was difficult to practice on a
regular basis (86% on-site, 89% home), 56% of the home group participants agreed that the
at-home trainer was a helpful teaching modality. Conclusion: Learning of laparoscopic skills
by novice trainees can be augmented by an independent learning approach using either home
or on-site laparoscopic trainers. Although over half the candidates found it was useful to have
the training device at home, none of the participants practiced more than an hour or two in the
three month training period. Thus, the solution to conducting training does not lie in merely
providing home training, but rather to understand the work-related stressors and reconfigure
jobs.

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