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Bellows et al. Laparoscopic training for surgical residents

INTRODUCTION hospital environment, has not been fully investigated.
As medical educators and mentors, the best
To maximize the benefit of time in the operating room, methods of teaching laparoscopic skills and the most
laparoscopic skills training outside the operating room efficacious learning environment where trainees feel
has become the gold standard for educating surgical motivated and allocate a high priority to practice needs
residents. It is well documented that residents benefit to be the standard for resident education. Clearly,
from this form of training and can lead to improved laparoscopic training should not be considered after
operative performance. In fact, training is an integral exhaustion from work-related activities. In fact, there
and essential component of a trainee’s job. However, is evidence to suggest that motor training during
there is no consensus regarding the optimal method periods of exhaustion can deteriorate and may create
or learning environment for teaching laparoscopic an environment that promotes poor technique. This
[14]
skills in order to maximize trainees’ education while is precisely why home training may be beneficial. It
maintaining an equitable and sustainable work-life would be portable, accessible, convenient, flexible
balance. Recently, several studies have suggested that and inexpensive once initiated. Indeed, trainees could
mandatory, proctored, proficiency-based goal-directed practice the laparoscopic skills at their preferred
training is the best method for training. [1-3] However, this time, for example when are well-rested and away
approach is not without disadvantages. For example, from work stressors, and not at a time that fits others’
this type of training requires a significant amount of schedules. Therefore, we hypothesized that an at-
practice time per trainee in a workplace environment home independent, proficiency-based laparoscopy
where shortened work hours are being mandated. [4-6] training method using a low-cost device will improve
This laborious process of proctored, on-site training the laparoscopic skills of novice trainees and that this
programs is time consuming and significantly impinges training method-environment combination would be
on the residents’ pre-existing didactic requirements, equivalent to traditional, independent hospital-based,
patient care responsibilities, and overall operative laparoscopic training. The primary endpoint of the
experience. [7-9] In fact, duty-hour limitations have led study was to compare trainee performance before and
to a significant re-evaluation of the traditional surgical after at home practice training.
education paradigm, with emphasis on increased
efficiency of educational efforts. Accordingly, a METHODS
disadvantage of these on-site training facilities is that
they are often not readily accessible to the resident. Participants
Unless dedicated training time is made mandatory for
residents, few residents independently take advantage Novice laparoscopists [First and Second Post Graduate
of these costly facilities during their already busy Year (PGY-1 and 2) general surgery residents, (n = 8)
week. If educators seek to facilitate laparoscopic and medical students (n = 9), at any year of training]
[10]
learning, they should provide the trainees with the were recruited into the study through word of mouth at
opportunities for extracurricular practice. Finally, there Tulane University Medical Center. Prior to beginning
is also an economical aspect to consider as the use of training, all participants completed a questionnaire
surgical educators can be costly, time consuming, and assessing demographics and previous exposure
difficult to achieve for smaller institutions. to laparoscopy. The Tulane University Institutional
Review Board approved this study, and all subjects
An independent learning approach where trainees are gave informed consent prior to participation.
given self-study resources (i.e. video/didactic tutorials)
as well as unlimited access to the on-site training Apparatus
facility and encouraged to practice at their own pace The Minimally Invasive Surgical Trainer (Joystick
is one alternative strategy. The advantages of such SimScope™; 3D Med, Franklin, Ohio) was used in this
[6]
self-directed training method are reduced instructor study for the home training device. This training device
time and simplified scheduling. Moreover, several is a self-contained, lightweight (15 lbs), and portable
studies have shown that learning can be facilitated box equipped with a camera and 10 inch LCD color
if learners are able to self-direct their own training monitor, which offered good visual resolution, and
experience. [11-13] However, in the United States, the optics with all the close-up and rotation options. The
training time on-site within the workplace environment trainer is also equipped with seven ports fitted with
is counted toward the already restricted resident duty grommets designed to hold an instrument or a trocar.
hours. A hybrid approach that employs an independent Tasks were carried out with the monitor at eye level and
learning approach using at-home, portable the laparoscopic instruments at a standard surgical
laparoscopic trainer outside the time constraints of the height between the monitor and the participant.
Mini-invasive Surgery ¦ Volume 1 ¦ September 30 127