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Bellows et al. Laparoscopic training for surgical residents

training time of over 29 h. For the other participants of improvement on the suturing task was significantly
who practiced the average total recorded training time greater for the on-site trained group on both forms of
was just 1.0 h (range 0.18-2.6 h), over 5 different days assessment, no statistically significant difference could
(range 1-15 days) during the entire 3-month training be demonstrated (P = 0.54). Only one participant from
period. the on-site group achieved proficiency on the suturing
task. However, this individual practiced significantly
The task-specific practice was as follows: for the more than all other participants (18 h) during the
pegboard task, only one subject (a medical student) in independent training period.
the on-site training group actually trained on this task
during the training period. By comparison, 4 out of 9 End-of-study questionnaire
(44.4%) subject in the home group practice this task. In total, 93% reported no or minimal exposure
For the suturing task, nine people (56%) practiced to laparoscopic surgery during the study period.
during the 3-month training period (4 in the on-site The ease of use of the home training device was
group with total training time 5.0 ± 4.3 h; 5 in the home evaluated using a 10-point Likert scale with anchored
group with total training time 1.0 ± 0.8 h). end points; 1 being easy and 10 being difficult. Many
respondents felt that the home box trainer was easy
Post-test skills assessment performance to use with a median score of 2. According to half
Since the number of participants in each group that of participants, the study experience was beneficial
actually practiced during the study period was small, to their laparoscopic skills education. Importantly,
this situation precluded any meaningful statistical regardless of the training location, a majority of each
breakdown for this subgroup. Therefore, for the post- group stated they had difficulty practicing regularly
test analysis all participants (i.e. those who did and (86% in on-site group, 89% in home group). The 44%
did not train at all) were included. Interestingly, most who do not practice cited the following reasons: lack of
participants achieved improvements regardless of time (57%), away rotations (29%), and the remaining
which group they were initially assigned for training or 14% cited various other reasons. Of the 56% who did
the amount of practice they recorded. For the pegboard practice still cited a lack of time (56%) as the major
task, post-training times for the participants in the on- reason they did not practice more often.
site group improved on average 65 s (37%) compared
to pretest scores (177.7 ± 23.8 s pre vs. 112.2 ± 9.3 DISCUSSION
s post, P = 0.047). By comparison, the home group
improved on average 41 s (22%), compared to pre- Laparoscopic training is an integral and essential
test scores (183 ± 21.5 vs. 142.9 ± 16.6 s, P = 0.039). component of a surgical trainee’s job. However,
The most marked improvement was noted with one within a changing surgical environment alternative
participant improving the pegboard time by 196 s (on- methods for laparoscopic training must be sought for
site group). Interestingly, the number of participants training which incorporate opportunities to practice.
who improved on the pegboard task (86% vs. 78%) In this un-blinded, randomized study, two proficiency-
and the average time to task completion after training based independent approaches were employed to
was not statistically significantly between the home and teach laparoscopic skills to beginners, with one tactic
on-site groups, respectively (P = 0.47). Importantly, employing standard on-site physical box trainers at
despite these improvements no participants, in either the workplace and the other relying on a similar device
group, achieved proficiency at re-testing for the used in the trainee’s home, outside the stress of the
pegboard task. work environment. Both methods allowed trainees to
practice their laparoscopic skills at their own pace.
As expected, the more complex task (suturing) In the beginning, pre-training skills were homogenous
provided the greater training challenge, however an with minimal baseline experience in the two groups.
improvement was noted in both groups. The suturing In the end, novice trainees showed improvement
task completion rate for both groups had significantly in their laparoscopic skills using our self-directed,
improved after the training period (71% vs. 29% on- proficiency-based home training program. However,
site group; P < 0.001 and 44% vs. 22% home group; at most, it was comparable to our on-site program in
P < 0.001). Finally, at re-test, the on-site group score terms of feasibility and rates of participation. Several
improved by an average of 113 points (114.9 ± 74.6 studies have shown that learning can be facilitated
pre vs. 228.4 ± 83.6 post, P > 0.05) compared to 39 if learners are able to self-direct their own training
points for the group trained at home on the portable experience [11-13] while other studies have shown
device (80 ± 53.5 pre vs. 118.7 ± 60.2 post, P > 0.05 that low cost, portable training device can improve
Wilcoxon matched pairs test). Although the magnitude laparoscopic skills. [18,19] However, the ability of a self-
Mini-invasive Surgery ¦ Volume 1 ¦ September 30 129