An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events

Abstract

Gunter De Win,1,2 Siska Van Bruwaene,3,4 Jyotsna Kulkarni,5 Ben Van Calster,6 Rajesh Aggarwal,7,8 Christopher Allen,9 Ann Lissens,4 Dirk De Ridder,3 Marc Miserez4,10 1Department of Urology, Antwerp University Hospital, 2Faculty of Health Sciences, University of Antwerp, Antwerp, 3Department of Urology, University Hospitals of KU Leuven, 4Centre for Surgical Technologies, KU Leuven, Leuven, Belgium; 5Kulkarni Endo Surgery Institute, Pune, India; 6Department of Development and Regeneration, KU Leuven, Leuven, Belgium; 7Department of Surgery, Faculty of Medicine, 8Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, QC, Canada; 9School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA; 10Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium Background: Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions.Materials and methods: In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue).Results:The odds of adverse events were 4.5 (95% confidence interval 1.3–15.3) and 3.9 (95% confidence interval 1.5–9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees.Conclusion: Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events. Keywords: laparoscopy, simulation, learning curve, transfer of skills

Keywords

• Laparoscopy
• Simulation
• Learning Curve
• Transfer of Skills