Pre-training on Southwestern stations decreases training time and cost for proficiency-based Fundamentals of Laparoscopic Surgery (FLS) training

SURGICAL EDUCATION use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examines the impact of a curriculum-based approach to laparoscopic suturing and knot tying.

Pre-training on Southwestern stations decreases training time and cost for proficiency-based Fundamentals of Laparoscopic Surgery (FLS) training Mouza T Goova, MD, Lisa A Hollett, RN, MS, Jarrod Dale, BS, Daniel J Scott, MD, FACS University of Texas Southwestern Medical Center, Dallas, TX

METHODS: Twenty-two (22) senior surgery residents in a University-based general surgery residency program were prospectively enrolled and randomized to receive either a simulation-based laparoscopic suturing curriculum (TR group, n⫽11) or standard clinical training (NR group, n⫽11). During a laparoscopic Nissen fundoplication with an attending surgeon blinded to trainee status, two consecutive intracorporeally knotted sutures were video recorded for analysis. Operative performance was assessed by two reviewers blinded to subject training status using a validated, errorbased system to an inter-rater agreement of ⬎⫽ 80%. Performance measures assessed were time, errors, and needle manipulations and comparisons between groups were made using a Mann-Whitney test.

INTRODUCTION: We previously reported a proficiency-based Fundamentals of Laparoscopic Surgery (FLS) curriculum that results in a 100% pass rate on the technical skills certification examination. We hypothesized that pre-training using the Southwestern (SW) videotrainer stations would decrease costs while maintaining benefit. METHODS: Group I (MS2, n⫽10, 6-month IRB-approved protocol) underwent FLS pre-testing (1 repetition of 5 tasks), SW station proficiency-based training, FLS post-testing (Post-test 1), FLS proficiency-based training, and Final FLS post-testing. Group II (MS2, n⫽10, previously reported data) underwent FLS proficiencybased training without pre-training. Costs were calculated for all consumable materials for both SW and FLS simulators. Values are mean ⫾ s.d (Mann-Whitney U, p⬍0.05 significant).

RESULTS: Compared to NR subjects, TR subjects performed significantly faster (Suture1 time 240⫾110 sec. vs. 455⫾97 sec, p⬍0.002; Total time 473⫾189 sec. vs. 729⫾171 sec, p⬍0.0004), made significantly fewer errors (Suture1 err 13⫾6 vs. 19⫾7, p⬍0.04; Total err 23⫾9 vs. 35⫾10, p⬍0.02) and 40% fewer excess needle manipulations (15⫾10 vs. 25⫾9, p⬍0.02).

RESULTS: During training, Group I achieved proficiency for all SW tasks and Groups I and II achieved proficiency for 96 % of the FLS tasks. A significant difference between groups for the number of repetitions was detected for 2 of the 5 FLS tasks. In Group I, participants demonstrated significant improvement from Pretest (149 ⫾ 39; 0% FLS pass rate) to Post-test 1 (293 ⫾ 83, p⬍0.001; 60% FLS pass rate), and to Final Post-test (444 ⫾ 60, p⬍0.001; 100% FLS pass rate). In Group II, participants demonstrated significant improvement from Pretest (158 ⫾ 78; 0% FLS pass rate) to Final Post-test (476 ⫾ 13, p⬍0.001; 100% FLS pass rate). Group I

Overall Training Time (hours) SW Stations Training Time (hours) FLS Training Time (hours) Cost

10.4 ⫾ 3.3

Group II

9.2 ⫾ 2.2

CONCLUSIONS: Subjects who receive simulation-based training demonstrate superior intra-operative performance of a highly complex surgical skill. Integration of such skills-training should become standard in a surgical residency’s training curriculum.

Training and assessment of basic suturing skills for fourth year medical students entering surgical residency

P Value

NS

Richard A Pierce, MD, PhD, Deron Tessier, MD, Debra Tiemann, RN, Jennifer Spitler, MD, Brent Matthews, MD, L Michael Brunt, MD Washington University School of Medicine, St Louis, MO

4.4 ⫾ 2.1 5.9 ⫾ 1.5

9.2 ⫾ 2.2

$ 818 ⫾ 118

$ 1108 ⫾ 393

0.001

INTRODUCTION: Skills training is increasingly important in surgical education. We trained senior medical students (MS) planning a surgical career in basic suturing skills and evaluated the impact of training on performance.

0.02

CONCLUSIONS: Pre-training on SW stations decreases training time for FLS skill acquisition while maintaining educational benefit. Importantly, this strategy decreases cost associated with using consumable materials for training.

Kent R Van Sickle, MD, E Matt Ritter, MD, Mercedeh Baghai, MD, Adam Goldenberg, MD, Ih-Ping Huang, MD, Anthony G Gallagher, PhD, C Daniel Smith, MD, FACS University of Texas Health Science Center-San Antonio, San Antonio, TX

METHODS: Fourth year MS matched for surgical internship were evaluated on 5 skills: interrupted suturing (IS), running subcuticular suture (SQ), one-handed (1H) and two-handed (2H) knot tying, and knot tying in a restricted space (RS). Skills were timed and videotaped baseline. After a 2-hour instructional session and home practice, retesting was done 6 weeks later. Videos were evaluated blinded by 2 independent reviewers using 5-point Likert scales for technique domains including motion accuracy, tissue/instrument handling, needle safety, knot tying, and global assessment. Student performance was compared to that of R3-R4 residents. Statistical analyses employed nonparametric ANOVA and Wilcoxon matchedpairs tests.

INTRODUCTION: Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The

RESULTS: Mean pre- and post-task times (in seconds) showed improved trends for IS (303 to 252), SQ (394 to 326) and 1H (88 to 62)

Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot-tying

© 2007 by the American College of Surgeons Published by Elsevier Inc.

ISSN 1072-7515/07/$32.00

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