Implementation of the laparoscopic simulator in a gynecological residency curriculum |
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Authors: | W Kolkman M A J Van de Put W B Van den Hout J B M Z Trimbos F W Jansen |
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Institution: | (1) Department of Gynecology, Leiden University Medical Center K6-76, P.O. Box 9600, 2300, RC, Leiden, The Netherlands;(2) Department of Medical Decision Making, Leiden University Medical Center J10-S, P.O. Box 9600, 2300, RC, Leiden, The Netherlands |
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Abstract: | Background In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery, there is a growing
need to improve laparoscopic training. This study was conducted to investigate if and when residents reached performance standards
for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators
in a gynecological residency curriculum.
Methods Residents across all 6 years of residency (postgraduate year PGY] 1–6) were tested once on our boxtrainer by performing five
inanimate tasks (pipe cleaner, rubber band, beads, cutting circle, intracorporeal knot tying). A sumscore for the five tasks
was calculated for each participant (sum of all scores). Scores were calculated by adding completion time and penalty points,
thus rewarding both speed and precision. These data were compared with scores of laparoscopic experts, which were set as performance
standards.
Results Of the participants, 111 were residents (7 PGY1, 27 PGY2, 29 PGY3, 28 PGY4, 14 PGY5, 6 PGY6) and 8 were experts. At the end
of residency, PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying. It was not until
PGY5 that residents reached the performance standard for the pipe cleaner task; PGY1, for rubber band; PGY5, for beads; PGY4,
for circle cutting; and PGY6, for sumscore. Throughout residency PGY6 had a mean total of only 3.6 h of simulator training
experience. No correlation was found between this previous voluntary simulator training experience and performance on our
boxtrainer during this study (sumscore), and between previous voluntary simulator training and total laparoscopic procedures
performed. In a combined multivariate analysis, sumscore performance remained significantly associated with the number of
laparoscopic procedures performed by residents when they were working as as a primary surgeon (p = 0.002), and not with the cumulative hours of simulator training during residency prior to participating in this study (p = 0.15).
Conclusions In a current Dutch gynecological residency curriculum, residents do not reach all performance standards for basic laparoscopic
skills on the boxtrainer. We conclude that the voluntary simulator training program has a substantial risk to fail and that
the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy. |
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Keywords: | Laparoscopic skills Training Assessment Performance standards Simulator Residency |
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