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Randomized controlled trial on the effect of coaching in simulated laparoscopic training

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An Erratum to this article was published on 08 January 2014

Abstract

Background

The effect of coaching on surgical quality and understanding in simulated training remains unknown. The aim of this study was compare the effects of structured coaching and autodidactic training in simulated laparoscopic surgery.

Methods

Seventeen surgically naive medical students were randomized into two groups: eight were placed into an intervention group and received structured coaching, and nine were placed into a control group and received no training. They each performed 10 laparoscopic cholecystectomies on a virtual reality simulator. The surgical quality of the first, fifth, and 10th operations was evaluated by 2 independent blinded assessors using the Competency Assessment Tool (CAT) for cholecystectomy. Understanding of operative strategy was tested before the first, fifth, and 10th operation. Performance metrics, path length, total number of movements, operating time, and error frequency were evaluated. The groups were compared by the Mann–Whitney U test. Proficiency gain curves were plotted using curve fit and CUSUM models; change point analysis was performed by multiple Wilcoxon signed rank analyses.

Results

The intervention group scored significantly higher on the CAT assessment of procedures 1, 5, and 10, with increasing disparity. They also performed better in the knowledge test at procedures 5 and 10, again with an increasing difference. The learning curve for error frequency of the intervention group reached competency after operation 7, whereas the control group did not plateau by procedure 10. The learning curves of both groups for path length and number movements were almost identical; the mean operation time was shorter for the control group.

Conclusions

Clinically relevant markers of proficiency including error reduction, understanding of surgical strategy, and surgical quality are significantly improved with structured coaching. Path length and number of movements representing merely manual skills are developed with task repetition rather than influenced by coaching. Structured coaching may represent a key component in the acquisition of procedural skills.

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Disclosures

S. Cole, H. Mackenzie, J. Ha, G. Hanna, and D. Miskovic have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery and Cancer, Imperial College London, London, UK

    Simon J. Cole, Hugh Mackenzie, Joon Ha & George B. Hanna

  2. John Goligher Colorectal Unit, The Leeds Teaching Hospitals, Leeds, LS9 7TF, UK

    Danilo Miskovic

Authors
  1. Simon J. Cole
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  2. Hugh Mackenzie
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  3. Joon Ha
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  4. George B. Hanna
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  5. Danilo Miskovic
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Correspondence to Hugh Mackenzie.

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Cole, S.J., Mackenzie, H., Ha, J. et al. Randomized controlled trial on the effect of coaching in simulated laparoscopic training. Surg Endosc 28, 979–986 (2014). https://doi.org/10.1007/s00464-013-3265-0

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  • DOI: https://doi.org/10.1007/s00464-013-3265-0

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