Surgical Endoscopy

, Volume 29, Issue 11, pp 3154–3162 | Cite as

Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance

  • Daniel A. Hashimoto
  • Pramudith Sirimanna
  • Ernest D. Gomez
  • Laura Beyer-Berjot
  • K. A. Ericsson
  • Noel N. Williams
  • Ara Darzi
  • Rajesh Aggarwal



This study investigated whether deliberate practice leads to an increase in surgical quality in virtual reality (VR) laparoscopic cholecystectomies (LC). Previous research has suggested that sustained DP is effective in surgical training.


Fourteen residents were randomized into deliberate practice (n = 7) or control training (n = 7). Both groups performed ten sessions of two VR LCs. Each session, the DP group was assigned 30 min of DP activities in between LCs while the control group viewed educational videos or read journal articles. Performance was assessed on speed and dexterity; quality was rated with global (GRS) and procedure-specific (PSRS) rating scales. All participants then performed five porcine LCs.


Both groups improved over 20 VR LCs in time, dexterity, and global rating scales (all p < 0.05). After 20 LCs, there were no differences in speed or dexterity between groups. The DP group achieved higher quality of VR surgical performance than control for GRS (26 vs. 20, p = 0.001) and PSRS (18 vs. 15, p = 0.001). For VR cases, DP subjects plateaued at GRS = 25 after ten cases and control group at GRS = 20 after five cases. At completion of VR training, 100 % of the DP group reached target quality of performance (GRS ≥ 21) compared with 30 % in the control group. There were no significant differences for improvements in time or dexterity over five porcine LCs.


This study suggests that DP leads to higher quality performance in VR LC than standard training alone. Standard training may leave individuals in a state of “arrested development” compared with DP.


Education Imaging & VR Cholecystectomy 



The authors would like to thank Steve Marchington and Kenneth Miller for their administrative and logistical support in arranging materials for use in this study. We thank Dr. Steve Siegel for his assistance with the manuscript and Dr. Andrew Cucchiara for his biostatistical support. The authors are grateful to Drs. Emma Meagher and Karen Kerr for administrative support and assistance in facilitating institutional collaboration. Daniel Hashimoto and Ernest Gomez were partly supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant TL1TR000138. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


Drs. Hashimoto, Sirimanna, Gomez, Beyer-Berjot, Williams, and Darzi have no relevant financial disclosures. Dr. Aggarwal is a consultant for Applied Medical. Dr. Ericsson receives royalties from the publication of a textbook on expertise and receives honoraria for lectures on the topic of expertise.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniel A. Hashimoto
    • 1
    • 5
  • Pramudith Sirimanna
    • 1
  • Ernest D. Gomez
    • 2
  • Laura Beyer-Berjot
    • 1
  • K. A. Ericsson
    • 3
  • Noel N. Williams
    • 2
  • Ara Darzi
    • 1
  • Rajesh Aggarwal
    • 4
    • 6
  1. 1.Department of Biosurgery and Surgical Technology, St. Mary’s HospitalImperial College LondonLondonUK
  2. 2.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of PsychologyFlorida State UniversityTallahasseeUSA
  4. 4.Department of SurgeryMcGill UniversityMontrealCanada
  5. 5.Department of SurgeryMassachusetts General HospitalBostonUSA
  6. 6.Faculty of Medicine, Arnold & Blema Steinberg Medical Simulation CentreMcGill UniversityMontrealCanada

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