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Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention

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Abstract

Background

Little evidence exists to guide educators in the best way to implement simulation within surgical skills curricula. This study investigated whether practicing a basic Fundamentals of Laparoscopic Surgery (FLS) simulator task [peg transfer (PT)] facilitates learning a more complex skill [intracorporeal suturing (ICS)] and compared the effect of PT training to mastery with training to the passing level on PT retention and on learning ICS.

Methods

For this study, 98 surgically naïve subjects were randomized to one of three PT training groups: control, standard training, and overtraining. All the participants then trained in ICS. The learning curves for ICS were analyzed by estimating the learning plateau and rate using nonlinear regression. Skill retention was assessed by retesting participants 1 month after training. The groups were compared using analysis of variance (ANOVA). Effectiveness of skill transfer was calculated using the transfer effectiveness ratio (TER). Data are presented as mean ± standard deviation (p < 0.05).

Results

The study was completed by 77 participants (28 control, 26 standard, and 23 overtrained subjects). The ICS learning plateau rose with increasing PT training (452 ± 10 vs. 459 ± 10 vs. 467 ± 10; p < 0.01). Increased PT training was associated with a trend toward higher initial ICS scores (128 ± 107 vs. 127 ± 110 vs. 183 ± 106; p = 0.13) and faster learning rates (15 ± 4 vs. 14 ± 4 vs. 13 ± 4 trials; p = 0.10). At retention, there were no differences in PT scores (p = 0.5). The PT training took 20 ± 10 min for standard training and 39 ± 20 min for overtraining (p < 0.01). Overtrained participants saved 11 ± 5 min in ICS training compared with the control subjects (p = 0.04). However, TER was 0.165 for the overtraining group and 0.160 for the standard training group, suggesting that PT overtraining took longer than the time saved on ICS training.

Conclusion

For surgically naïve subjects, part-task training with PT alone was associated with slight improvements in the learning curve for ICS. However, overtraining with PT did not improve skill retention, and peg training alone was not an efficient strategy for learning ICS.

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Acknowledgments

This research project was supported by a Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) research grant. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation receives an unrestricted educational grant from Covidien. We thank SAGES for awarding us a research grant for this project. We also thank the students who participated in this study.

Disclosures

Nicoleta O. Kolozsvari receives salary support from the McGill Surgeon Scientist program. Nicoleta O. Kolozsvari, Pepa Kaneva, Chantalle Brace, Genevieve Chartrand, Marilou Vaillancourt, Jiguo Cao, Daniel Banaszek, Sebastian Demyttenaere, Melina C. Vassiliou, Gerald M. Fried, and Liane S. Feldman have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, 1650 Cedar Avenue, Room E19-117, Montreal, QC, H3G 1A4, Canada

    Nicoleta O. Kolozsvari, Pepa Kaneva, Chantalle Brace, Genevieve Chartrand, Marilou Vaillancourt, Daniel Banaszek, Sebastian Demyttenaere, Melina C. Vassiliou, Gerald M. Fried & Liane S. Feldman

  2. Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada

    Jiguo Cao

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  1. Nicoleta O. Kolozsvari
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  2. Pepa Kaneva
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  3. Chantalle Brace
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Correspondence to Liane S. Feldman.

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Kolozsvari, N.O., Kaneva, P., Brace, C. et al. Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention. Surg Endosc 25, 2063–2070 (2011). https://doi.org/10.1007/s00464-011-1743-9

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