Surgical Endoscopy

, Volume 31, Issue 9, pp 3718–3727 | Cite as

Practice does not always make perfect: need for selection curricula in modern surgical training

  • Marisa LouridasEmail author
  • Peter Szasz
  • Andras B Fecso
  • Michael G Zywiel
  • Parisa Lak
  • Ayse B. Bener
  • Kenneth A Harris
  • Teodor P Grantcharov



It is hypothesized that not all surgical trainees are able to reach technical competence despite ongoing practice. The objectives of the study were to assess a trainees’ ability to reach technical competence by assessing learning patterns of the acquisition of surgical skills. Furthermore, it aims to determine whether individuals’ learning patterns were consistent across a range of open and laparoscopic tasks of variable difficulty.


Sixty-five preclinical medical students participated in a training curriculum with standardized feedback over forty repetitions of the following laparoscopic and open technical tasks: peg transfer (PT), circle cutting (CC), intracorporeal knot tie (IKT), one-handed tie, and simulated laparotomy closure. Data mining techniques were used to analyze the prospectively collected data and stratify the students into four learning clusters. Performance was compared between groups, and learning curve characteristics unique to trainees who have difficulty reaching technical competence were quantified.


Top performers (22–35%) and high performers (32–42%) reached proficiency in all tasks. Moderate performers (25–37%) reached proficiency for all open tasks but not all laparoscopic tasks. Low performers (8–15%) failed to reach proficiency in four of five tasks including all laparoscopic tasks (PT 7.8%; CC 9.4%; IKT 15.6%). Participants in lower performance clusters demonstrated sustained performance disadvantage across tasks, with widely variable learning curves and no evidence of progression towards a plateau phase.


Most students reached proficiency across a range of surgical tasks, but low-performing trainees failed to reach competence in laparoscopic tasks. With increasing use of laparoscopy in surgical practice, screening potential candidates to identify the lowest performers may be beneficial.


Selection Technical skills Competence Surgical trainees Simulation training Learning curves 



The authors thank Cameron Irani, George Kerezov, Peter Grantcharov, Shariyar Syed, and Sangita Sequeira for their contributions to this study.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no competing interest.


Dr. Louridas received the laparoscopic equipment and sutures for this study from Covidien and financial support from The Royal College of Physicians and Surgeons of Canada (RCPSC) through the H.S. Morton Exchange Fellowship Fund. Dr. Grantcharov has IP and equity ownership in SST Inc and grants with the Canadian branches of Ethicon, Medtronic, Olympus, and Baxter. Drs. Harris, Szasz, Fecso, Zywiel, Bener and Miss. Lak have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2017_5572_MOESM1_ESM.docx (207 kb)
Supplementary material 1 (DOCX 206 kb)


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Marisa Louridas
    • 1
    Email author
  • Peter Szasz
    • 1
  • Andras B Fecso
    • 1
  • Michael G Zywiel
    • 1
  • Parisa Lak
    • 2
  • Ayse B. Bener
    • 2
  • Kenneth A Harris
    • 3
  • Teodor P Grantcharov
    • 1
  1. 1.Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Department of Mechanical and Industrial EngineeringRyerson UniversityTorontoCanada
  3. 3.Royal College of Physicians and Surgeons of CanadaOttawaCanada

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