Abstract
Background
Mental training of laparoscopic procedures with E-learning has been shown to translate to the operating room. The present study aims to explore whether the use of checklists during E-learning improves transfer of skills to the simulated OR on a Virtual Reality (VR) trainer for Roux-en-Y gastric bypass (RYGB).
Methods
Laparoscopy naive medical students (n = 80) were randomized in two groups. After an E-learning introduction to RYGB, checklist group rated RYGB videos using the validated Bariatric Objective Structured Assessment of Technical Skills (BOSATS) checklist while group without checklist only observed the videos. Participants then performed RYGB on a VR-trainer twice and were evaluated by a blinded expert rater using BOSATS. A multiple choice (MC) knowledge test on RYGB was performed. Suturing on a cadaveric porcine small bowel was evaluated using objective structured assessment of technical skill (OSATS).
Results
Checklist group was better in the knowledge test (A 8.3 ± 1.1 vs. B 7.1 ± 1.3; p ≤ 0.001) and there was a trend towards better VR RYGB performance (BOSATS) on the first try (85.9 ± 10.2 vs. 81.1 ± 11.5; p = 0.058), but not on the second try (92.0 ± 9.7 vs. 89.3 ± 10.5; p = 0.251). Suturing as measured by OSATS was not different (29.5 ± 3.0 vs. 29.0 ± 3.5; p = 0.472).
Conclusion
This study presents evidence that the use of a BOSATS checklist during E-learning helps trainees to improve their knowledge acquisition with E-learning. The transfer from mental training to the simulated OR environment seems to be partially enhanced by use of the BOSATS checklist. However, more research is required to investigate potential benefits.
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Abbreviations
- BOSATS:
-
Bariatric objective structured assessment of technical skill
- MC:
-
Multiple choice
- MIS:
-
Minimally invasive surgery
- OR:
-
Operating room
- OSATS:
-
Objective structured assessment of technical skills
- RYGB:
-
Roux-en-Y gastric bypass
- VR:
-
Virtual reality
References
Santos LMP, de Oliveira IV, Peters LR, Conde WL (2010) Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system. Obes Surg 20:943–948
Cottam DR, Nguyen NT, Eid GM, Schauer PR (2005) The impact of laparoscopy on bariatric surgery. Surg Endosc 19:621–627
Aggarwal R, Moorthy K, Darzi A (2004) Laparoscopic skills training and assessment. Br J Surg 91(12):1549–1558
Figert PL, Park AE, Witzke DB, Schwartz RW (2001) Transfer of training in acquiring laparoscopic skills1. J Am Coll Surg 193(5):533–537
Aggarwal R, Grantcharov TP, Eriksen JR, Blirup D, Kristiansen VB, Funch-Jensen P et al (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244:310–314
Satava RM, Cuschieri A, Hamdorf J (2003) Metrics for objective assessment of surgical skills workshop. Metrics for objective assessment. Surg Endosc 17:220–226
Yiannakopoulou E, Nikiteas N, Perrea D, Tsigris C (2015) Virtual reality simulators and training in laparoscopic surgery. Int J Surg Lond Engl 13:60–64
Friedman RL, Pace BW (1996) Resident education in laparoscopic cholecystectomy. Surg Endosc 10:26–28
El Boghdady M, Tang B, Tait I, Alijani A (2017) The effect of a simple intraprocedural checklist on the task performance of laparoscopic novices. Am J Surg 214(2):373–377
Chang OH, King LP, Modest AM, Hur H-C (2016) Developing an objective structured assessment of technical skills for laparoscopic suturing and intracorporeal knot tying. J Surg Educ 73(2):258–263
Nickel F, Kowalewski K-F, Rehberger F, Hendrie JD, Mayer BFB, Kenngott HG et al (2017) Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy. Surg Endosc 31:714–722
Giannotti D, Patrizi G, Casella G, Di Rocco G, Marchetti M, Frezzotti F et al (2014) Can virtual reality simulators be a certification tool for bariatric surgeons?. Surg Endosc 28:242–248
Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK et al (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463; discussion 463–464
Pape-Koehler C, Chmelik C, Aslund AM, Heiss MM (2010) An interactive and multimedia-based manual of surgical procedures: Webop—an approach to improve surgical education. Zentralbl Chir 135:467–471
Mutter D, Vix M, Dallemagne B, Perretta S, Leroy J, Marescaux J (2011) WeBSurg: an innovative educational Web site in minimally invasive surgery—principles and results. Surg Innov 18:8–14
Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG et al (2015) Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 94:e764
Pape-Koehler C, Immenroth M, Sauerland S, Lefering R, Lindlohr C, Toaspern J et al (2013) Multimedia-based training on Internet platforms improves surgical performance: a randomized controlled trial. Surg Endosc 27:1737–1747
Livingston EH (2010) The incidence of bariatric surgery has plateaued in the U.S. Am. J Surg 200:378–385
Seki Y, Kasama K (2010) Current status of laparoscopic bariatric surgery. Surg Technol Int 20:139–144
Nickel F, Schmidt L, Bruckner T, Billeter AT, Kenngott HG, Müller-Stich B-P et al (2016) Gastrointestinal quality of life improves significantly after sleeve gastrectomy and Roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg 27:1292–1297
Sánchez-Santos R, Estévez S, Tomé C, González S, Brox A, Nicolás R et al (2012) Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg 22:34–41
Zevin B, Bonrath EM, Aggarwal R, Dedy NJ, Ahmed N, Grantcharov TP et al (2013) Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery. J Am Coll Surg 216:955–965
Regehr G, MacRae H, Reznick RK, Szalay D (1998) Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med J Assoc Am Med Coll 73:993–997
De La Garza JR, Kowalewski K-F, Friedrich M, Schmidt MW, Bruckner T, Kenngott HG et al (2017) Does rating the operation videos with a checklist score improve the effect of E-learning for bariatric surgical training? Study protocol for a randomized controlled trial. Trials 18:134
Lewis TM, Aggarwal R, Kwasnicki RM, Rajaretnam N, Moorthy K, Ahmed A et al (2012) Can virtual reality simulation be used for advanced bariatric surgical training? Surgery 151(6):779–784
Muresan C, Lee TH, Seagull J, Park AE (2010) Transfer of training in the development of intracorporeal suturing skill in medical student novices: a prospective randomized trial. Am J Surg 200(4):537–541
Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M, Davidson BR (2013) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 8:CD006575
Palter VN, Grantcharov TP (2014) Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: a randomized controlled trial. Ann Surg 259:443–448
Doumouras AG, Saleh F, Anvari S, Gmora S, Anvari M, Hong D (2018) Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg 267(3):489–494
Shen S-C, Tsai C-Y, Liao C-H, Liu Y-Y, Yeh T-S, Liu K-H (2018) Learning curve of laparoscopic Roux-en-Y gastric bypass in an Asian low-volume bariatric unit. Asian J Surg 41(2):170–175
Shin RB (2005) Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 1(2):91–94
Alam M, Nodzenski M, Yoo S, Poon E, Bolotin D (2014) Objective structured assessment of technical skills in elliptical excision repair of senior dermatology residents: a multirater, blinded. JAMA Dermatol 150:608–612
van Hove PD, Tuijthof GJM, Verdaasdonk EGG, Stassen LPS, Dankelman J (2010) Objective assessment of technical surgical skills. Br J Surg 97:972–987
Nickel F, Hendrie JD, Stock C, Salama M, Preukschas AA, Senft JD et al (2016) Direct observation versus endoscopic video recording-based rating with the objective structured assessment of technical skills for training of laparoscopic cholecystectomy. Eur Surg Res Eur Chir Forsch Rech Chir Eur 57:1–9
Acknowledgements
The authors would like to thank Carly Rae Garrow for proofreading of the manuscript. This study has been presented at the annual congress of the German Society of Surgery 2017 in Munich.
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Javier R. De La Gaza M.D., Mona W Schmidt, Karl-Friedrich Kowalewski, M.D., Laura Benner, Philip C. Müller M.D., Hannes Kenngott M.D., Lars Fischer M.D., Beat P. Müller-Stich M.D., Felix Nickel M.D. have no conflict of interest or financial ties to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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De La Garza, J.R., Schmidt, M.W., Kowalewski, KF. et al. Does rating with a checklist improve the effect of E-learning for cognitive and practical skills in bariatric surgery? A rater-blinded, randomized-controlled trial. Surg Endosc 33, 1532–1543 (2019). https://doi.org/10.1007/s00464-018-6441-4
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DOI: https://doi.org/10.1007/s00464-018-6441-4