Abstract
Background
The influence of visual-spatial discordance during training on laparoscopic skills is poorly understood. It has been proposed that training in visual-spatial discordant situations can improve performance in the forward alignment, which was the basis of our hypothesis. Our study’s aim was to conduct a randomized control trial to explore the impact of simulated training in visual-spatial discordant situations on forward alignment performance.
Methods
The participants were 80 medical students who were randomized into four groups. Group A served as the control and performed all peg transfers in the forward alignment. Groups B, C, and D experienced varied rounds of either increasing or decreasing sensorimotor discordance. The students were trained and tested using the peg transfer task used in the Fundamentals of Laparoscopic Surgery curriculum. Based on the group, each student performed 10 peg transfer practice rounds in their assigned alignment. After each practice session, each student was tested and scored in forward alignment performance. A baseline test, followed by three practice sessions, and three tests were done.
Results
Group A (control) demonstrated a statistically significant overall increase in scoring of 37.1% from baseline when compared to the final test. Groups B, C, and D showed improvements of 3.7%, 27.1%, and 19.3%, respectively, between baseline and the final test, yet none demonstrated consistent linear improvements. On multi-variate analysis, students who practiced in the side or reverse alignment positions scored 25 and 37 points lower, respectively, than students who practiced in the forward alignment.
Conclusion
Our study suggests that training in visual-spatial discordant conditions does not lead to the development of forward alignment laparoscopic skills. This could have important implications when developing future laparoscopic skills training curriculums. To our knowledge, this is the largest study to date assessing the impacts of training in visual-spatial discordance situations on performance in the forward alignment.
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Acknowledgements
This research project was supported in part by a grant from the Graduate Medical Education, Inc. (GMEI) Resident-led Research Mini-Grant Program, and an NIH (National Institutes of Health) grant award R25HL108864-01 to Elahé Crockett. Nashwa Khogali-Jakary was a 2013 NIH-National Heart, Lung and Blood Institute (NIH-NHLBI) scholar, and her research training was supported through the above NIH award (5-R25HL108864-01).
Funding
Funding received from the National Institutes of Health: National Heart, Lung and Blood Institute (NIH-NHLBI) award (Grant Number: 5-R25HL108864-01) to Elahé Crockett, Ph.D., MS, and Graduate Medical Education, Inc. (GMEI) Resident-led Research Mini-Grant Program (Grant Number: DS100069)
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Dr. Nashwa Khogali-Jakary discloses that she reports grants from the National Heart, Lung, Blood Institute, during the conduct of the study. Drs. John Kanitra, Alan Davis, David Henry, Elahé T. Crockett, Srinivas Kavuturu, as well as Ms. Pamela Haan, Mr. Rama Gupta, Ms. Cheryl Anderson, Ms. Caroline Moon, and Ms. Terry McLeod have no conflicts of interest or financial ties to disclose.
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Khogali-Jakary, N., Kanitra, J.J., Haan, P.S. et al. Laparoscopic Simulation in Reverse and Side Alignment Impact on Forward Alignment Performance: A Randomized Controlled Trial. Surg Endosc 34, 298–303 (2020). https://doi.org/10.1007/s00464-019-06766-2
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DOI: https://doi.org/10.1007/s00464-019-06766-2