Institutional members access full text with Ovid®

Share this article on:

Development and Validation of a Comprehensive Curriculum to Teach an Advanced Minimally Invasive Procedure: A Randomized Controlled Trial

Palter, Vanessa N. MD*; Grantcharov, Teodor P. MD, PhD

doi: 10.1097/SLA.0b013e318258f5aa
Randomized Clinical Trial

Objective: To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery.

Background: Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures.

Methods: This prospective, single-blinded randomized controlled trial allocated 25 surgical residents to receive either conventional residency training or a comprehensive training curriculum for laparoscopic colorectal surgery. The curriculum consisted of proficiency-based psychomotor training on a virtual reality simulator, cognitive training, and participation in a cadaver lab. The primary outcome measure in this study was surgical performance in the operating room. All participants performed a laparoscopic right colectomy, which was video recorded and assessed using 2 previously validated assessment tools. Secondary outcome measures were knowledge relating to the execution of the procedure, assessed with a multiple-choice test, and technical performance on the simulator.

Results: Curricular-trained residents demonstrated superior performance in the operating room compared with conventionally trained residents (global score 16.0 [14.5–18.0] versus 8.0 [6.0–14.5], P = 0.030; number of operative steps performed 16.0 [12.5–17.5] versus 8.0 [6.0–14.5], P = 0.021; procedure-specific score 71.1 [54.4–81.6] versus 51.1 [36.7–74.4], P = 0.122). Curricular-trained residents scored higher on the multiple-choice test (10 [9–11] versus 7.5 [5.3–7.5], P = 0.047), and outperformed conventionally trained residents in 7 of 8 tasks on the simulator.

Conclusions: Participation in a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery results in improved technical knowledge and improved performance in the operating room compared with conventional residency training. Reg. ID#NCT 01371136.

Supplemental Digital Content is Available in the Text.Currently, no ex vivo comprehensive curricula have been described or validated for advanced laparoscopic procedures. This randomized controlled trial describes a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery. Surgical residents who train using this curriculum demonstrate superior performance in the operating room compared with conventionally trained residents.

*Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Reprints: Vanessa N. Palter, MD, University of Toronto, 600 University Ave, Rm 440, Toronto, Ontario M5G 1X5, Canada. E-mail: vanessa.palter@utoronto.ca.

Disclosure: V.P. is supported by the Fellowship Grant from the Canadian Institute for Health Research, the Studies in Medical Education Fellowship from the Royal College of Physicians and Surgeons of Canada, and the American Society of Colon and Rectal Surgeons Research Foundation Limited Project Grant.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2012 Lippincott Williams & Wilkins, Inc.