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Validation of a Structured Training and Assessment Curriculum for Technical Skill Acquisition in Minimally Invasive Surgery: A Randomized Controlled Trial

Palter, Vanessa N. MD, PhD*; Orzech, Neil MD, MEd*; Reznick, Richard K. MD, MEd, FACS; Grantcharov, Teodor P. MD, PhD, FACS

doi: 10.1097/SLA.0b013e31827051cd
Randomized Controlled Trials

Objective: To develop and validate an ex vivo comprehensive curriculum for a basic laparoscopic procedure.

Background: Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Moreover, neither the effect of ex vivo training on learning curves in the operating room (OR), nor the effect on nontechnical proficiency has been investigated.

Methods: This randomized single-blinded prospective trial allocated 20 surgical trainees to a structured training and assessment curriculum (STAC) group or conventional residency training. The STAC consisted of case-based learning, proficiency-based virtual reality training, laparoscopic box training, and OR participation. After completion of the intervention, all participants performed 5 sequential laparoscopic cholecystectomies in the OR. The primary outcome measure was the difference in technical performance between the 2 groups during the first laparoscopic cholecystectomy. Secondary outcome measures included differences with respect to learning curves in the OR, technical proficiency of each sequential laparoscopic cholecystectomy, and nontechnical skills.

Results: Residents in the STAC group outperformed residents in the conventional group in the first (P = 0.004), second (P = 0.036), third (P = 0.021), and fourth (P = 0.023) laparoscopic cholecystectomies. The conventional group demonstrated a significant learning curve in the OR (P = 0.015) in contrast to the STAC group (P = 0.032). Residents in the STAC group also had significantly higher nontechnical skills (P = 0.027).

Conclusions: Participating in the STAC shifted the learning curve for a basic laparoscopic procedure from the operating room into the simulation laboratory. STAC-trained residents had superior technical proficiency in the OR and nontechnical skills compared with conventionally trained residents. (The study registration ID is NCT01560494.)

This study describes the development and validation of a structured training and assessment curriculum (STAC) for a basic laparoscopic procedure. In a randomized controlled trial, surgical residents were allocated to conventional residency training or the STAC. STAC-trained residents achieved superior technical proficiency in the operating room, and participating in the STAC shifted the learning curve for a basic laparoscopic procedure from the operating room into the simulation laboratory.

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

Department of Surgery, Queen's University, Kingston, Ontario, Canada

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

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

Disclosure: Vanessa Palter is supported by a CIHR Fellowship award, and the Royal College of Physicians and Surgeons of Canada Studies in Medical Education Fellowship. Neil Orzech is supported by a Royal College of Physicians and Surgeons of Canada Medical Education Research Grant. The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.