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Does the Incorporation of Motion Metrics Into the Existing FLS Metrics Lead to Improved Skill Acquisition on Simulators? A Single Blinded, Randomized Controlled Trial

Stefanidis, Dimitrios MD, PhD, FACS, FASMBS*; Yonce, Thomas C.*; Korndorffer, James R. Jr MD, FACS; Phillips, Ryan*; Coker, Aikaterini*

doi: 10.1097/SLA.0b013e318285f531
Randomized Controlled Trials

Objective: We hypothesized that training to expert-derived levels of speed and motion will lead to improved learning and will translate to better operating room (OR) performance of novices than training to goals of speed or motion alone.

Background: Motion tracking has been suggested to be a more sensitive performance metric than time and errors for the assessment of surgical performance.

Methods: An institutional review board–approved, single blinded, randomized controlled trial was conducted at our level-I American College of Surgeons accredited Education Institute. Forty-two novices trained to proficiency in laparoscopic suturing after being randomized into 3 groups: The speed group (n = 14) had to achieve expert levels of speed, the motion group (n = 15) expert levels of motion (path length and smoothness), and the speed and motion group (n = 13) both levels. To achieve proficiency, all groups also had to demonstrate error-free performance. The FLS suture module (task 5) was used for training inside the ProMIS simulator that tracks instrument motion. All groups participated in transfer and retention tests in the OR. OR performance was assessed by a blinded expert rater using Global Operative Assessment of Laparoscopic Skills, speed, accuracy, and inadvertent injuries.

Results: Thirty (71%) participants achieved proficiency and participated in the transfer and retention tests. The speed group achieved simulator proficiency significantly faster than the other groups (P < 0.001). With the exception of a higher injury rate during the transfer test for the speed group (that reversed during the retention test), there were no significant performance differences among the groups on all assessed parameters.

Conclusions: The incorporation of motion metrics into the time/accuracy goals of the FLS laparoscopic suturing curriculum had limited impact on participant skill transfer to the OR. Given the increased training requirements for such a curriculum, further study is needed before the addition of motion metrics to the current FLS metrics can be recommended.

Using a randomized controlled design, this study examined the role of incorporating motion metrics into the training goals of the fundamentals of laparoscopic surgery laparoscopic suturing curriculum and found that an increase in training duration had little impact on skill transfer to the operating room.

*Carolinas Simulation Center, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Healthcare System, Charlotte, NC

Department of Surgery, Tulane University School of Medicine, New Orleans, LA.

Reprints: Dimitrios Stefanidis, MD, PhD, FACS, FASMBS, Carolinas Simulation Center, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas HealthCare System, 1025 Morehead Medical Dr, Ste 300, Charlotte, NC 28204. E-mail:

Disclosure: This study was funded by a SAGES research grant. Ethicon Endosurgery donated the simulators and supplies used in this study. No funding other than the simulators was received from Ethicon Endosurgery. Dr Stefanidis has received honoraria for lectures from Ethicon, Gore, and Bard. Drs Stefanidis and Korndorffer, Mr Yonce, Mr Phillips, and Ms Coker have no additional commercial associations or financial relationships that might pose a conflict of interest in connection with this manuscript.

RTC: NCT01052168

© 2013 by Lippincott Williams & Wilkins.