Authors: W Kolkman M A J Van de Put W B Van den Hout J B M Z Trimbos F W Jansen
Publish Date: 2006/12/13
Volume: 21, Issue: 8, Pages: 1363-1368
Abstract
In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery there is a growing need to improve laparoscopic training This study was conducted to investigate if and when residents reached performance standards for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators in a gynecological residency curriculumResidents across all 6 years of residency postgraduate year PGY 1–6 were tested once on our boxtrainer by performing five inanimate tasks pipe cleaner rubber band beads cutting circle intracorporeal knot tying A sumscore for the five tasks was calculated for each participant sum of all scores Scores were calculated by adding completion time and penalty points thus rewarding both speed and precision These data were compared with scores of laparoscopic experts which were set as performance standardsOf the participants 111 were residents 7 PGY1 27 PGY2 29 PGY3 28 PGY4 14 PGY5 6 PGY6 and 8 were experts At the end of residency PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying It was not until PGY5 that residents reached the performance standard for the pipe cleaner task PGY1 for rubber band PGY5 for beads PGY4 for circle cutting and PGY6 for sumscore Throughout residency PGY6 had a mean total of only 36 h of simulator training experience No correlation was found between this previous voluntary simulator training experience and performance on our boxtrainer during this study sumscore and between previous voluntary simulator training and total laparoscopic procedures performed In a combined multivariate analysis sumscore performance remained significantly associated with the number of laparoscopic procedures performed by residents when they were working as as a primary surgeon p = 0002 and not with the cumulative hours of simulator training during residency prior to participating in this study p = 015In a current Dutch gynecological residency curriculum residents do not reach all performance standards for basic laparoscopic skills on the boxtrainer We conclude that the voluntary simulator training program has a substantial risk to fail and that the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy
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