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Do soft skills predict surgical performance?: a single-center randomized controlled trial evaluating predictors of skill acquisition in virtual reality laparoscopy.

Journal World journal of surgery
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Virtual reality (VR) training in minimal invasive surgery (MIS) is feasible in surgical residency and beneficial for the performance of MIS by surgical trainees. Research on stress-coping of surgical trainees indicates the additional impact of soft skills on VR performance in the surgical curriculum. The aim of this study was to evaluate the impact of structured VR training and soft skills on VR performance of trainees. METHOD: The study was designed as a single-center randomized controlled trial. Fifty first-year surgical residents with limited experience in MIS ("camera navigation" in laparoscopic cholecystectomy only) were randomized for either 3 months of VR training or no training. Basic VR performance and defined soft skills (self-efficacy, stress-coping, and motivation) were assessed prior to randomization using basic modules of the VR simulator LapSim(®) and standardized psychological questionnaires. Three months after randomization VR performance was reassessed. Outcome measurement was based on the results derived from the most complex of the basic VR modules ("diathermy cutting") as the primary end point. A correlation analysis of the VR end-point performance and the psychological scores was done in both groups. RESULTS: Structured VR training enhanced VR performance of surgical trainees. An additional correlation to high motivational states (P < 0.05) was found. Low levels of self-efficacy and negative stress-coping were related to poor VR performance in the untrained control group (P < 0.05). This correlation was absent in the trained intervention group (P > 0.05). CONCLUSION: Low self-efficacy and negative stress-coping strategies seem to predict poor VR performance. However, structured training along with high motivational states is likely to balance out this impairment.

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The validity of take-home surgical simulators to enhance resident technical skill proficiency.

Journal American journal of surgery
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: It is unknown whether surgical residents who learn minimal-access surgery skills in an unstructured environment (ie, at home), will develop a technical skill set that rivals that of those trained in the more traditional, structured learning environment. METHODS: Seven surgery residents were provided structured learning through didactic and hands-on skills training sessions and consistent supervision throughout training. A second group of 7 residents participated in an unstructured learning curriculum of training without supervision. End points were determined at the end of training using a standardized simulator based on predetermined performance measures. RESULTS: Both groups achieved high task scores, with comparable scores on gesture proficiency, hand movement smoothness, instrument movement smoothness, errors, and time elapsed. There was no significant difference between group differences in final skills scores. CONCLUSIONS: Unstructured learning is equally effective in delivering quality skills training when compared with structured training.

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Sex is not everything: the role of gender in early performance of a fundamental laparoscopic skill.

Journal Surgical endoscopy
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Existing literature on the acquisition of surgical skills suggests that women generally perform worse than men. This literature is limited by looking at an arbitrary number of trials and not adjusting for potential confounders. The objective of this study was to evaluate the impact of gender on the learning curve for a fundamental laparoscopic task. METHODS: Thirty-two medical students performed the FLS peg transfer task and their scores were plotted to generate a learning curve. Nonlinear regression was used to estimate learning plateau and learning rate. Variables that may affect performance were assessed using a questionnaire. Innate visual-spatial abilities were evaluated using tests for spatial orientation, spatial scanning, and perceptual abilities. Score on first peg transfer attempt, learning plateau, and learning rate were compared for men and women using Student's t test. Innate abilities were correlated to simulator performance using Pearson's coefficient. Multivariate linear regression was used to investigate the effect of gender on early laparoscopic performance after adjusting for factors found significant on univariate analysis. Statistical significance was defined as P < 0.05. RESULTS: Nineteen men and 13 women participated in the study; 30 were right-handed, 12 reported high interest in surgery, and 26 had video game experience. There were no differences between men and women in initial peg transfer score, learning plateau, or learning rate. Initial peg transfer score and learning rate were higher in subjects who reported having a high interest in surgery (P = 0.02, P = 0.03). Initial score also correlated with perceptual ability score (P = 0.03). In multivariate analysis, only surgical interest remained a significant predictor of score on first peg transfer (P = 0.03) and learning rate (P = 0.02), while gender had no significant relationship to early performance. CONCLUSIONS: Gender did not affect the learning curve for a fundamental laparoscopic task, while interest in surgery and perceptual abilities did influence early performance.

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Limited value of haptics in virtual reality laparoscopic cholecystectomy training.

Journal Surgical endoscopy
Year 2011
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: Haptics is an expensive addition to virtual reality (VR) simulators, and the added value to training has not been proven. This study evaluated the benefit of haptics in VR laparoscopic surgery training for novices. METHODS: The Simbionix LapMentor II haptic VR simulator was used in the study. Randomly, 33 laparoscopic novice students were placed in one of three groups: control, haptics-trained, or nonhaptics-trained group. The control group performed nine basic laparoscopy tasks and four cholecystectomy procedural tasks one time with haptics engaged at the default setting. The haptics group was trained to proficiency in the basic tasks and then performed each of the procedural tasks one time with haptics engaged. The nonhaptics group used the same training protocol except that haptics was disengaged. The proficiency values used were previously published expert values. Each group was assessed in the performance of 10 laparoscopic cholecystectomies (alternating with and without haptics). Performance was measured via automatically collected simulator data. RESULTS: The three groups exhibited no differences in terms of sex, education level, hand dominance, video game experience, surgical experience, and nonsurgical simulator experience. The number of attempts required to reach proficiency did not differ between the haptics- and nonhaptics-training groups. The haptics and nonhaptics groups exhibited no difference in performance. Both training groups outperformed the control group in number of movements as well as path length of the left instrument. In addition, the nonhaptics group outperformed the control group in total time. CONCLUSION: Haptics does not improve the efficiency or effectiveness of LapMentor II VR laparoscopic surgery training. The limited benefit and the significant cost of haptics suggest that haptics should not be included routinely in VR laparoscopic surgery training.

Primary study

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Mental practice enhances surgical technical skills: a randomized controlled study.

Journal Annals of surgery
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To assess the effects of mental practice on surgical performance. BACKGROUND: Increasing concerns for patient safety have highlighted a need for alternative training strategies outside the operating room. Mental practice (MP), "the cognitive rehearsal of a task before performance," has been successful in sport and music to enhance skill. This study investigates whether MP enhances performance in laparoscopic surgery. METHODS: After baseline skills testing, 20 novice surgeons underwent training on an evidence-based virtual reality curriculum. After randomization using the closed envelope technique, all participants performed 5 Virtual Reality (VR) laparoscopic cholecystectomies (LC). Mental practice participants performed 30 minutes of MP before each LC; control participants viewed an online lecture. Technical performance was assessed using video Objective Structured Assessment of Technical Skills-based global ratings scale (scored from 7 to 35). Mental imagery was assessed using a previously validated Mental Imagery Questionnaire. RESULTS: Eighteen participants completed the study. There were no intergroup differences in baseline technical ability. Learning curves were demonstrated for both MP and control groups. Mental practice was superior to control (global ratings) for the first LC (median 20 vs 15, P = 0.005), second LC (20.5 vs 13.5, P = 0.001), third LC (24 vs 15.5, P < 0.001), fourth LC (25.5 vs 15.5, P < 0.001) and the fifth LC (27.5 vs 19.5, P = 0.00). The imagery for the MP group was also significantly superior to the control group across all sessions (P < 0.05). Improved imagery significantly correlated with better quality of performance (ρ 0.51–0.62, Ps < 0.05). CONCLUSIONS: This is the first randomized controlled study to show that MP enhances the quality of performance based on VR laparoscopic cholecystectomy. This may be a time- and cost-effective strategy to augment traditional training in the OR thus potentially improving patient care.

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Toward effective pediatric minimally invasive surgical simulation.

Journal Journal of pediatric surgery
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND/PURPOSE: Simulation is increasingly being recognized as an important tool in the training and evaluation of surgeons. Currently, there is no simulator that is specific to pediatric minimally invasive surgery (MIS). A fundamental technical difference between adult and pediatric MIS is the degree of motion scaling. Smaller instruments and areas of dissection under greater optical magnification require finer, more precise hand movements. We hypothesized that this can be used to detect differences in skills proficiency between pediatric and general surgeons. METHODS: We programmed a virtual reality simulation of intracorporeal suturing with modes that used motion scaling to mimic conditions of either adult or pediatric MIS. The participants consisted of pediatric and general surgeons who wore motion-sensing gloves. Metrics included time elapsed, penetration errors, tool movement smoothness, hand movement smoothness, and gesture level proficiency. RESULTS: For all measures, pediatric surgeons demonstrated superior proficiency on exercises conducted in pediatric conditions (P < .05). Performance in adult conditions was similar between the 2 groups. CONCLUSION: Pediatric surgeons possess unique skills compared with general surgeons that relate to the technical challenges they routinely face, reinforcing the need for a surgical simulator specific to pediatric MIS. This validates our simulator and the manipulation of motion scaling as a useful training tool.

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Effects of virtual reality simulator training method and observational learning on surgical performance.

Journal World journal of surgery
Year 2011
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Virtual reality (VR) simulators and Web-based instructional videos are valuable supplemental training resources in surgical programs, but it is unclear how to optimally integrate them into minimally invasive surgical training. METHODS: Medical students were randomized to proficiency-based training on VR laparoscopy and endoscopy simulators by two different methods: proctored training (automated simulator feedback plus human expert feedback) or independent training (simulator feedback alone). After achieving simulator proficiency, trainees performed a series of laparoscopic and endoscopic tasks in a live porcine model. Prior to their entry into the animal lab, all trainees watched an instructional video of the procedure and were randomly assigned to either observe or not observe the actual procedure before performing it themselves. The joint effects of VR training method and procedure observation on time to successful task completion were evaluated with Cox regression models. RESULTS: Thirty-two students (16 proctored, 16 independent) completed VR training. Cox regression modeling with adjustment for relevant covariates demonstrated no significant difference in the likelihood of successful task completion for independent versus proctored training [Hazard Ratio (HR) 1.28; 95% Confidence Interval (CI) 0.96-1.72; p=0.09]. Trainees who observed the actual procedure were more likely to be successful than those who watched the instructional video alone (HR 1.47; 95% CI 1.09-1.98; p=0.01). CONCLUSIONS: Proctored VR training is no more effective than independent training with respect to surgical performance. Therefore, time-consuming human expert feedback during VR training may be unnecessary. Instructional videos, while useful, may not be adequate substitutes for actual observation when trainees are learning minimally invasive surgical procedures.

Primary study

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Basic surgical skills training: does it work?

Authors Koch J , Clements S , Abbott J
Journal The Australian & New Zealand journal of obstetrics & gynaecology
Year 2011
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND AND AIM: We assessed the RANZCOG Basic Surgical Skills Workshop (BSSW) with regards to trainees' basic knowledge and skill using a laparoscopic pelvi-trainer. METHODS: First-year trainees answered a multiple choice questionnaire (MCQ) and performed timed simulated laparoscopic exercises with a pelvi-trainer before completing a 2-day workshop. Assessment was repeated following the workshop, at 6 months and 5 years. RESULTS: MCQ results improved immediately after the workshop (baseline 16/34 vs post-course 23/34; P = 0.0001) declined at 6 months (post-course 24/34 vs 6 months 20/34; P = 0.009) with no change at 5 years (20/34 at 5 years). The time to complete both the simple and the complex laparoscopic exercises improved significantly following the workshop (simple: baseline 30 s, post-course 23 s; P = 0.008, complex: baseline 219 s, post-course 145 s; P = 0.0001) and was maintained at 6 months (simple: post-course 22 s, 6 months 23 s; P = 0.644, complex: post-course 124 s, 6 months 125 s; P = 0.958), but the time to complete the simple exercise was no better at 5 years and the time to complete the complex exercise was increased at 5 years (6 months 115 s, 5 years 172 s, P = 0.023). CONCLUSIONS: First-year trainees' basic knowledge of electrosurgery, hysteroscopy and laparoscopy and the time to perform skills on a laparoscopic pelvi-trainer improved after a BSSW but there was no further improvement at 5 years.

Primary study

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Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator

blocked
Journal Gynecological Surgery
Year 2010
Links DOI Google Scholar

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand–eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparoscopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.

Primary study

Unclassified

A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training.

Journal Journal of the American College of Surgeons
Year 2010
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: The aim of this study was to compare the human cadaver model with an augmented reality simulator for straight laparoscopic colorectal skills acquisition. STUDY DESIGN: Thirty-five sigmoid colectomies were performed on a cadaver (n = 7) or an augmented reality simulator (n = 28) during a laparoscopic training course. Prior laparoscopic colorectal experience was assessed. Objective structured technical skills assessment forms were completed by trainers and trainees independently. Groups were compared according to technical skills and events scores and satisfaction with training model. RESULTS: Prior laparoscopic experience was similar in both groups. For trainers and trainees, technical skills scores were considerably better on the simulator than on the cadaver. For trainers, generic events score was also considerably better on the simulator than on the cadaver. The main generic event occurring on both models was errors in the use of retraction. The main specific event occurring on both models was bowel perforation. Global satisfaction was better for the cadaver than for the simulator model (p < 0.001). CONCLUSIONS: The human cadaver model was more difficult but better appreciated than the simulator for laparoscopic sigmoid colectomy training. Simulator training followed by cadaver training can appropriately integrate simulators into the learning curve and maintain the benefits of both training methodologies.