Procedural specificity in laparoscopic simulator training: protocol for a randomised educational superiority trial

BMC Medical Education

Jeanett Strandbygaard¹  Bent Ottesen¹  Susanne Rosthøj²  Jane Lindschou³  Lars Konge⁴  Jette Led Sorensen¹  Flemming Bjerrum¹ 

[1] Department of Obstetrics and Gynecology, The Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark;Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;Centre for Clinical Education, Simulationscenter Rigshospitalet, Capital Region of Denmark, Copenhagen, Denmark

关键词: Virtual reality training;    Simulation;    Procedural training;    Specificity;    Laparoscopy;   

Others  :  1090701
DOI  :  10.1186/1472-6920-14-215

 received in 2014-08-13, accepted in 2014-10-02,  发布年份 2014

【 摘 要 】

Background

The use of structured curricula for minimally invasive surgery training is becoming increasingly popular. However, many laparoscopic training programs still use basic skills and isolated task training, despite increasing evidence to support the use of training models with higher functional resemblance, such as whole procedural modules. In contrast to basic skills training, procedural training involves several cognitive skills such as elements of planning, movement integration, and how to avoid adverse events. The objective of this trial is to investigate the specificity of procedural practice in laparoscopic simulator training.

Methods/Design

A randomised single-centre educational superiority trial. Participants are 96 surgical novices (medical students) without prior laparoscopic experience. Participants start by practicing a series of basic skills tasks to a predefined proficiency level on a virtual reality laparoscopy simulator. Upon reaching proficiency, the participants are randomised to either the intervention group, which practices two procedures (an appendectomy followed by a salpingectomy) or to the control group, practicing only one procedure (a salpingectomy) on the simulator. 1:1 central randomisation is used and participants are stratified by sex and time to complete the basic skills. Data collection is done at a surgical skills centre.

The primary outcome is the number of repetitions required to reach a predefined proficiency level on the salpingectomy module. The secondary outcome is the total training time to proficiency. The improvement in motor skills and effect on cognitive load are also explored.

Discussion

The results of this trial might provide new knowledge on how the technical part of surgical training curricula should be comprised in the future. To examine the specificity of practice in procedural simulator training is of great importance in order to develop more comprehensive surgical curricula.

Trial registration

ClinicalTrials.gov: NCT02069951

【 授权许可】

   
2014 Bjerrum et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Strandbygaard J, Bjerrum F, Maagaard M, Rifbjerg Larsen C, Ottesen B, Sorensen JL: A structured four-step curriculum in basic laparoscopy: development and validation. Acta Obstet Gynecol Scand 2014, 93:359-366.
• [2]Reznick RK, Macrae H: Teaching surgical skills–changes in the wind. N Engl J Med 2006, 355:2664-2669.
• [3]Grantcharov TP, Reznick RK: Teaching procedural skills. BMJ 2008, 336:1129-1131.
• [4]Våpenstad C, Buzink SN: Procedural virtual reality simulation in minimally invasive surgery. Surg Endosc 2013, 27:364-377.
• [5]Schreuder HWR, van Hove PD, Janse JA, Verheijen RRM, Stassen LPS, Dankelman J: An “intermediate curriculum” for advanced laparoscopic skills training with virtual reality simulation. J Minim Invasive Gynecol 2011, 18:597-606.
• [6]Kolozsvari NO, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Demyttenaere S, Vassiliou MC, Fried GM, Feldman LS: Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention. Surg Endosc 2011, 25:2063-2070.
• [7]Sabbagh R, Chatterjee S, Chawla A, Kapoor A, Matsumoto ED: Task-specific bench model training versus basic laparoscopic skills training for laparoscopic radical prostatectomy: a randomized controlled study. Can Urol Assoc J 2009, 3:22-30.
• [8]Lucas SM, Zeltser IS, Bensalah K, Tuncel A, Jenkins A, Pearle MS, Cadeddu JA: Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure. J Urol 2008, 180:2588-2591. discussion 2591
• [9]Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L: Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc 2014, 28:1821-1829.
• [10]Strandbygaard J, Bjerrum F, Maagaard M, Winkel P, Larsen CR, Ringsted C, Gluud C, Grantcharov T, Ottesen B, Sorensen JL: Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized trial. Ann Surg 2013, 257:839-844.
• [11]Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS: Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 2009, 338:b1802.
• [12]Zijlstra F: Efficiency in Work Behaviour: A Design Approach for Modern Tools. Netherlands: Delft University of Technology; 1993. [PhD thesis]
• [13]van der Schatte Olivier RH, Van't Hullenaar CDP, Ruurda JP, Broeders IAMJ: Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 2009, 23:1365-1371.
• [14]Bharathan R, Vali S, Setchell T, Miskry T, Darzi A, Aggarwal R: Psychomotor skills and cognitive load training on a virtual reality laparoscopic simulator for tubal surgery is effective. Eur J Obstet Gynecol Reprod Biol 2013, 169:347-352.
• [15]Schulz KF, Altman DG, Moher D, CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010, 8:18. BioMed Central Full Text
• [16]Atkinson A, Riani MA: Robust Diagnostic Regression Analysis. New York, NY: Springer; 2000.
• [17]Efron B, Tibshirani R: An Introduction to the Bootstrap. New York: Chapman & Hall; 1993.
• [18]Benjamini Y, Hochberg Y: Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Royal Stat Soc Ser 1995, 57:289-300.
• [19]Hiemstra E, Kolkman W, Jansen FW: Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum. Gynecol Surg 2008, 5:321-325.
• [20]Schreuder H, van den Berg C, Hazebroek E, Verheijen R, Schijven M: Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG 2011, 119:263-265.
• [21]Magill R, Anderson D: Motor Learning and Control: Concepts and Applications. New York: McGraw-Hill Higher Education; 2013.
• [22]Ericsson KA: The Influence of Experience and Deliberate Practice on the Development of Superior Expert Performance. In The Cambridge Handbook of Expertise and Expert Performance. Edited by Ericsson KA, Charness N, Feltovich PJ, Hoffman RR. New York: Cambridge University Press; 2006:683-704.
• [23]Ericsson KA: Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004, 79:S70-81.
• [24]Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA: Reconsidering fidelity in simulation-based training. Acad Med 2014, 89:387-392.
• [25]Sabbagh R, Chatterjee S, Chawla A, Hoogenes J, Kapoor A, Matsumoto ED: Transfer of laparoscopic radical prostatectomy skills from bench model to animal model: a prospective, single-blind, randomized, controlled study. J Urol 2012, 187:1861-1866.
• [26]O'keeffe SL, Harrison AJ, Smyth PJ: Transfer or specificity? An applied investigation into the relationship between fundamental overarm throwing and related sport skills. Phys Educ Sport Pedagog 2007, 12:89-102.
• [27]Moradi J, Movahedi A, Salehi H: Specificity of learning a sport skill to the visual condition of acquisition. J Mot Behav 2014, 46:17-23.
• [28]Young JQ, Van Merrienboer J, Durning S, Ten Cate O: Cognitive Load Theory: Implications for medical education: AMEE Guide No. 86. Med Teach 2014, 36:371-384.
• [29]Spruit EN, Band GPH, Hamming JF, Ridderinkhof KR: Optimal training design for procedural motor skills: a review and application to laparoscopic surgery. Psychol Res 2013. [Epub ahead of print]
• [30]Savović J, Jones HE, Altman DG, Harris RJ, Jüni P, Pildal J, Als-Nielsen B, Balk EM, Gluud C, Gluud LL, Ioannidis JPA, Schulz KF, Beynon R, Welton NJ, Wood L, Moher D, Deeks JJ, Sterne JAC: Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Ann Intern Med 2012, 157:429-438.
• [31]Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC: Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 2008, 336:601-605.
• [32]Kjaergard LL, Villumsen J, Gluud C: Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001, 135:982-989.
• [33]Cook DA, West CP: Perspective: Reconsidering the focus on “outcomes research” in medical education: a cautionary note. Acad Med 2013, 88:162-167.