Laparoscopy
A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill

https://doi.org/10.1016/j.amjsurg.2005.10.014Get rights and content

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Background

Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes.

Methods

The minimally invasive VR simulator (MIST-VR) has 12 abstract laparoscopic tasks, each at 3 graduated levels of difficulty (easy, medium, and hard). Twenty medical students completed 2 sessions of all tasks at the easy level, 10 sessions at the medium level, and finally 5 sessions of the 2 most complex tasks at the hard level. At the medium level, subjects were randomized into 2 equal groups performing either all 12 tasks (group A) or the 2 most complex tasks (group B). Performance was measured by time taken, path length, and errors for each hand. The results were compared between groups, and to those of 10 experienced laparoscopic surgeons.

Results

Baseline performance of both groups was similar at the easy level. At the medium level, learning curves for all 3 parameters reached plateau at the second (group A, P < .05) and sixth (group B, P < .05) repetitions. Performance at the hard level was similar between the 2 groups, and all achieved the pre-set expert criteria.

Conclusion

A graduated laparoscopic training curriculum enables trainees to familiarise, train and be assessed on laparoscopic VR simulators. This study can aid the incorporation of VR simulation into established surgical training programmes.

Section snippets

Methods

Twenty medical students with no previous laparoscopic experience were recruited to undergo a training program on the MIST-VR simulator. Training sessions were delivered over a maximum period of 14 days, with 2 sessions per day, each at least 1 hour apart. A study coordinator was present during all training sessions to provide technical assistance.

MIST-VR is the most widely validated laparoscopic VR simulator and has 12 basic tasks at 3 levels of difficulty: easy, medium, and hard (Fig. 1)[20],

Statistical Analysis

Data were analyzed by the Statistical Package for the Social Sciences version 11.5 (SPSS, Chicago, IL) using nonparametric tests. Data on learning curves were analyzed by the Friedman (nonparametric repeated measures analysis of variance [ANOVA]) test. Multiple comparisons were then made to identify when plateau of skills had occurred. Comparison of performance between groups A and B was undertaken using the Mann-Whitney U test. A level of P < .05 was considered statistically significant.

Results

All 20 participants completed the study curriculum, and there were no demographic differences between groups A (12 tasks) and B (2 tasks) (Table 1). At the easy level, baseline performance scores were similar for groups A and B in terms of time taken (P = .588), economy of movement (P = .813), and error scores (P = .496). Assessment of performance during training at the medium level for groups A and B on task 6 for core skills 1 revealed a statistically significant flattening of the learning

Comments

This study has established an evidence-based VR training curriculum for the acquisition of psychomotor skill. Previous studies have demonstrated plateau of skill acquisition at the easy and medium levels [8], [9], [12]. However, it was the aim of this study to define a stepwise curriculum moving from easy to medium and onto hard levels of difficulty, and to provide objective evidence regarding the most efficient use of the simulator.

This study has shown that it is possible to acquire the same

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