Baseline laparoscopic skills performance correlates to proficiency-based training duration

Abstract

Proficiency-based curricula using laparoscopic simulators are effective but may be difficult to implement as individual rates of skill acquisition vary widely. The purpose of this study was to determine the relationship between baseline performance and the amount of training necessary to reach proficiency. We analyzed performance data from our laparoscopic skills curriculum database for surgery residents who trained between 2002 and 2004. Only those subjects who completed the curriculum by achieving previously reported proficiency levels were included ( n = 40, R1--R5); all had minimal prior simulator exposure. Training consisted of simulator practice using three task groups: (1) video-trainer (VT), 5 tasks; (2) MIST-VR CS1, 6 tasks; and (3) MIST-VR CS2, 6 tasks. Prior to training, all residents underwent initial testing by completing three repetitions of each task. The task baseline score was defined as the mean of the three repetitions. A composite score was defined as the sum of the task baseline scores for each task group. An overall score was defined as the sum of the three composite scores. The total number of repetitions and time necessary to complete the curriculum were compared to baseline testing data. Statistical analysis was performed using Pearson correlation; P < 0.05 was considered significant. The mean total number of repetitions to reach competency was 213 (107–587) and the mean training time was 6.7 h (2.8–18.9). All three composite scores and the overall score correlated significantly with the total number of repetitions. The VT composite score and overall score correlated significantly with the total training time. These data document a significant correlation between baseline simulator performance and the amount of training required to reach proficiency. Using simulators to measure baseline abilities may allow curricula to be better tailored to meet the individual needs of each resident and to help ensure that sufficient training time is allocated. TABLE—ABSTRACT 61 Total # of repetitions Total training time VT Composite r = 0.5; P < 0.005 r = 0.5; P < 0.005 CS1 Composite r = 0.6; P < 0.001 NS CS2 Composite r = 0.6; P < 0.001 NS Overall Score r = 0.6; P < 0.001 r = 0.4; P < 0.02