Re: “Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training”

Abstract

We appreciate the opportunity to respond to Dr Rulli’s and Galata’s comments on our article entitled “Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training” originally appearing in the August 2006 issue of Surgery. 1 Stefanidis D. Korndorffer Jr, J.R. Black F.W. Dunne J.B. Sierra R. Touchard C.L. et al. Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. Surgery. 2006; 140: 252-262 Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar We want to thank Drs. Rulli and Galata for the thoughtfulness of their comments; they describe a step-wise approach of skills training in laparoscopic surgery that starts with low fidelity, inanimate models (simulators), continues with animal models, and ends with training in the operating room. We agree with their view that laboratory training alone may be insufficient to produce consistent clinical performance at the present time. Indeed, we have shown previously that although proficiency-based training in laparoscopy on the currently available low fidelity simulators leads to improved operating room performance, it does not allow trainees to reach expert performance under real operating room conditions. 2 Korndorffer Jr, J.R. Dunne J.B. Sierra R. Stefanidis D. Touchard C.L. Scott D.J. Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg. 2005; 201: 23-29 Abstract Full Text Full Text PDF PubMed Scopus (341) Google Scholar , 3 Stefanidis D. Korndorffer Jr, J.R. Heniford B.T. Markley S. Sierra R. Scott D.J. Closing the gap in operative performance between novices and experts: does harder mean better for laparoscopic simulator training?. J Am Coll Surg. 2006; 203: S76-S77 Abstract Full Text Full Text PDF Google Scholar Nevertheless, we maintain that the goal of simulator training is not to replace the operating room experience but rather to augment it. Simulator training enables trainees to be better prepared and more confident when they enter the operating room having already overcome much of the learning curve of new skills and procedures on the simulators. 4 Fried G.M. Feldman L.S. Vassiliou M.C. Fraser S.A. Stanbridge D. Ghitulescu G. et al. Proving the value of simulation in laparoscopic surgery. Ann Surg. 2004; 240: 518-525 Crossref PubMed Scopus (650) Google Scholar , 5 Peters J.H. Fried G.M. Swanstrom L.L. Soper N.J. Sillin L.F. Schirmer B. et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery. 2004; 135: 21-27 Abstract Full Text Full Text PDF PubMed Scopus (499) Google Scholar Realizing the importance of such training, most United States general surgery residency programs offer it to their residents. 6 Korndorffer Jr, J.R. Stefanidis D. Scott D.J. Laparoscopic skills laboratories: current assessment and a call for resident training standards. Am J Surg. 2006; 191: 17-22 Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar Nonetheless, more work is needed to develop effective and efficient curricula for simulator training. Therefore, the aim of our study was to identify ways to further optimize simulator training.