Abstract
Abstract: Introduction: To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator. Methods: This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. It was established the task of performing laparoscopic stitches, with five simple knots, in the beginning and in the end, in a suture mold, in an abdominal cavity simulator, in 18 minutes. The main outcomes were time and quality of performance. The students were evaluated before the first and after all stages of the training regarding the quantity and quality of the knots or the subject of the stage and satisfaction with the training model. ANOVA and Student’s t tests were performed for the independent samples and the chi-square test for the categorical variables. For variables with serial measurements, general linear models were used. Univariate binomial models were used in the evaluation variables of the training model. P values <0.05 were considered significant. Results: The values of the medians were analyzed between the first and last stages of the training; of the number of simple knots (0.0 and 15.0) and laparoscopic knots (0.0 and 3.0), the adequacy of the sizes of the suture tail ends (0.0 and 11.0), the number of adjusted initial simple knots ( 0.0 and 3.0) and adjusted sequential ones (0.0 and 24.0). There was statistical significance in all evaluated parameters (p< 0.001). The learning curve showed that 99.1% of the students attained competence. The degree of satisfactory evaluation of the training model was considered good or great in 97% or more, with statistical relevance in 8 of the 10 evaluated statements. Conclusions: The study demonstrated that the students showed competence progression and learning curve evolution. The degree of student satisfaction in relation to the training model stages was very significant.
Highlights
To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator
In the 1980s, with the start of minimally-invasive laparoscopic surgery, surgeons were encouraged to acquire a series of new skills to overcome previously nonexistent technical challenges in conventional surgical practice, such as: loss of depth perception and spatial orientation due to two-dimensional vision, inverted perception of hand movements when working with surgical instruments, “fulcrum effect of the abdominal wall”, limited degree of movement due to the use of rigid instruments introduced by means of trocars fixed to the abdominal wall, decreased haptic sensitivity due to resistance inside the trocars and the use of long instruments and the need to perform the tasks with both hands, i.e., ambidexterity[4,5,6]
The results of student satisfaction evaluations showed a high degree of agreement with the presented statements with at least ninety-seven percent of the answers in the items I partially agree, and I totally agree
Summary
To evaluate the progression of competence, learning curve and degree of satisfaction with the training model of medical students undergoing training to perform laparoscopic knots in a simulator. Methods: This was a prospective, longitudinal, interventional study, carried out from April 2016 to July 2017, with the participation of 52 students from the Centro Universitário Christus, Fortaleza, Brazil, from the first to the third year of medical school, undergoing theoretical practical, systematic, and methodized training, with progression of skills to perform laparoscopic knots in a simulation environment in four stages, with a total duration of 16 hours. The initial model introduced the concept of medical residency based on the German experience of training for surgeons Over time, this training model was gradually adopted in the United States and throughout America[1, 2]. In the 1980s, with the start of minimally-invasive laparoscopic surgery, surgeons were encouraged to acquire a series of new skills to overcome previously nonexistent technical challenges in conventional surgical practice, such as: loss of depth perception and spatial orientation due to two-dimensional vision, inverted perception of hand movements when working with surgical instruments, “fulcrum effect of the abdominal wall”, limited degree of movement due to the use of rigid instruments introduced by means of trocars fixed to the abdominal wall, decreased haptic sensitivity due to resistance inside the trocars and the use of long instruments and the need to perform the tasks with both hands, i.e., ambidexterity[4,5,6]
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