(BACKGROUND) Traditionally, surgical residents learn and master surgical skills while they are doing operation under the proper direction of senior staff or supervisors. In the case of laparoscopically assisted surgery, in which learning curve depends on efficient instruction due to the complicated procedures, both operator and director can share the same image as well as the observer, and most of all, the procedures are usually recorded in the videotapes. We introduced audio-visual tutoring system, in which the trainees can review the senior surgeonfs advice recorded on the videotape using wireless microphone during operation. In this study, we investigated the effect of this method on the trainee with various skill levels.
(METHOD) The study was conducted as a randomized controlled trial. Fourteen examiners, consist of eight postgraduate students in engineering with no prior surgical or endoscopic surgical experience and six surgical residents lacking the experience of endoscopic surgery, were divided into two groups (four students and three residents). One group was assigned to audio-visual learning (group A, n=7) and the others to visual learning (group B, n=7). Both groups underwent task of suturing and knot tying using a box trainer under instruction. The time limit was 18 minutes. The first trial and instruction was recorded on a videotape. After 8 hours, both the groups had feedback by watching video of the first trial. The video had audio for group A but did not have audio for group B. After watching the video once, the same suturing and knot tying task was imposed on both the groups. The total time taken to complete the task was noted. The proportion of shortening of time was compared between the groups. The Mann-Whitney U test was used to calculate statistical significance, determined to be a p value less than 0.05.
(RESULTS) The average improvement was significantly greater in group A (from 457 s to 170 s, improving ratio; 37.1 %) than that in the group B (from 484 s to 382 s, improving ratio; 68.7 %) (p = 0.018). Achievement rate of group A and group B were 85.7% and 71.4% respectively. Improvement rate of students and residents had no significant difference (p=0.25).
(CONCLUSION) Audio-visual tutoring system is simple and useful method in skill acquisition during proficiency based laparoscopic operation training for the trainee in various levels.
Program Number: P151