Dimitrios Stefanidis, MD PhD, Thomas C Yonce, Ryan C Phillips, Aikaterini Coker. Carolinas Simulation Center, Carolinas Healthcare System
Introduction: Motion tracking has been suggested to be a more sensitive performance metric compared with time and errors during simulator training. It is unknown, however, whether the incorporation of such metrics into the training goals of a proficiency-based simulator curriculum such as the FLS translates to improved operative performance of learners. We hypothesized that training to expert-derived levels of speed and motion will lead to improved learning and will translate to better operating room performance of novices compared to training to goals of speed or motion alone.
Methods and Procedures: An IRB-approved, blinded, randomized controlled trial was conducted at our level-I ACS-accredited education institute. 45 novices were stratified according to their baseline performance on the FLS suture model and randomized into three groups: The first group (Speed Group, n=15) trained in laparoscopic suturing until the expert level of speed was achieved. The second group (Motion Group, n=14) trained until expert levels of motion (pathlength and smoothness) were achieved. The third group (Speed and Motion, n=13) trained until expert levels of speed and motion were achieved. The ProMIS simulator that allows motion tracking and task 5 of the FLS curriculum were used for training. Besides the speed and motion metrics, to achieve proficiency participant performance had to also be error free. After training completion all groups were tested on a live porcine Nissen fundoplication model (Post-test) and retested 3 months later in the absence of practice (Retention-test). OR performance was assessed by a blinded expert rater using GOALS, task time, knot security and accuracy errors, and inadvertent injuries to adjacent structures. ANOVA was used for group comparisons. Data are presented as mean±s.d.
Results: Participant age was 23±3 years. 35% were women, and 95% right handed without differences among the groups. 30 (71%) participants achieved proficiency and participated in the Transfer-test and 26 in the Retention-test. The Speed group achieved proficiency significantly faster. With the exception of a higher injury rate during the post-test for the Speed group (that reversed during the retention test) there were no significant performance differences among the groups (see table)
Speed Group | Motion Group | Speed/ Motion Group | p-value | |
# Reps to Proficiency | 66±16 | 160±42 | 196±72 | <0.001 |
# Training Sessions | 15±3 | 25±5 | 23±5 | <0.001 |
Post-test | ||||
GOALS Ratings | 18±4 | 17.3±3 | 16.5±3 | 0.32 |
Task Time (sec) | 252±116 | 310±115 | 242±82 | 0.08 |
# Knot Errors | 0.7±0.7 | 1±0.7 | 1.5±1.4 | 0.24 |
# Inadvertent Injuries | 1.8±2.2 | 0.8±1.3 | 0.4±1.1 | 0.02 |
Retention-test | ||||
GOALS Ratings | 18.9±3 | 17.5±3 | 18.8±2 | 0.25 |
Task Time (sec) | 229±76 | 260±78 | 226±71 | 0.37 |
# Knot Errors | 0.9±0.9 | 1±0.8 | 1±1 | 0.96 |
# Inadvertent Injuries | 0.2±0.4 | 0.8±1.1 | 1.2±1.6 | 0.06 |
Conclusions: The incorporation of motion metrics into the time/accuracy goals of the FLS laparoscopic suturing curriculum led to fewer injuries in the operating room by novice learners but this effect dissipated 3 months later. Given the increased training requirements for such a curriculum and its limited effectiveness on trainee performance the addition of motion metrics to the current FLS metrics cannot be recommended based on the results of this study.
Session Number: SS13 – Simulation
Program Number: S071