Efficiency, Learning Curve and Skill Transfer in Robotic vs. Laparoscopic Simulation Training: A Randomized Controlled Trial Between Medical Students and Surgical Residents

Sahil Gambhir, BMSc, Caroline Moon, BS, Rama Gupta, BS, Pam Haan, RN, BSN, Cheryl Anderson, RN, BSN, MSA, Alan Davis, PhD, Terry McLeod, RN, BSN, Deb Collier, RN, BSN, MA, Nashwa Khogali, DO, MSA, David Henry, MD, Derek Ornelas, MD, Srinivas Kavuturu, MD. Michigan State University

Introduction: Our study objective is to evaluate efficiency, learning curve and transference of simulation skills among novice medical students and to compare with novice surgical residents.

Methods and Procedures: Novice medical students (no previous laparoscopic or robotic experience) were randomized to one of two groups to assess peg transfer skills using the da Vinci® robotic system and Fundamentals of Laparoscopic (FLS) Surgery trainer box. The sequence (robotic then laparoscopic or vice-versa) was crossed over to assess the transfer of skills. Each group performed 10 practice repetitions before testing in standard forward alignment. Novice surgical residents (no robotic experience) were tested in peg transfer tasks only using the da Vinci® robotic system. Peg transfer was also tested in reverse alignment for all three groups. The criterion for learning was to accomplish the task in less than 90 seconds twice in a row, with no errors. Group test scores were compared using ANOVA and the unpaired t-test.

Results:

Medical Students (n=40)

FLS Peg Transfer

Robotic Peg Transfer p-value

Overall Test Scores (seconds)

80.8+18.9

72.3+22.2

0.031

Learning Curve (sessions)

8.0+2.4

6.0+2.7

<0.001

Reverse Alignment Scores (seconds)

300.0 + 0.0

148.9+49.7

<0.001

Medical Students vs. Residents (n=10)

Residents

Medical Students

p-value

Forward test scores (seconds)

67.1+12.3

72.3+22.2

0.478

Forward learning curve (sessions)

4.4+3.2

6.0+2.7

0.121

Reverse test scores (seconds)

148.9+49.7

157.5+43.2

0.626

When assessing transfer of skill from laparoscopic to robotic or vice versa, there is no significant difference between the medical students and the residents (p = 0.368).

Conclusions: Novice medical students performed significantly better on robotic peg transfer tasks (in forward and reverse alignment) when compared to tasks performed on the FLS trainer box. Among students completing peg transfer tasks, robotic participants had a significantly shorter learning curve than participants using the FLS trainer box. No significant difference was noted between residents and students on robotic peg transfer skills. Reverse alignment peg transfer was found to be significantly easier on robotics vs. FLS trainer box. We found no evidence of transference of skills between laparoscopic and robotics approaches.

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