Nicole Santos1, Akole Lamien2, Austin Findley2, Michael Galloway2, Minia Hellan2, Mary McCarthy2, Thomas Simon2, Ali Linsk1, Alex Derevianko1, Jaisa Olasky3, Emilie Fitzpatrick4, Brian Nguyen4, Steven Schwaitzberg5, Daniel Jones4, Suvranu De6, Caroline G Cao2. 1Cambridge Health Alliance, 2Wright State University, 3Mount Auburn Hospital, 4Beth Israel Deaconess Medical Center, 5State University of New York at Buffalo, 6Rensselaer Polytechnic Institute
Background: The Virtual Translumenal Endoscopic Surgery Trainer (VTEST) simulator is a virtual reality system that was designed to train the hybrid-NOTES technique. Transfer of skill acquired while training on the VTEST was measured in a near-real cholecystectomy procedure staged in the EASIE-R model.
Methods: Sixteen medical students were divided randomly and evenly into 2 groups: Control, Training. All subjects performed the cholecystectomy procedure on the VTEST simulator to establish a baseline (pre-test). The training group received 15 training sessions, over a period of 3 consecutive weeks, consisting of 5 trials per session or as many trials as can be accomplished in one hour, whichever was achieved first. At the end of the training period, all subjects performed one trial on the VTEST simulator (post-test), and again 2 to 3 weeks later (retention test). Two months after that, subjects performed the hybrid-NOTES cholecystectomy procedure on an EASIE-R model. Performance with the EASIE-R simulator was video-recorded, and three tasks within the cholecystectomy procedure were isolated for evaluation: clipping, cutting, and dissecting the gallbladder. Objective performance measures, such as time and error, were extracted from the videos by two independent reviewers, while subjective performance was scored by four expert surgeons who were blinded to the training conditions. Expert reviewers used a modified version of the Operative Performance Rating System by the American Board of Surgery and the Objective Structured Assessment of Technical Skills (OSATS) tool.
Results: There was no difference in task completion time between the control and training groups, (t(10)=1.045, p=.161) in the cutting and clipping tasks. However, there was a significant difference in the number of errors, t(10)=-1.847, p=.047. There was no difference in subjective performance between the training groups for the clipping and cutting tasks. In the gallbladder dissection task, however, there was a statistical significance in “instrument handling” based on one of the surgeons’ ratings (t(14)=1.919, p=.03), and a statistical significance in “time and motion” based on another surgeon’s rating (t(14)=2.118, p=.03).
Conclusions: Results indicate that 3 weeks of training on the VTEST simulator did not allow the subjects to transfer their learned skills equally to the near-real environment, even though they retained the skills when tested for retention. This new insight suggests that modification of the training method for different types of surgical skills may be warranted to optimize their transfer to the real environment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86827
Program Number: P320
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster