JL Quezada, MD1, C Jarry, MD1, R Tejos, MD1, D Asbun, MD2, G Escalona, MD1, R Avila, MD1, P Achurra, MD1, N Jarufe, MD1, J Varas, MD1. 1Pont. Universidad Catolica de Chile, 2UCSF Fresno
INTRODUCTION: Simulation training is a validated method for acquiring laparoscopic skills. Simulation has become a standard part of surgical residencies. However, its effectiveness is limited when there are difficulties with access to formal instruction and feedback. Training sessions may then be sporadic or lack continuity in oversight by instructors. It can furthermore be difficult for teaching personnel to commit time, and hiring new trainers can represent a high opportunity cost.
This study presents the development, implementation, and results of a novel smartphone application that enables remote teacher-student interaction. This interface is used to complete a validated 16-session advanced laparoscopy simulation program (ALSP) using a deferred video/audio feedback (DVF) modality.
METHODS: A web-based and mobile iOS and Android application (LAPP) was developed to enable a remote teacher-student interaction. LAPP allows expert instructors to assess video-recorded training sessions of students at distant locations. Instructors use DVF to guide the trainees through the ALSP and give specific and personalized feedback on how to improve performance. (Figure 1).
Two remote training center groups (RC) were created. A control group (CG) was recruited at the base teaching institution. All RC trainees were instructed and assessed using LAPP, and the CG through traditional in-person feedback. Pre- and post-training perfomances were video recorded for each trainee and blindly evaluated by two experts using a global rating scale (GRS) and a specific rating scale (SRS). Non-parametric statistic tests were used as needed. A cutoff score for passing and certfication in the ALSP was set to 20 of 25 points in the GRS.
RESULTS: A total of 30 trainees from two different RC were trained via LAPP and compared with 20 local trainees from the CG. Performance in the RC group improved significantly after the ALSP in both GRS and SRS scores, from 15 [6–17] to 23 [20–25], and from 12 [11–15] to 18 [15–20] respectively. All trainees achieved an ALPS certification approval score and the results between all groups (RC and CG) were comparable. (Table 1).
CONCLUSION: DVF delivered through a mobile app is as effective as in-person instruction in teaching advanced laparoscopic surgical skills. The results imply that through remote DVF training, implementation of a simulation curriculum is possible in situations that may otherwise be limited by teaching resources. LAPP provides a cost-effective method of teaching through simulation remotely, and may allow expansion of robust simulation training curriculums.
Figure 1.
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Table 1.
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Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94432
Program Number: S006
Presentation Session: Education
Presentation Type: Podium