Recognition of Prior Learning: A promising Tool in the Selection of Surgical Trainees; A Laparoscopic Simulation Study

Salim Abunnaja1, C. Keith White, MD1, Shohan Shetty, MD2, J Alexander Palesty, MD, FACS1. 1Saint Mary’s Hospital, 2UT Southwestern Medical Center

Introduction: Recognition of Prior Learning (RPL) is a process commonly used by the military, aviation, industry, and training institutions for a variety of purposes, most significantly, recruitment and career planning. Continued advancement in surgical education, including more minimally invasive and robotic assisted surgeries, may allow RPL to assist selection committees in their evaluation of the technical competitiveness of surgical candidates. We aim to determine if RPL through objective skills testing can be used as a component of surgical candidates evaluation.

Methods: Seventy medical students (34 male & 36 female) from five medical schools participated in this study using a Lap Sim virtual reality simulator (Surgical Science, Goteborg, Sweden). A validated curriculum for training general surgery residents was used. The surgical training curriculum consisted of three tasks: coordination, grasping, and lifting and grasping. The participants completed a survey after completion of the tasks for the evaluation of data points such as an interest in a surgical career. Performance was scored and learning curves were computer-generated. The results were analyzed using ANOVA and unpaired t-tests.

Results: Based on the computer generated scores and overall repetitions, 14 participants had above average skill (21%), 35 had average skill (53%) and 17 had below average skill (26%). Four students were excluded due to previous practice on our simulation system. When groups were broken down into those with surgical interests and those without, there were no overall significant differences. However, the number of participants with below average skills was significantly lower in students interested in surgical training (13%) when compared to those with no interest in surgical training (32%). In addition, there were more participants with average scores in the surgical group (65%) as compared to the non-surgical group (47%).

Conclusions: Application of RPL through skills testing using virtual reality simulators may be an additional selection criterion for surgical training selection committees. Additionally, this may allow prospective trainees to realize their limitations or learn which skills need to be improved upon, or maybe even reconsider their field of choice. Our results reveal the use of a standardized laparoscopic training simulator curriculum can differentiate between participants with differing levels of skill. The decision to pursue a surgical career may have affected the prior learning of these individuals and the increased skill performance.

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