Telesimulation in Africa: An Effective Method for Teaching the Fundamentals of Laparoscopic Surgery in Developing Countries

Introduction: Several challenges exist with laparoscopic skills training in developing countries including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Africa. Methods: A total of 16 surgeons from 2 centers in Botswana participated in this 10 week study. FLS Telesimulation (TS) was setup using a previously described platform for 8 surgeons in the TS group. A standard FLS simulator was available for the 8 surgeons in the self-practice (SP) group. Pre-test FLS scores were obtained during an initial trip to Botswana. Participants in the TS group had one training session per week with an FLS proctor at the University of Toronto who provided feedback and demonstrated proper technique. Participants in the SP group had access to the FLS DVD and were instructed to train on FLS at least once per week. FLS post-test scores were obtained in Botswana by a trained FLS proctor at the conclusion of the study. Results: Pre-test FLS scores were the same in both groups. Participants in the telesimulation group had a significantly higher post-test FLS score than those in the self-practice group (86±8 vs 52±15, p=.001). 100% of trainees in the telesimulation group achieved an FLS simulator certification passing score, compared to only 25% in the self-practice group (p=.002). Conclusions: We have shown that remote telesimulation is an effective method for teaching the Fundamentals of Laparoscopic Surgery in Africa, achieving a 100% FLS skills pass rate. This training platform provides a cost-effective method of teaching in developing countries, and could be used to teach laparoscopic skills anywhere in the world with internet access. Further studies are needed to validate whether telesimulation can be used to remotely and accurately score FLS for official certification purposes.

Session: Podium Presentation

Program Number: S072