The Impact of a National Laparoscopic Skills Competition on use of Surgical Simulators

Greig L McCreery, MD, BESc¹, Christopher M Schlachta, MD². ¹London Health Sciences Centre; Western University, ²Canadian Surgical Technologies and Advanced Robotics (CSTAR); London HSC; Western University

INTRODUCTION: Dedicated practice using laparoscopic simulators has been shown to improve intra-operative performance. Yet, voluntary utilization is minimal. An annual national laparoscopic suturing competition has been held in Canada since 2009, employing the concept of “serious games” to enhance residents’ use of simulation. We hypothesize that competition amongst peers with the opportunity to compete at the national level positively influences residents’ reported use of laparoscopic skills simulations.

METHODS: A web-based survey was distributed via email to assess the relationship between current Canadian General Surgery residents’ reported use of laparoscopic simulation and participation in skills competition. Secondary outcomes included assessing attitudes regarding simulation training, factors limiting use of simulation, and associations between competition level and reported simulator usage. Comparator groups were analyzed using statistical tests of distribution (chi-square, Fishers exact test) and correlation (Pearson’s, Spearman’s) using SPSS.

RESULTS: One hundred ninety (23%) of an estimated 826 potential participants responded. 59% were male. PGY 1 through PGY5 training levels were well represented, ranging from 15% of responses from PGY5 trainees to 25% of PGY3’s. PGY6 residents made up only 2.6% of responses. 60% reported performing less than fifty laparoscopic surgeries as the primary operator, and 83% rated their laparoscopic abilities as novice or intermediate. 79% agreed or strongly agreed that use of simulation practice improves intra-operative performance; 71% that it is an efficient use of time; and 72% that simulation should be a mandatory component of training. The most common factors limiting use of simulation training were lack of time (90%), and lack of after-hours access (33%). Lack of interest was cited by 15% of respondents. 58% reported employing simulator practice less than once per month, and 18% reported never using a simulator. Reported duration of simulator use in the prior 6 months was less than one hour for 37%, up to 5 hours for 28% and up to ten hours for 20%. 73.2% had participated in some form of laparoscopic skills competition. Of those, only 51% agreed or strongly agreed that the opportunity to compete was motivation to utilize skills trainers (45% of all respondents). No association was found between those with competition experience and frequency (more or less than once per month, p = 1.0) or duration (more or less than 5 hours, p = 0.169) of simulator use. However, 83% of those who had competed at the national level reported greater than 5 hours of simulator use in the previous 6 months compared to those with no competition experience (26%), local competition (40%) and local national-qualifying competition (23%) (p < 0.001). Similar results were found with respect to frequency of simulation practice.

CONCLUSIONS: This study does not support the hypothesis that the opportunity for skills competition increases voluntary use of simulation-based training amongst all residents. Indeed, only that minority of individuals competing at the national level demonstrated significantly higher simulation use. Despite low reported use, attitudes towards simulation training were generally positive. Lack of time and access were the most commonly cited factors limiting simulator use.