The Impact of Structured Intensive Laparoscopic Training Course on Residents Operative Performance in Animal Lab

Iman Ghaderi, MD, MSc¹, Tung Tran, MD², Julia Samame, MD¹, Hany Takla, MD¹, Rose Ibrahim, MD¹, Hannah Loebl, BA¹, Carlos Galvani, MD¹. ¹University of Arizona, ²MedStar Health

Introduction: Simulation-based training has gained popularity in recent years. The objective of this study was to examine the impact of an intensive laparoscopic training course on residents performance in animal lab.

Methods and Procedures: Surgical residents from a teaching Hospital participated in a 3- day structured intensive laparoscopic training course. The junior residents (PGY1-2) performed 2 basic (cholecystectomy and incisional hernia repairs) and senior residents (PGY3-5) performed 3 advanced laparoscopic procedures (Nissen fundoplication, splenectomy, and low anterior colon resection) on live pigs. Each resident performed the same procedure twice in two consecutive days. Their operative performance was assessed using validated assessment tools including the Global Operative Assessment of Laparoscopic Skills (GOALS) for general laparoscopic skills and procedure-specific skills including GOALS-Incisional Hernia, Operative Performance Rating System (OPRS) for cholecystectomy, colectomy and a rating scale for Nissen fundoplication. The assessments were completed by faculty and residents (self-assessment) after each procedure.  The Wilcoxon rank test was used to examine the effect of training on resident performance after one repetition. Statistical significance was considered at p < 0.05.

Results: Forty surgical residents (20 junior and 20 senior residents) participated in four courses in 2015.  Residents general laparoscopic skills improved in incisional hernia repair and Nissen fundoplication (p <0.05). Their scores also improved in procedure specific ratings in cholecystectomy, incisional hernia repair and low anterior colectomy (p< 0.05). (Table 1) The scores between faculty and resident assessments were moderately to strongly correlated (r>0.6)

Conclusion: Trainees show significant improvements in performance in general laparoscopic and procedure specific skills after an intensive laparoscopic training course. These effects are reproduced through a wide range of laparoscopic procedures. Future studies are needed to examine the skill retention and number of sessions required to achieve competency. 

Procedure	General laparoscopic skills Improvement day 1 to day 2 (p value)		Procedure specific skills Improvement day 1 to day 2 (p value)
Rater	Faculty	Self	Faculty	Self
Cholecystectomy	0.63	0.91	0.01*	0.43
Incisional hernia repair	0.01*	0.01*	0.01*	0.18
Nissen fundoplication	0.04*	0.01*	0.054	0.07
Splenectomy	0.26	0.12	N/A	N/A
Low Anterior Colectomy	0.1	0.01*	0.03*	0.01*

*P value< 0.05