Tomoko Mizota, MD, Yo Kurashima, MD, PhD, Saseem Poudel, MD, Yusuke Watanabe, MD, PhD, Toshiaki Shichinohe, MD, PhD, Satoshi Hirano, MD, PhD. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine
Introduction: Although the effectiveness of simulation training outside of the operation room has been firmly demonstrated, there is disparity among training environments in institutions around the world. Outside North America, very few residents actually have access to simulation facilities and trainers. We had earlier successfully demonstrated the efficiency of the remote training system using a two-way web-conference software in training technical skills in a number of short sessions. Due to the limited time available in these sessions, we hypothesized that concentrating in one step at a time in each session would be more efficient than a conventional training method. The purpose of this study was to assess the impact of a stepwise method on remote training of basic laparoscopic skills for novice surgeons.
Methods: Residents were voluntarily enrolled to the study. They were randomly assigned to stepwise training group (SG) or conventional training group (CG). All participants were trained to predefined the proficiency level in the intracorporeal suturing task of the Fundamentals of Laparoscopic Surgery (FLS). They were trained remotely by a coach using our previously developed system once a week. They were encouraged to do self-practice between coaching sessions. For SG, the task divided into three sub-tasks; needle-handling, needle-driving, and knot-tying. The goals for each sub-task were predefined based on the proportion of time spent by experts on each sub-task. SG were required to achieve these goals in each step before they moved to the next step. CG were trained on the whole task in every session. The length of coaching time was recorded as the primary outcome. The number of coaching sessions and the length of self-practice time were also recorded. Data were expressed as median [interquartile range].
Results: Twenty (10 SG; 10 CG) residents from 10 institutes were participated in this study. No significant difference was found in the characteristics and the baseline performance of the two groups. All participants achieved proficiency after training. Total coaching time of SG tended to be shorter than that of CG (22 minutes [16-30] vs. 38 minutes [18-55], p=0.20). There was no statistical difference in the number of coaching sessions (4 [4-4.5] vs. 4 [4-6.25], p=0.97) and the length of self-practice time (253 minutes [118-358] vs. 203 minutes [114-268], p=0.71) until achieving proficiency between two groups.
Conclusion: In the remote training setup, the stepwise method has prospects to help residents and attendings reduce their time for simulation training.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78716
Program Number: S064
Presentation Session: Education, Simulation and Assessment
Presentation Type: Podium