Thinking Outside the (Trainer) Box: A Competition Curriculum to Develop Laparoscopic Proficiency and Problem-solving in Surgical Trainees

N Lafayette, MD, D Ricaurte, MD, J Dussel, MD, J Gauthier, MD, S Kurtzman, MD, L Melman, MD. Waterbury Hospital

INTRO: Surgical trainees are faced with pressure to learn more in less time.  It takes about 10 hours (600 minutes) of dedicated practice time for a novice to reach basic laparoscopic proficiency.  This requires dedicated practice outside the OR; however, this is often difficult for residents to achieve in their first year of training. In addition to manual skills, residents must also learn effective management skills. This aspect of training is difficult to simulate.  The objectives of this study were: 1) to develop a competition curriculum and see if our interns would reach the 600-minute mark by its end, 2) to observe the voluntary usage (in minutes/week) of the skills lab before, during, and after curriculum implementation, and 3) to see if adding a teamwork dimension halfway through the competition would increase skills lab usage.

METHODS: Twelve residents (PGY levels 1-5) were asked to practice FLS tasks from the validated curriculum.  Participation was not required. All trainees had unrestricted access to trainer boxes and practice materials.  All four interns had little or no prior experience with FLS.   The curriculum was run between February-May 2015.  In February & March, residents practiced tasks on their own.  During April & May, any PGY level first-assist was allowed and competitors could develop strategies for time reduction.  “Top Gun” was awarded for lowest time based on time and accuracy.  “Wingman” was awarded for highest score based on strategy development. The time each resident spent in practice was tracked using a logbook and the Hours Keeper app.  Minutes for each intern were then totaled, and the monthly sum of resident-minutes for all PGY levels was quantitated.  Students t-test was used to compare means, and significance was set at p<0.05.

RESULTS: Three of the four interns achieved greater than or equal to 600 minutes of practice time by the end of the competition (range 578-2975 min).  In total, ten of twelve residents eagerly participated in the curriculum.  The usage of the skills lab increased significantly compared to baseline (Table 1).  Although practice time was not significantly more after addition of a team strategy element, it was successful in maintaining usage hours higher than baseline.

CONCLUSIONS: A competition curriculum motivates surgical trainees to practice and can help them achieve proficiency during their first year of training.  Through this model, any PGY-level trainee can practice manual as well as team management skills in a simulated environment.