Intro: Surgical skills training outside the OR is beneficial. The best methods have yet to be identified. In a series of three studies, we attempted unsuccessfully to document predictive validity of simulation training.
Methods: In each study we used Global Operative Assessment of Laparoscopic Skills (GOALS) to evaluate operative performance 1.) Prospective, randomized, multi-center trial to assess performance of junior residents in the OR after training to criteria or not training on a laparoscopic simulator [LapSim® Surgical Science Ltd., Göteborg, Sweden]). 2.) Retrospective review of operative performance of junior residents operating as primary surgeon before and after implementation of a laparoscopic skills training curriculum. 3.) Intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator.
Results: We failed to document predictive validity in all three studies. In each study, no difference was found between trained and untrained residents in GOALS domains of depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy.
Conclusions: We found a lack of correlation between three types of training outside the operating room and improved operative performance. Possible explanations include.) Too few subjects; 2.) Introducing training too late on the learning curve; and 3.) Training criteria too easy. Awareness of these failures can improve design of future studies.
Program Number: P155