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      Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum

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          Abstract

          The complexity of acquiring minimally invasive surgical (MIS) skills, combined with smaller case volumes for residents have pushed the development of skills training facilities on simulators outside the operating room (OR). Medico-legal and financial constraints have stimulated this development even more. However, the implementation of simulator training into a residency curriculum is shown to be troublesome. MIS skills training is organized in a uniform and easily applicable way in the Dutch obstetrics and gynecology residency curriculum. Every resident is obliged to attend the same basic surgical skills course, named Cobra-alpha course, intentionally during postgraduate year (PGY) 1 or 2. Furthermore, surgical skills are trained, evaluated and expanded on simulators in teaching hospitals. Additional to the Cobra-alpha course, residents may attend advanced training courses and congresses focusing on laparoscopy and hysteroscopy. This organization guarantees a uniform introduction to MIS skills training for every resident. However, preconditions for continuous training and evaluation after this introduction have to be optimized.

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          Most cited references22

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          Virtual reality training improves operating room performance: results of a randomized, double-blinded study.

          To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.
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            Assessment of technical skills transfer from the bench training model to the human model.

            This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F(2,44) = 3.49, P <0.05) and global scores (F(2,44) = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.
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              Laparoscopic virtual reality and box trainers: is one superior to the other?

              Virtual reality (VR) simulators now have the potential to replace traditional methods of laparoscopic training. The aim of this study was to compare the VR simulator with the classical box trainer and determine whether one has advantages over the other. Twenty four novices were tested to determine their baseline laparoscopic skills and then randomized into the following three group: LapSim, box trainer, and no training (control). After 3 weekly training sessions lasting 30-min each, all subjects were reassessed. Assessment included motion analysis and error scores. Nonparametric tests were applied, and p < 0.05 was deemed significant. Both trained groups made significant improvements in all parameters measured ( p < 0.05). Compared to the controls, the box trainer group performed significantly better on most of the parameters, whereas the LapSim group performed significantly better on some parameters. There were no significant differences between the LapSim and box trainer groups. LapSim is effective in teaching skills that are transferable to a real laparoscopic task. However, there appear to be no substantial advantages of one system over the other.
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                Author and article information

                Contributors
                +31-071-5264047 , +31-071-5248181 , F.W.Jansen@lumc.nl
                Journal
                Gynecol Surg
                Gynecological Surgery
                Springer-Verlag (Berlin/Heidelberg )
                1613-2076
                1613-2084
                29 May 2008
                29 May 2008
                November 2008
                : 5
                : 4
                : 321-325
                Affiliations
                Department of Gynecology, Leiden University Medical Centre (LUMC), P.O. Box 9600, 2300 RC, Leiden, The Netherlands
                Article
                402
                10.1007/s10397-008-0402-1
                3133645
                21841942
                9e68685f-425d-466c-bc4a-ae65198eb26b
                © The Author(s) 2008
                History
                : 15 February 2008
                : 15 April 2008
                Categories
                Techniques and Instrumentation
                Custom metadata
                © Springer-Verlag 2008

                Obstetrics & Gynecology
                training,simulation,surgical skills,implementation,residency curriculum
                Obstetrics & Gynecology
                training, simulation, surgical skills, implementation, residency curriculum

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