2005 SAGES Abstracts

POSTER ABSTRACTS
(CS2) tasks, and 5 validated VT tasks. Participants were then
stratified according to pre-test composite score (sum of each
task mean), and randomized into two groups. All subjects
trained during one-hour weekly sessions over a 1-year period.
In Group I (n=10) training continued until previously reported
proficiency levels were achieved on each task (maximum
attempts - 80); in Group II (n=11), training continued until 30
repetitions where performed on each task. Statistical analysis
was performed using t-tests, and chi-square.
RESULTS: At pre-test there was no significant difference
between scores of the two groups. During the study period all
subjects completed the assigned training on all 17 tasks. Upon
curriculum completion, proficiency was demonstrated for 98%
of tasks by Group I compared to 72% of tasks for Group II
(p<0.001). Compared to Group II, Group I achieved a significant
better final score after fewer repetitions, which suggest
that goal directed criteria might have enhanced motivation and
maximized learning. Additionally, a non-significant trend
towards a shorter training duration was noted for Group
I.CONCLUSIONS: These data indicate that proficiency-based
training results in superior performance and is more efficient
compared to repetition-based endpoints. Future simulator
training should incorporate predetermined proficiency scores
as training goals and repetition-based training should be abandoned.
P174–Education/Outcomes
THE ROLE OF OBSERVATION IN THE ACQUISITION OF
LAPAROSCOPIC TECHNICAL SKILLS, Donna D Stanbridge RN,
Melina C Vassiliou MD,Liane S Feldman MD,Simon Bergman
MD,Gerald M Fried MD, Steinberg-Bernstein Centre for
Minimally Invasive Surgery, McGill University, Montreal, QC
Introduction: The observation of a motor task can activate cognitive
processes similar to those seen during actual performance
of that task. The technical challenges inherent to laparoscopic
surgery have created a growing interest in how these
skills are acquired. Research in surgery and motor learning
has focused primarily on hands-on practice of skills, either in
the operating room or in a simulation laboratory. The purpose
of this study was to examine the relationship between repeated
observation during MIS surgery without hands-on experience
and the acquisition of laparoscopic technical skills in a
physical simulator.
Methods: After demonstration and explanation, 12 perioperative
nurses (6 MIS-trained and 6 non-MIS trained) were scored
during 2 iterations of the peg transfer task in the MISTELS
(McGill Inanimate System for Training and Evaluation of
Laparoscopic Skills) physical simulator. Scores and baseline
characteristics (age, gender, handedness, years of OR experience)
were compared between the MIS-trained group (n=6)
and the non-MIS group (n=6). Fisher?s Exact test was used to
analyze proportions and the Students t-test was used for continuous
data.
Results: There were no differences in baseline characteristics
between the MIS and non-MIS trained nurses. The mean score
in the peg transfer task (average of both iterations) for the MIS
group was 71.5 (95% CI 61.1-81,9) compared to 44.6 (36.2-52.9,
p=0.0025) for the non-MIS group.
Conclusions: Active observation and participation in a MIS surgical
team may contribute to the acquisition of laparoscopic
technical skills. The role of observation in the training and
evaluation of laparoscopic skills merits further study.
P175–Education/Outcomes
INTEGRATING BASIC SKILLS IS COST-EFFECTIVE FOR TEACH-
ING LAPAROSCOPIC SUTURING, Dimitrios Stefanidis MD,
Sarah Markley MS,Rafael Sierra MD,James R Korndorffer Jr
MD,Bruce J Dunne PhD,Daniel J Scott MD, Tulane University
Health Sciences Center
BACKGROUND: Laparoscopic suturing is an advanced skill
that requires specialized training and is difficult to acquire. We
hypothesize that mastering basic skills first may enhance skill
acquisition and reduce resource requirements for a videotrainer
(VT) suturing curriculum.
METHODS: Medical students (n=18) with no previous VT experience
were enrolled in an IRB-approved protocol, pre-tested
on a validated suturing model, and randomized into two
groups. Group I (n=9) trained (unsupervised) until proficiency
levels were achieved on 5 basic tasks, whereas Group II (n=9)
received no basic training. Both groups then trained (supervised)
on the suturing model (1hr every other day) until previously
reported proficiency levels were achieved. Scores (based
on time and errors), training parameters, instruction requirements
(interventions), and cost (material and personnel) were
compared between groups using t-test.
RESULTS: Pretest scores were similar for both groups and all
subjects achieved the proficiency levels. The overall time
required to finish the curriculum was similar for both groups
(Group I 353 ± 58 vs. Group II 310 ± 98 min, NS). The Group I
training strategy was more cost-effective with a savings of
$147 per trainee. Group I required less active instruction (3 ±1
interventions) compared to Group II (7 ± 4), p