Laparoscopic Skills Laboratories: Laparoscopic Skills Laboratories: Current Assessment and a Call for Current Assessment and a Call for

Resident Training StandardsResident Training Standards

James R. Korndorffer, Jr., MD, James R. Korndorffer, Jr., MD,

Dimitris Stefanidis, MD, Daniel J. Scott, MDDimitris Stefanidis, MD, Daniel J. Scott, MD

BackgroundBackground

Training in laparoscopic skills laboratories Training in laparoscopic skills laboratories has been shown to transfer to real has been shown to transfer to real operationsoperations1-41-4

Prior study showed 80% of programs had Prior study showed 80% of programs had laparoscopic surgery labslaparoscopic surgery labs55

However, perceived slow adoption to the However, perceived slow adoption to the use of labs in residency training programsuse of labs in residency training programs

1 Korndorffer Jr. JR, et al. Surg Endosc (2005) 19: 161-1672 Seymour NE, et al. Ann Surg (2002) 263: 458 - 4633 Scott DJ, et al. J Am Coll Surg (2000) 191: 272-2834 Fried GM. et al. Surg Endosc (1999) 13: 1077 – 10815 Marks JM, et al. Surg Endosc (2001) 15: 1011-1015

PurposePurpose Believed benefitBelieved benefit of laparoscopic skills labsof laparoscopic skills labs PrevalencePrevalence Composition of the “average lab”Composition of the “average lab”

PurposePurpose““average” skills Labaverage” skills Lab

PurposePurpose

Believed valueBelieved value of laparoscopic skills labsof laparoscopic skills labs

PrevalencePrevalence

Composition of the “average lab”Composition of the “average lab”

UtilizationUtilization

CostsCosts

MethodsMethods

Survey: mailed to all surgical residency Survey: mailed to all surgical residency program directors program directors

Unique identifierUnique identifier

All non-responders contacted by e-mailAll non-responders contacted by e-mail

Remaining no-responders again contacted Remaining no-responders again contacted by mailby mail

MethodsMethods

ResultsResults

64% response rate (162)64% response rate (162) University programs 62%University programs 62% University affiliated/Community 64%University affiliated/Community 64% Community 72%Community 72%

Graduate 647 residents Graduate 647 residents

42 have laparoscopic fellowships42 have laparoscopic fellowships

ResultsResultsPerceivedPerceived ValueValue

Improves OR PerformanceImproves OR Performance Efficient MethodEfficient Method

Recruitment AidRecruitment Aid Have Skills LabsHave Skills Labs

88% 78%

75%55%

ResultsResultsEquipmentEquipment

0%

20%

40%

60%

80%

100%

3.9 / lab (range 1 -15)

ResultsResultsEquipmentEquipment Mirror TypeMirror Type

33% (range 0 - 6)33% (range 0 - 6)

TV TypeTV Type 60% (range 0 - 6)60% (range 0 - 6)

Trainer Box andTrainer Box andLaparoscopeLaparoscope 55% (range 0 - 10)55% (range 0 - 10)

Free StandingFree Standing 31 % (range 0 - 5)31 % (range 0 - 5)

ResultsResultsEquipmentEquipment

0%

20%

40%

60%

80%

100%

3.8 / lab (range 1 - 15)

1.7 / lab (range 1 - 7)

ResultsResultsEquipmentEquipment

MIST-VRMIST-VR 61% (range 0 - 3)61% (range 0 - 3)

EndoscopyEndoscopy 34 % 34 %

OtherOther 37% (range 0 – 3)37% (range 0 – 3)

ResultsResultsUtilization -Utilization - Basic SkillsBasic Skills

0%10%20%30%40%50%60%70%80%90%

100%

Rosse

r/UTSW

ResultsResultsUtilization -Utilization - Basic SkillsBasic Skills

0%10%20%30%40%50%60%70%80%90%

100%

Rosse

r/UTSW

MIS

TELS/FLS

ResultsResultsUtilizationUtilization Basic SkillsBasic Skills

0%10%20%30%40%50%60%70%80%90%

100%

Rosse

r/UTSW

MIS

TELS/FLS

MIS

T_VR

ResultsResultsUtilizationUtilization Basic SkillsBasic Skills

0%10%20%30%40%50%60%70%80%90%

100%

Rosse

r/UTSW

MIS

TELS/FLS

MIS

T-VR

Dept.

Creat

ed

? ?? ?

?

ResultsResultsUtilization -Utilization - SuturingSuturing SkillsSkills

0%10%20%30%40%50%60%70%80%90%

100%

Intra

corp

oreal

Extra

corp

oreal

Endostitc

h

Suture

Ass

ista

nt

"Our o

wn"

?

ResultsResultsUtilization - resident timeUtilization - resident time

Mean time in lab 50 min/weekMean time in lab 50 min/week Range 0 - 5 hrs / wkRange 0 - 5 hrs / wk

48 % less than 1 hr / wk48 % less than 1 hr / wk

Required training 55 % Required training 55 % Range “one session”/ year - 5 hrs/weekRange “one session”/ year - 5 hrs/week

ResultsResultsCostsCosts

StaffingStaffing 1.7 People/lab (range 0 - 5)1.7 People/lab (range 0 - 5)

MD - 79 %MD - 79 % Fellow/resident - 43 %Fellow/resident - 43 % Other - 21 % Other - 21 %

Monetary Monetary Set up $133,000 ($300 - 1 mil)Set up $133,000 ($300 - 1 mil) Annual budget $11,000 ($0 - 50,000)Annual budget $11,000 ($0 - 50,000) Source of FundsSource of Funds

43 % corporate 26 % department 43 % corporate 26 % department

13 % hospital 14 % other13 % hospital 14 % other

3 % government3 % government

SummarySummary

Benefits proven and accepted by mostBenefits proven and accepted by most Small majority have labsSmall majority have labs ““Average Lab”Average Lab”

0.7 mirror trainers0.7 mirror trainers 1.2 TV trainers1.2 TV trainers 1.4 Box Trainers1.4 Box Trainers 0.5 free standing trainers0.5 free standing trainers 0.3 MIST - VR0.3 MIST - VR 0.2 Endoscopic VR0.2 Endoscopic VR 0.3 Other VR0.3 Other VR 0.8 hrs/week0.8 hrs/week 1.7 people for staffing1.7 people for staffing $133.000 set up$133.000 set up

ConclusionConclusion

Impediments to implementationImpediments to implementation What to use and how to use itWhat to use and how to use it

CurriculumCurriculum

Resident motivationResident motivation Program director involvementProgram director involvement

Where to find time in the 80 hr Where to find time in the 80 hr work-weekwork-week

Need to be creativeNeed to be creative AccessibleAccessible

CostsCosts

ConclusionConclusion

Significant variability of equipment and Significant variability of equipment and training practices exist in currently available training practices exist in currently available labs. Strategies are needed for more labs. Strategies are needed for more widespread implementation of skills labs, and widespread implementation of skills labs, and standards should be developed to facilitate standards should be developed to facilitate uniform adoption of validated curricula that uniform adoption of validated curricula that reliably maximize training efficiency and reliably maximize training efficiency and educational benefit. educational benefit.

Laparoscopic Skills Laboratories: Laparoscopic Skills Laboratories: Current Assessment and a Call for Current Assessment and a Call for

Resident Training StandardsResident Training Standards

James R. Korndorffer, Jr., MD, James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD, Daniel J. Scott, MDDimitris Stefanidis, MD, Daniel J. Scott, MD