Skill transfer from colonoscopy simulator to real patients: results of a randomized controlled trial
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evaluation metrics must accurately reflect different skill levels. Prior to implementing the Simbionix LapMentor(tm) into our surgical curriculum, we undertook this study to determine its ability to dif- ferentiate between subjects of varied laparoscopic skill. METHODS: Medical students, interns, residents, and faculty lapa- roscopic surgeons (n6-14 per group) performed 5 consecutive rep- etitions of six laparoscopic skills tasks: 30 degree Camera Manipula- tion, Eye-Hand Coordination, Clipping/Grasping, Cutting, Electrocautery, and Translocation of Objects. The LapMentor(tm) measured performance in 4-12 parameters per task. Mean perfor- mance in each parameter was compared between subject groups. Pairwise comparisons among the four groups were made by post-hoc t-tests with Bonferroni technique. Significance was set at p 0.05. RESULTS: Only the Eye-Hand Coordination and Clipping/ Grasping tasks had expert-level discrimination--where faculty out- performed other groups. Even then, fewer than 50% of the evalua- tion parameters (5/12 in Eye-Hand Coordination and 1/4 in Clipping/Grasping) had expert-level discrimination. CONCLUSIONS: Over half of LapMentor(tm) tasks were unable to differentiate between laparoscopic experts and subjects of lesser skill. Therefore, performance on those tasks as determined by current metrics may not accurately reflect a subject’s true level of ability. While feedback to the manufacturer may eventually allow for greater sensitivity of evaluation parameters, at present, the LapMentor(tm) may not be a useful construct by which to assess a trainee’s skill level or to monitor their progress. Skill transfer from colonoscopy simulator to real patients: results of a randomized controlled trial Jason Park MD, Laura Musselman MD, Peter Rossos MD, Stanley Hamstra PhD, StephenWolman MD, Helen MacRae MD, Richard Reznick MD, FACS University of Toronto, Toronto, ON Canada INTRODUCTION: Although simulator-based training has theo- retic benefits, skill transfer to clinical contexts for colonoscopy has not been objectively demonstrated. This study assessed whether prac- tice on a computer-based colonoscopy simulator improved perfor- mance on a resident’s first patient colonoscopy. METHODS: General surgery and internal medicine residents with limited endoscopic experience were randomized into treatment (n 12) or control (n 12) groups, and then evaluated as they performed a baseline procedure on the colonoscopy simulator. The treatment group then recieved simulator practice while controls had no specific learning intervention. All residents then performed a patient colonoscopy in a clinical setting. Both the simulator and clinical procedures were evaluated by blinded faculty endoscopists using pre- viously validated global rating scales. RESULTS: No baseline differences were found between groups on the simulated colonoscopy. Residents in the treatment group prac- ticed independently on the simulator for an average of 125 minutes. On the clinical procedure, the treatment group had significantly higher mean global ratings scores than controls (17.9 versus 14.8 out of maximum 35, t(22) 1.84, p 0.04). One resident in the treat- ment and none in the control group completed the entire colonos- copy to the cecum on their own in the allotted time and no compli- cations occurred in either group. CONCLUSIONS: After a short practice session, simulator-trained residents performed significantly better than controls on patient colonoscopies. This demonstration of skill transfer sets the stage for future efforts to optimally situate these simulators within evidence- based educational curricula and practice. Gender differences in medical student minimally invasive surgery skills and choice of surgery as a career Ashley K Vavra MD, Neal Barshes MD, King King PhD, Michael Millie MD, Michael Peters MD, Herminio Ojeda MD, Eric Knauer MD, Robert Obermeyer MD, John Goss MD, John Sweeney MD, FACS Baylor College of Medicine, Houston, TX INTRODUCTION: This study compares the minimally invasive surgery (MIS) skills, specialty choice, and criteria used for specialty selection between female and male medical students. METHODS: The MIS skills curriculum consists of four weekly 2-hour sessions. The time required to complete three MIS skills tasks was recorded at the initial and final sessions. A survey was adminis- tered to determine specialty rank, attitudes towards surgery and fac- tors important in specialty choice. A follow-up survey was adminis- tered to assess experiences of gender discrimination on surgical vs. non-surgical rotations. RESULTS: 108 students participated (45 male, 63 female). MIS skills improved from initial to final session (p0.001). Male and female student performance was similar. Compared to females, male students ranked surgery higher (p0.015) and ranked prestige within (p0.048) and outside (p0.015) the medical profession as factors significantly more important in specialty selection. No gender differences were found in the value placed on work hours, call hours, approach to patient care or types of medical problems encountered. On follow-up survey, female students felt mentorship opportunities were less available on surgical rotations compared to non-surgical rotations (35% vs. 58%) and that male students were encouraged more by surgical residents and/or faculty than were female students (64% vs. 27%). CONCLUSIONS: Male and female medical students demonstrate similar MIS skill levels. Male students more likely rank surgery as a top career choice. The perceived differences regarding mentorship opportunities and differential encouragement of genders on surgical rotations may influence gender disparity in surgical specialty choice. S78 Research in Surgical Education J Am Coll Surg
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Transcript of Skill transfer from colonoscopy simulator to real patients: results of a randomized controlled trial
evaluation metrics must accurately reflect different skill levels. Priorto implementing the Simbionix LapMentor(tm) into our surgicalcurriculum, we undertook this study to determine its ability to dif-ferentiate between subjects of varied laparoscopic skill.
METHODS: Medical students, interns, residents, and faculty lapa-roscopic surgeons (n�6-14 per group) performed 5 consecutive rep-etitions of six laparoscopic skills tasks: 30 degree Camera Manipula-tion, Eye-Hand Coordination, Clipping/Grasping, Cutting,Electrocautery, and Translocation of Objects. The LapMentor(tm)measured performance in 4-12 parameters per task. Mean perfor-mance in each parameter was compared between subject groups.Pairwise comparisons among the four groups were made by post-hoct-tests with Bonferroni technique. Significance was set at p� 0.05.
RESULTS: Only the Eye-Hand Coordination and Clipping/Grasping tasks had expert-level discrimination--where faculty out-performed other groups. Even then, fewer than 50% of the evalua-tion parameters (5/12 in Eye-Hand Coordination and 1/4 inClipping/Grasping) had expert-level discrimination.
CONCLUSIONS: Over half of LapMentor(tm) tasks were unableto differentiate between laparoscopic experts and subjects of lesserskill. Therefore, performance on those tasks as determined by currentmetrics may not accurately reflect a subject’s true level of ability.While feedback to the manufacturer may eventually allow for greatersensitivity of evaluation parameters, at present, the LapMentor(tm)may not be a useful construct by which to assess a trainee’s skill levelor to monitor their progress.
Skill transfer from colonoscopy simulator to realpatients: results of a randomized controlled trialJason Park MD, Laura Musselman MD, Peter Rossos MD,Stanley Hamstra PhD, Stephen Wolman MD, Helen MacRae MD,Richard Reznick MD, FACSUniversity of Toronto, Toronto, ON Canada
INTRODUCTION: Although simulator-based training has theo-retic benefits, skill transfer to clinical contexts for colonoscopy hasnot been objectively demonstrated.This study assessed whether prac-tice on a computer-based colonoscopy simulator improved perfor-mance on a resident’s first patient colonoscopy.
METHODS: General surgery and internal medicine residents withlimited endoscopic experience were randomized into treatment (n�12) or control (n� 12) groups, and then evaluated as they performeda baseline procedure on the colonoscopy simulator. The treatmentgroup then recieved simulator practice while controls had no specificlearning intervention. All residents then performed a patientcolonoscopy in a clinical setting. Both the simulator and clinicalprocedures were evaluated by blinded faculty endoscopists using pre-viously validated global rating scales.
RESULTS: No baseline differences were found between groups onthe simulated colonoscopy. Residents in the treatment group prac-
ticed independently on the simulator for an average of 125 minutes.On the clinical procedure, the treatment group had significantlyhigher mean global ratings scores than controls (17.9 versus 14.8 outof maximum 35, t(22)� 1.84, p� 0.04). One resident in the treat-ment and none in the control group completed the entire colonos-copy to the cecum on their own in the allotted time and no compli-cations occurred in either group.
CONCLUSIONS: After a short practice session, simulator-trainedresidents performed significantly better than controls on patientcolonoscopies. This demonstration of skill transfer sets the stage forfuture efforts to optimally situate these simulators within evidence-based educational curricula and practice.
Gender differences in medical student minimallyinvasive surgery skills and choice of surgery as acareerAshley K Vavra MD, Neal Barshes MD, King King PhD,Michael Millie MD, Michael Peters MD, Herminio Ojeda MD,Eric Knauer MD, Robert Obermeyer MD, John Goss MD,John Sweeney MD, FACSBaylor College of Medicine, Houston, TX
INTRODUCTION: This study compares the minimally invasivesurgery (MIS) skills, specialty choice, and criteria used for specialtyselection between female and male medical students.
METHODS: The MIS skills curriculum consists of four weekly2-hour sessions. The time required to complete three MIS skills taskswas recorded at the initial and final sessions. A survey was adminis-tered to determine specialty rank, attitudes towards surgery and fac-tors important in specialty choice. A follow-up survey was adminis-tered to assess experiences of gender discrimination on surgical vs.non-surgical rotations.
RESULTS: 108 students participated (45 male, 63 female). MISskills improved from initial to final session (p�0.001). Male andfemale student performance was similar. Compared to females, malestudents ranked surgery higher (p�0.015) and ranked prestigewithin (p�0.048) and outside (p�0.015) the medical profession asfactors significantly more important in specialty selection. No genderdifferences were found in the value placed on work hours, call hours,approach to patient care or types of medical problems encountered.On follow-up survey, female students felt mentorship opportunitieswere less available on surgical rotations compared to non-surgicalrotations (35% vs. 58%) and that male students were encouragedmore by surgical residents and/or faculty than were female students(64% vs. 27%).
CONCLUSIONS: Male and female medical students demonstratesimilar MIS skill levels. Male students more likely rank surgery as atop career choice. The perceived differences regarding mentorshipopportunities and differential encouragement of genders on surgicalrotations may influence gender disparity in surgical specialty choice.
S78 Research in Surgical Education J Am Coll Surg
