Elaborating a learning program on laparoscopy: Assessment of the evolution of the novices' performance according to initial training with simulator or animal model

Abstract

INTRODUCTION & OBJECTIVES: This study sought to determinate the most efficient sequence for training new surgeons in laparoscopy: beginning with simulators, followed by surgery on animals, or beginning with surgery on animals and then using manual and virtual simulators. MATERIAL & METHODS: Forty-eight medical students without any experience in laparoscopy were enrolled and split into two groups. Group A consisted of 24 students who started with laparoscopic nephrectomy on pigs, followed by the use of simulators. Group B consisted of 24 students who started with manual and virtual simulators, followed by nephrectomy. In group A, one student performed the surgery, while the other used a camera over a one hour period, after which they switched roles(arterial clipping 30 points; vein clipping 30 points; complete nephrec tomy 20 points; no accidents 20 points). In group B, six pairs of students started with the virtual simulator in cutting and tying activities(50 points). Another six pairs of students began with the manual simulator, evaluated by a board incutting and tying(50 points). After one hour, the students changed roles. Nonparametric test was init ially applied to assess any starting point difference among groups. Then groups A and B were assessed regarding the score index improvement independently of the training sequence, in order to disclose an eventual difference of rhythm of improvement between groups. If a di fference of rhythm of improvement of the score between groups A and b was detected, the data were analyzed in order to disclose the sequence with the most increased score variation. RESULTS: There was no absolute variation of score between groups from the starting until the end of training (p=0.124 and p= 0.053). However, there was a difference in the rhythm of improvement of the novices, when we compare groups from the start to the end of training period (p<0.0001). The analysis of the absolute variation of the score according to the initial sequence of training, showed that the group who started in the animal model presented a skill improvement of 30.5% when after training on the si mulator, although those who started training in simulators presented a performance improvement of 98% after training in animal(p<0.001). CONCLUSIONS: Our data show that nov ice surgeons who start training in animal model have poor improvement with forward training with simulators. These data and the ethical and economic issues will be considered for the refinement of an educational curriculum.