Modeling the Learning Curves of Incoming Surgical Trainees
•Simulation training is used to enhance technical skills outside the operating room.
•Studies have also found that 5-10% of trainees fail to acquire adequate technical skills both in the operating room, and in a simulation environment.1
•These residents often require maximum resources during training.
•Examining the merit for including technical skills performance as a component of the residency selection process is essential.
•Laparoscopic box trainer tasks are inexpensive and an easily reproducible method to evaluate trainees’ skill acquisition.2
•Pattern cutting (PC), peg transfer (PG), cutting and intracorporeal (IC) knot tying are well-studies laparoscopic tasks with documented proficiency metrics.3
• To define distinct learning curves (LC) for three basic laparoscopic tasks.
• To determine the minimum number of repetitions required to accurately predict an individual’s LC based the literature.2
• To assess the use of LC assessment to identify non-performers during selection into surgical training.
•Predictive LC models were created for laparoscopic PC, PG and IC using 65 novice trainees who performed over 40 repetitions of each task.
• Trainees were categorized into performers and non-performers.
• ROC analysis determined the maximum number of repetitions required by an individual’s LC.
• Subsequently, Canadian residency training (CaRMS) applicants to general surgery and obstetrics & gynecology participated in a skills assessment.
• The LC models were used to determine the number of non-performer applicants.
• Various models were tested for each task to find one with high sensitivity and specificity.
• The PC, PT and IC tasks required a minimum of 8, 10 and 5 repetitions respectively to adequately predict overall performance.
o PC – average of repetitions 5-8
o PT – average of repetitions 1-10
o IC – average of repetitions 1-5
•Individual LC’s for 3 different laparoscopic tasks can be predicted with excellent sensitivity and specificity based on observations of 10 repetitions or less.
•This information can be used for early identification of trainees who may have difficulty with laparoscopic technical skills.
•Performance on these tasks may be implemented during selection or early residency training.
•This year the U of T OBGYN residency program implemented a technical skills assessment as part of the residency selection process based on the results of this study.
1.Grantcharov TP, Funch-Jensen P. Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition. Am J Surg. 2009;197(4):447-449.
2.Louridas ML, Szasz P, Fesco AB, et al. Practice does not always make perfect: The need for selection criteria in modern surgical training. Surg End. In press.
3.Peters JH, Fried GM, Swanstrom LL, et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery. Jan 2004;135(1):21-27.