Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention.
BACKGROUND
Proficiency-based training in laparoscopic suturing and knot tying translates to the operating room, but little is known about the durability of acquired skill. The purpose of this study was to determine the effect of maintenance training on skill retention after demonstration of proficiency.


METHODS
Medical students (n=18) with no previous laparoscopic or simulator experience were enrolled in an IRB-approved randomized controlled trial. All subjects trained to proficiency (score of 512, based on time and errors) on a previously validated suturing model (Fundamentals of Laparoscopic Surgery videotrainer). Subjects were then randomized to a control group, which received no additional training, and an ongoing training group, which trained again to proficiency at 1 and 3 months (immediately after testing). Simulator testing was repeated at 2 weeks, 1 month, 3 months, and 6 months after initial training. No subject had interval operative experience.


RESULTS
Both groups demonstrated excellent skill retention during followup; performance scores, reported as means+/-SD, were 488+/-57 versus 482+/-55 at 2 weeks (p=ns), 483+/-81 versus 491+/-64 at 1 month (p=ns), 467+/-75 versus 470+/-67 at 3 months (p=ns), and 462+/-62 versus 492+/-43 at 6 months (p=0.02) for the control versus ongoing training groups, respectively. At 6 months, the ongoing training group showed better skill retention (95% versus 90%; p=0.02) and a trend for achieving the proficiency level (33% versus 18%; p=0.2) more often than the control group.


CONCLUSIONS
Although proficiency-based training results in excellent skill retention, ongoing training substantially enhances performance and minimizes skill loss. Curricula should incorporate training that fosters maintenance of proficiency.
Department of Surgery, Carolinas Medical Center, Charlotte, NC, and Tulane University School of Medicine, New Orleans, LA, USA.
Dimitrios
D
Stefanidis
James R
JR
Korndorffer
Sarah
S
Markley
Rafael
R
Sierra
Daniel J
DJ
Scott
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D014584:User-Computer Interface