title: Criterion-based training with surgical simulators: proficiency of experienced surgeons.
abstract: OBJECTIVE
  In our effort to establish criterion-based skills training for surgeons, we assessed the performance of 17 experienced laparoscopic surgeons on basic technical surgical skills recorded electronically in 26 modules selected in 5 commercially available, computer-based simulators.
  
  
  METHODS
  Performance data were derived from selected surgeons randomly assigned to simulator stations, and practicing repetitively during one and one-half day sessions on 5 different simulators. We measured surgeon proficiency defined as efficient, error-free performance and developed proficiency score formulas for each module. Demographic and opinion data were also collected.
  
  
  RESULTS
  Surgeons' performance demonstrated a sharp learning curve with the most performance improvement seen in early practice attempts. Median scores and performance levels at the 10th, 25th, 75th, and 90th percentiles are provided for each module. Construct validity was examined for 2 modules by comparing experienced surgeons' performance with that of a convenience sample of less-experienced surgeons.
  
  
  CONCLUSIONS
  A simple mathematical method for scoring performance is applicable to these simulators. Proficiency levels for training courses can now be specified objectively by residency directors and by professional organizations for different levels of training or post-training assessment of technical performance. But data users should be cautious due to the small sample size in this study and the need for further study into the reliability and validity of the use of surgical simulators as assessment tools.
authors.affiliation: Department of Obstetrics-Gynecology, Stanford University, 251 Campus Drive West, Stanford, CA 94305, USA.
authors.forename: Wm LeRoy
authors.initials: WL
authors.lastname: Heinrichs
authors.forename: Brian
authors.initials: B
authors.lastname: Lukoff
authors.forename: Patricia
authors.initials: P
authors.lastname: Youngblood
authors.forename: Parvati
authors.initials: P
authors.lastname: Dev
authors.forename: Richard
authors.initials: R
authors.lastname: Shavelson
authors.forename: Harrith M
authors.initials: HM
authors.lastname: Hasson
authors.forename: Richard M
authors.initials: RM
authors.lastname: Satava
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Paul Alan
authors.initials: PA
authors.lastname: Wetter
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D013647:Task Performance and Analysis