Do the laparoscopic skills of trainees deteriorate over time?
BACKGROUND
Without ongoing practice, acquired motor skills may deteriorate over time. The purpose of this study is to document the level of retention of laparoscopic skills over time.


METHODS
Thirty-three general-surgery PGY 1, 2, and 3 residents trained to established criteria and passed an exam for each of seven technical skills (camera navigation, instrument navigation, camera/instrument coordination, grasping, lifting and grasping, cutting, and clip applying) on a virtual simulator (LapSim Surgical Science Ltd., Göteborg, Sweden). Six months later, the residents again completed the exam for each of the seven skills. During the 6 months, the simulators were available, but additional practice was not required. The retesting process consisted of three attempts, the first of which was acclimatization. The results of the subsequent two exams were compared with baseline data.


RESULTS
At retest, the number of residents who passed clip applying (7, 21%) and cutting tasks (18, 55%) was significantly lower than for the other five tasks (p < 0.05). In failed tests, instrument wandering and tissue damage were more common than increases in task time. Upper-level residents were significantly more likely to pass than first-year residents were (p < 0.01). Time of day did not influence passing rates.


CONCLUSIONS
Six months after training to criteria, instrument and tissue-handling skills deteriorated more than the speed with which a task is completed. Evidence of skill retention was present for some but not all tasks. Fine motor skills, required to perform more difficult tasks, deteriorated more than skills needed for easier tasks.
Sinha
Prashant
P
College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Hogle
Nancy J
NJ
Fowler
Dennis L
DL
D000328:Adult; D002983:Clinical Competence; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods; D009048:Motor Skills; D011214:Practice, Psychological; D011597:Psychomotor Performance; D013997:Time Factors