title: Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition.
abstract: BACKGROUND
  The study was carried out to determine the learning curve patterns for basic laparoscopic technical skills.
  
  
  METHODS
  Thirty-seven surgical residents with limited laparoscopic experience performed 10 repetitions of 6 tasks on a virtual-reality trainer (MIST-VR) with standardized distribution of practice. Assessment was based on time, errors, and economy of motion as measured by MIST-VR. Proficiency levels were established by testing experienced laparoscopic surgeons.
  
  
  RESULTS
  Four learning curve patterns were determined. Surgeons in group 1 (5.4%) demonstrated proficiency from the beginning; group 2 (70.3%) achieved predefined expert criteria between 2 and 9 repetitions; group 3 (16.2%) demonstrated improvement but was unable to achieve proficiency within 10 repetitions. Group 4 (8.1%) underperformed and showed no tendency of skills improvement, reflecting a group of subjects who probably are unable to learn laparoscopic technique.
  
  
  CONCLUSIONS
  The results indicated that a group of subjects could not reach proficiency in the psychomotor skills relevant for laparoscopy. We believe that this is an important issue that should be addressed in future research.
authors.affiliation: University of Toronto, St Michael's Hospital, Toronto, ON, Canada. grantcharovt@smh.toronto.on.ca
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education; D003198:Computer Simulation; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D011597:Psychomotor Performance; D013514:Surgical Procedures, Operative / Q000193:education* / Q000706:statistics & numerical data*