title: Is the aptitude of manual skills enough for assessing the training effect of students using a laparoscopy simulator?
abstract: BACKGROUND
  The aim of this study was to determine if students are suitable candidates to assess the learning effect through a virtual reality laparoscopy simulator (LapSim).
  
  
  METHODS
  14 medical students in their final year without any previous experience with a virtual reality simulator were recruited as subjects. In order to establish a "base line" all subjects were instructed into the "clip application" task - a basis module of the laparoscopy simulator - at the beginning of the study. They were then randomized into two groups. Group A (n=7) had parameter adjusted to an easy level of performance, while group B (n=7) was adjusted to a difficult level. In both levels, errors simulated clinically relevant situations such as vessel rupture and subsequent bleeding. Each participant had to repeat the clip application task ten times consecutively.
  
  
  RESULTS
  The mean time for completion ten repetitions was 15 min pro participant in group A and 20 min in group B. From the first to the fifth repetition group A improved significantly the task completion time from 238.9 s to 103.3 s (p<0.007) consecutively and also improved the error score from 312 to 177 (p<0.07). At the tenth repetition they increased the task completion time from 103.3 s to 152.2 s (p<0.09) and increased their error score from 177 to 202 (p=0.25).From the first to the fifth repetition group B also improved the task completion time from 131.6 s to 104.5 s (p<0.31) consecutively and improved the error score from 235 to 208 (p<0.32) but at the tenth repetition they increased the task completion time from 104.5 s to 142.4 s (p<0.45) and clearly increased their error score from 208 to 244 (p<0.38).
  
  
  CONCLUSIONS
  These results suggest that medical students, who lack clinical background, may be not suitable candidates for assessing the efficiency of a training model using a laparoscopy simulator. If medical students are appointed for such studies, they should receive didactic sessions in the context of a clinical curriculum prior to manual training.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany. hassan@med.uni-marburg.de
authors.forename: Iyad
authors.initials: I
authors.lastname: Hassan
authors.forename: Andreas
authors.initials: A
authors.lastname: Zielke
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