title: Proficiency-based laparoscopic and endoscopic training with virtual reality simulators: a comparison of proctored and independent approaches.
abstract: BACKGROUND
  Virtual reality (VR) simulators for laparoscopy and endoscopy may be valuable tools for resident education. However, the cost of such training in terms of trainee and instructor time may vary depending upon whether an independent or proctored approach is employed.
  
  
  METHODS
  We performed a randomized controlled trial to compare independent and proctored methods of proficiency-based VR simulator training. Medical students were randomized to independent or proctored training groups. Groups were compared with respect to the number of training hours and task repetitions required to achieve expert level proficiency on laparoscopic and endoscopic simulators. Cox regression modeling was used to compare time to proficiency between groups, with adjustment for appropriate covariates.
  
  
  RESULTS
  Thirty-six medical students (18 independent, 18 proctored) were enrolled. Achievement of overall simulator proficiency required a median of 11 hours of training (range, 6-21 hours). Laparoscopic and endoscopic proficiency were achieved after a median of 11 (range, 6-32) and 10 (range, 5-27) task repetitions, respectively. The number of repetitions required to achieve proficiency was similar between groups. After adjustment for covariates, trainees in the independent group achieved simulator proficiency with significantly fewer hours of training (hazard ratio, 2.62; 95% confidence interval, 1.01-6.85; p = 0.048).
  
  
  CONCLUSIONS
  Our study quantifies the cost, in instructor and trainee hours, of proficiency-based laparoscopic and endoscopic VR simulator training, and suggests that proctored instruction does not offer any advantages to trainees. The independent approach may be preferable for surgical residency programs desiring to implement VR simulator training.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0016, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Vandromme
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Tyra
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D004504:Education, Medical, Undergraduate; D004724:Endoscopy / Q000193:education*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D017145:Models, Educational; D013337:Students, Medical; D014584:User-Computer Interface; D055815:Young Adult