title: Resident perceptions of advanced laparoscopic skills training.
abstract: BACKGROUND
  The purpose of this study was to explore resident perceptions regarding four current models for teaching laparoscopic suturing and to assess the current quality of training in advanced minimally invasive surgical techniques at an academic teaching center.
  
  
  METHODS
  This study included 14 senior general surgery residents (PGY 3-5) participating in a workshop in advanced laparoscopy. Four training tools were used in the course curriculum: the Fundamentals of Laparoscopic Surgery (FLS) black box suturing model, a synthetic Nissen fundoplication model, a virtual reality (VR) simulator suturing task, and a porcine jejuno-jejunostomy model. After the workshop, residents were asked to complete a questionnaire relating to their experience with laparoscopic surgery, and their opinions regarding the four training models. Model rank was analyzed with one-way ANOVA, and χ(2) analysis with Fisher's exact test was used to analyze model effectiveness.
  
  
  RESULTS
  The majority of residents had strong experience in basic laparoscopic cases such as cholecystectomy and appendectomy; however, few participants had experience in advanced cases. As a group, the residents ranked the porcine model first (average 1.6, median 1), followed by the synthetic Nissen model (average 2.0, median 2), the FLS model (average 2.5, median 3), and the VR trainer (average 3.2, median 4). Finally, each resident was asked to rate the four models individually with respect to their educational value. Scores were on a Likert scale from 1 to 5. Nine of 11 (81.8%) residents rated the animal model as "extremely helpful" while only 3 of 14 (21.4%) participants rated the VR model as "extremely helpful" (p = 0.048).
  
  
  CONCLUSIONS
  This study demonstrates that operative experience in advanced laparoscopy for senior residents is suboptimal. Residents learning this skill in a simulated environment prefer animal or video-trainers as teaching models rather than virtual reality. This has implications when designing a curriculum for advanced endoscopy.
authors.affiliation: Toronto General Hospital, The Wilson Centre, 200 Elizabeth Street, 1ES 565, Toronto, ON, M5G 2C4, Canada. Vanessa.palter@utoronto.ca
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Palter
authors.forename: Neil
authors.initials: N
authors.lastname: Orzech
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D001290:Attitude; D003198:Computer Simulation; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D023421:Models, Animal; D013536:Suture Techniques / Q000193:education*; D013663:Teaching / Q000379:methods*; D014584:User-Computer Interface