title: A middle fidelity model is effective in teaching and retaining skill set needed to perform a laparoscopic pyloromyotomy.
abstract: BACKGROUND
  An inanimate technical skills trainer for laparoscopic pyloromyotomy (LP) has not been described. A middle fidelity model, reproducing the three consistent steps in LP, was developed as a component of a teaching module for surgical residents, and tested on medical students, residents, and pediatric surgeons.
  
  
  METHODS
  In the first phase of the study, a cohort of 29 pediatric surgeons used the LP model and completed questionnaires about the model's realism and accuracy. Descriptive statistics were used to analyze questionnaire responses. Chi-square tests were performed to determine if level of experience influenced responses. For the second phase of the study, medical students and surgical residents individually participated in the training of cognitive knowledge about hypertrophic pyloric stenosis and skills acquisition for LP. Subject testing consisted of simulator task performance and multiple-choice quiz administration immediately after training and repeated at 8 weeks after training. Data were analyzed by using paired sample t-tests and one-way analyses of variance (ANOVA).
  
  
  RESULTS
  The pediatric surgeons agreed that the model accurately simulated essential components of the pyloromyotomy, and that the model would be an excellent tool to introduce surgeons to LP. A total of 26 students and early surgical residents completed the training and testing. Knowledge-based test performance improved from pre- to postinstruction by 17.45 [standard error of the mean (SEM) + 3.5] (P < 0.001) and from preinstruction to 8 weeks by 4.54 (SEM = 3.2) (P = 0.17). Mean improvement in time of simulator task performance was 85.2 +/- 75.4 seconds. Based on a one-way ANOVA, higher level of training was associated with decreased mean times (P = 0.04).
  
  
  CONCLUSIONS
  Face and content validities of the simulation were demonstrated by the pediatric surgeons. An effective training experience was demonstrated with medical students and residents. At 2 months, simulator task-completion rates and task-performance times showed technical skills were retained, whereas, based on test scores, cognitive knowledge was not as well retained.
authors.affiliation: Department of General Surgery, University of Kentucky College of Medicine, Chandler Medical Center, Lexington, Kentucky 40536-0298, USA. jiocono@uky.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Plymale
authors.forename: Ana
authors.initials: A
authors.lastname: Ruzic
authors.forename: James
authors.initials: J
authors.lastname: Hoskins
authors.forename: Judith
authors.initials: J
authors.lastname: French
authors.forename: Sean C
authors.initials: SC
authors.lastname: Skinner
authors.forename: Mark
authors.initials: M
authors.lastname: Yuhas
authors.forename: Dan
authors.initials: D
authors.lastname: Davenport
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Iocono
mesh_terms: D010535:Laparoscopy / Q000193:education*; D008953:Models, Anatomic; D011707:Pyloric Stenosis / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D013664:Teaching Materials