title: Completion of a novel, virtual-reality-based, advanced laparoscopic curriculum improves advanced laparoscopic skills in senior residents.
abstract: BACKGROUND
  Virtual reality simulators contribute to basic laparoscopic skill acquisition. These trainers have not yet been shown to contribute to the acquisition of more advanced laparoscopic skills as measured by the Fundamentals of Laparoscopic Surgery (FLS). We have customized novel basic and advanced curricula for the LapSim trainer (Surgical Science, Göteborg, Sweden). Successful completion of these programs is required of our residents. We hypothesize that the successful completion of our advanced curriculum will result in the significant improvement of our residents' advanced laparoscopic skills as measured by the FLS skills scores.
  
  
  METHODS
  In all, 23 surgical residents (PGY 1-4), who had already passed our basic skills curriculum, completed our advanced LapSim curriculum. All individuals underwent FLS skills testing before and after completing the training. Laparoscopic case experience during the training period was documented for all trainees. FLS scores were analyzed by t test and controlled for case experience.
  
  
  RESULTS
  Posttraining FLS scores demonstrate a significant increase for all residents from a mean of 57-66 (p < 0.02), especially for seniors (PGY 3-4): 56-68 (p < 0.01). The operative laparoscopic case volume ranged from 1-90 (mean, 30) for juniors (PGY 1-2) and 12-76 (mean 50) for seniors during the training period. Junior resident FLS improvement was dependent on case volume during the period of training; residents with less than 30 cases had a mean improvement of 0, whereas those with at least 30 cases had a 15 point improvement (p < 0.01). Senior resident FLS score improvement was independent of case numbers during the training period.
  
  
  CONCLUSIONS
  Completion of our advanced LapSim curriculum results in improved advanced laparoscopic skills in senior residents as measured by FLS scores. This skill improvement is independent of laparoscopic case experience. Continuing to mandate the use of this skills curriculum should improve our residents' performance in advanced laparoscopic surgical procedures.
authors.affiliation: Section of Gastrointestinal Surgery, Yale School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: Lucian
authors.initials: L
authors.lastname: Panait
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Hogle
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Fowler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003237:Connecticut; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D058996:Quality Improvement; D014584:User-Computer Interface