title: Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair.
abstract: BACKGROUND
  The laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy requires 250 repairs to master. Simulation training could potentially accelerate this process. We describe the development, evaluation and implementation of a TEP mastery learning curriculum.
  
  
  METHODS
  We developed a 2-stage curriculum comprising online knowledge modules and skills practice on a simulator (the Guildford-MATTU TEP trainer; Limbs & Things, Ltd, Bristol, UK). Learners demonstrated mastery at each stage before advancing. The knowledge endpoint was a multiple-choice test. The skills endpoint was procedure time, as established by timing 5 experienced staff surgeons. Participants were proctored individually, receiving personalized feedback after each attempt until mastery time was achieved. The times to perform a simulated repair, number of attempts, and training time to reach mastery were compared between groups.
  
  
  RESULTS
  The mastery time was established at 2 minutes. Nine medical students, 36 general surgery residents (PGY 1-5), and 3 surgery fellows participated as learners. All learners achieved the knowledge and skills mastery endpoints. For the skill endpoint, participants required a median of 69 minutes (range, 13-193 minutes) and 16 simulated repairs (range, 7-27 repairs). The mean number of attempts and total training time to reach mastery varied by group (p < 0.001); more experienced residents required fewer attempts and less time to reach mastery.
  
  
  CONCLUSIONS
  When training with a mastery learning-type simulation-based curriculum, surgical trainees can achieve the technical skill required to perform key portions of the TEP repair under artificial conditions with a performance similar to that of an expert, and are ready to move to the next phase of training in the operating room.
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernández-Irizarry
authors.forename: Marianne
authors.initials: M
authors.lastname: Huebner
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000193:education* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D007858:Learning; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D015397:Program Evaluation; D012187:Retroperitoneal Space / Q000601:surgery; D013997:Time Factors; D014481:United States