The effect of simulation in improving students' performance in laparoscopic surgery: a meta-analysis.
BACKGROUND
There is increasing interest in using simulators for laparoscopic surgery training, and simulators have rapidly become an integral part of surgical education.


METHODS
We searched MEDLINE, EMBASE, Cochrane Library, and Google Scholar for randomized controlled studies that compared the use of different types of simulators. The inclusion criteria were peer-reviewed published randomized clinical trials that compared simulators versus standard apprenticeship surgical training of surgical trainees with little or no prior laparoscopic experience. Of the 551 relevant studies found, 17 trials fulfilled all inclusion criteria. The effect sizes (ES) with 95 % confidence intervals [CI] were calculated for multiple psychometric skill outcome measures.


RESULTS
Data were combined by means of both fixed- and random-effects models. Meta-analytic combined effect size estimates showed that novice students who trained on simulators were superior in their performance and skill scores (d = 1.98, 95 % CI: 1.20-2.77; P < 0.01), were more careful in handling various body tissue (d = 1.08, 95 % CI: 0.36-1.80; P < 0.01), and had a higher accuracy score in conducting laparoscopic tasks (d = 1.38, 95 % CI: 0.30-2.47; P < 0.05).


CONCLUSIONS
Simulators have been shown to provide better laparoscopic surgery skills training for trainees than the traditional standard apprenticeship approach to skill development. Surgical residency programs are highly encouraged to adopt the use of simulators in teaching laparoscopic surgery skills to novice students.
Department of Surgery, College of Medicine, Qassim University, P.O. Box 6655, Buraidah, Qassim, 51452, Saudi Arabia. azzamalkadi@gmail.com
Azzam S
AS
Al-Kadi
Tyrone
T
Donnon
Elizabeth
E
Oddone Paolucci
Philip
P
Mitchell
Estifanos
E
Debru
Neal
N
Church
D002983:Clinical Competence; D003198:Computer Simulation; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*