Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial.
OBJECTIVE
To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery.


BACKGROUND
Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures.


METHODS
This prospective, single-blinded randomized controlled trial allocated 25 surgical residents to receive either conventional residency training or a comprehensive training curriculum for laparoscopic colorectal surgery. The curriculum consisted of proficiency-based psychomotor training on a virtual reality simulator, cognitive training, and participation in a cadaver lab. The primary outcome measure in this study was surgical performance in the operating room. All participants performed a laparoscopic right colectomy, which was video recorded and assessed using 2 previously validated assessment tools. Secondary outcome measures were knowledge relating to the execution of the procedure, assessed with a multiple-choice test, and technical performance on the simulator.


RESULTS
Curricular-trained residents demonstrated superior performance in the operating room compared with conventionally trained residents (global score 16.0 [14.5-18.0] versus 8.0 [6.0-14.5], P = 0.030; number of operative steps performed 16.0 [12.5-17.5] versus 8.0 [6.0-14.5], P = 0.021; procedure-specific score 71.1 [54.4-81.6] versus 51.1 [36.7-74.4], P = 0.122). Curricular-trained residents scored higher on the multiple-choice test (10 [9-11] versus 7.5 [5.3-7.5], P = 0.047), and outperformed conventionally trained residents in 7 of 8 tasks on the simulator.


CONCLUSIONS
Participation in a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery results in improved technical knowledge and improved performance in the operating room compared with conventional residency training. Reg. ID#NCT 01371136.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. vanessa.palter@utoronto.ca
Vanessa N
VN
Palter
Teodor P
TP
Grantcharov
D002983:Clinical Competence; D003082:Colectomy / Q000193:education* / Q000379:methods; D003479:Curriculum; D003697:Delphi Technique; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D016730:Program Development; D011446:Prospective Studies; D016037:Single-Blind Method; D014584:User-Computer Interface; D054928:Validation Studies as Topic