A randomized crossover trial examining low- versus high-fidelity simulation in basic laparoscopic skills training.
BACKGROUND
Previous randomized studies have compared high- versus low-fidelity laparoscopic simulators; however, no proficiency criteria were defined and results have been mixed. The purpose of this research was to determine whether there were any differences in the learning outcomes of participants who had trained to proficiency on low- or high-fidelity laparoscopic surgical simulators.


METHODS
We conducted a randomized, prospective crossover trial with participants recruited from New South Wales, Western Australia, and South Australia. Participants were randomized to high-fidelity (LapSim, Surgical Science) or low-fidelity (FLS, SAGES) laparoscopic simulators and trained to proficiency in a defined number of tasks. They then crossed over to the other fidelity simulator and were tested. The outcomes of interest were the crossover mean scores, the proportion of tasks passed, and percentage passes for the crossover simulator tasks.


RESULTS
Of the 228 participants recruited, 100 were randomized to LapSim and 128 to FLS. Mean crossover score increased from baseline for both simulators, but there was no significant difference between them (11.0 % vs. 11.9 %). FLS-trained participants passed a significantly higher proportion of crossover tasks compared with LapSim-trained participants (0.26 vs. 0.20, p = 0.016). A significantly higher percentage of FLS-trained participants passed intracorporeal knot tying than LapSim-trained participants (35 % vs. 8 %, p < 0.001).


CONCLUSIONS
Similar increases in participant score from baseline illustrate that training on either simulator type is beneficial. However, FLS-trained participants demonstrated a greater ability to translate their skills to successfully complete LapSim tasks. The ability of FLS-trained participants to transfer their skills to new settings suggests the benefit of this simulator type compared with the LapSim.
Department of Surgery, The Royal Adelaide Hospital, Adelaide, SA, Australia.
Swee Chin
SC
Tan
Nicholas
N
Marlow
John
J
Field
Meryl
M
Altree
Wendy
W
Babidge
Peter
P
Hewett
Guy J
GJ
Maddern
D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation / Q000592:standards*; D018592:Cross-Over Studies; D004501:Education, Medical / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D011446:Prospective Studies