Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection.
BACKGROUND
Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-week autonomous training period at home on a traditional laparoscopic box trainer. Previous research did not demonstrate a significant progress in laparoscopic skills after this training period. This study aims to identify factors determining autonomous training on a laparoscopic box trainer at home.


METHODS
Residents (n = 97) attending 1 of 7 ASC courses between January 2009 and June 2011 were consecutively included. After 6 weeks of autonomous, training a questionnaire was completed. A random subgroup of 30 residents was requested to keep a time log. All residents received an online survey after attending the ASC. We performed outcome comparison to examine the accuracy of individual responses.


RESULTS
Out of 97 residents, the main motives for noncompliant autonomous training included a lack of (training) time after working hours (n = 80, 83.3%), preferred practice time during working hours (n = 76, 31.6%), or another surgical interest than MIS (n = 79, 15.2%). Previously set training goals would encourage autonomous training according to 27.8% (n = 18) of residents. Thirty participants submitted a time log and reported an average 76.5-minute weekly training time. All residents confirmed that autonomous home practice on a laparoscopic box trainer is valuable.


CONCLUSIONS
Autonomous practice should be structured and inclusive of adequate and sufficient feedback points. A minimally required practice time should be set. An obligatory assessment, including corresponding consequence should be conducted. Compliance herewith may result in increased voluntary (autonomous) simulator based (laparoscopic) training by residents.
Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands. p.vanempel@vumc.nl
Pieter J
PJ
van Empel
Mathilde G E
MG
Verdam
Magnus
M
Strypet
Lennart B
LB
van Rijssen
Judith A
JA
Huirne
Fedde
F
Scheele
H Jaap
HJ
Bonjer
W Jeroen
WJ
Meijerink
D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D003430:Cross-Sectional Studies; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D010535:Laparoscopy / Q000193:education*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education* / Q000379:methods; D009426:Netherlands; D018794:Problem-Based Learning; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000193:education; D013997:Time Factors; D055815:Young Adult