title: Does surgical "warming up" improve laparoscopic simulator performance?
abstract: BACKGROUND
  The objective of this study was to determine if preoperative warming up by obstetrics and gynecology trainees, using a validated bench model for intracorporeal suturing, improves efficiency, precision, and quality of laparoscopic suturing.
  
  
  METHODS
  A randomized crossover design was used. Fourteen obstetrics and gynecology residents were randomized [3 junior (year 2) and 11 senior (years 3-5) residents]. Participants were randomized to warm-up or no warm-up and then acted as their own controls at least 2 weeks later. Warm-up consisted of the use of a laparoscopic bench model to practice intracorporeal suturing for 15 minutes. All participants performed a prevalidated intracorporeal suturing task (after either warm-up or no warm-up), which was scored based on time, precision, and knot strength. Each participant also completed a questionnaire anonymously to determine if they believed that warming up improved their performance, regardless of the score they received.
  
  
  RESULTS
  Thirteen participants completed the study. There was no difference in score when warm-up was compared with no warm-up for the group as a whole. When the junior residents were excluded from the analysis, however, analysis of variance showed a significant improvement in score only when a warm-up was completed in the second session (P = 0.022). The questionnaire revealed that 81.8% of participants felt that warming up subjectively improved their ability, independent of their actual score.
  
  
  CONCLUSIONS
  This study demonstrates that a preoperative warm-up, combined with repetition, is beneficial in improving senior obstetrics and gynecology residents' laparoscopic suturing performance. This demonstrates a novel approach to resident education for teaching advanced laparoscopic skills.
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite C703, Toronto, ON M4N 3M5, Canada. jamie.kroft@utoronto.ca
authors.forename: Jamie
authors.initials: J
authors.lastname: Kroft
authors.forename: Michael
authors.initials: M
authors.lastname: Ordon
authors.forename: Rebecca
authors.initials: R
authors.lastname: Arthur
authors.forename: Richard
authors.initials: R
authors.lastname: Pittini
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D018592:Cross-Over Studies; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D017145:Models, Educational; D009774:Obstetrics / Q000193:education*; D011214:Practice, Psychological; D015397:Program Evaluation; D011787:Quality of Health Care; D013537:Sutures / Q000592:standards