Structured training on box trainers for first year surgical residents: does it improve retention of laparoscopic skills? A randomized controlled study.
OBJECTIVE
Structured training on box trainers in laparoscopic skills in the initial years of residency has been used and found to be effective. Although there are studies that confirm immediate improvement after training, there is a lack of well-designed trials addressing the crucial issue of retention of these skills over time. The purpose of this study is to assess improvement in laparoscopic skills of surgical trainees after structured training on box trainers, compared with traditional training (observing and assisting laparoscopic procedures in the operation rooms) immediately and after 5 months.


METHODS
Forty surgical residents in their first 2 months of residency training were randomized to either structured training on box trainers, in addition to traditional training, or to traditional training alone. Groups were equivalent with regards to demographics, previous operative experience, and baseline skills. Structured training consisted of 4 sessions with 6 tasks on box trainers under supervision and self practice. Task-based objective structured practical examinations (OSPE) were completed before and after each task. At the end of the training, residents were assessed by a blinded faculty member with the global operative assessment of laparoscopic skills (GOALS) rating scale. Residents also completed a satisfaction questionnaire. Focus group discussions were conducted for both groups. The GOALS were repeated for both the groups at the end of 5 months to assess retention of skills.


RESULTS
The mean GOALS score was significantly higher for the structured training group (mean/SD 20.35 + 0.74) compared with the traditional training group (mean/SD 16.35 + 1.75, p < 0.01) at the end of 5 months. The mean global rating scale (GRS) score was significantly higher (Pre 7.55 + 0.99 vs. Post 16.4 + 0.68, p < 0.01) for the structured training group at the end of course. Residents in the structured training group had significantly improved skills immediately after the training and had better retention of skills at the end of five months.


CONCLUSIONS
Structured training on box trainers, in addition to traditional training, compared with traditional training alone, leads to better skills and improved confidence of residents. There is significant retention of skills at the end of 5 months. These results provide support for incorporation of structured training with box trainers for laparoscopic skills into surgical training programs.
Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India. avisupe@gmail.com
Avinash
A
Supe
Ramkrishna
R
Prabhu
Ilene
I
Harris
Steven
S
Downing
Ara
A
Tekian
D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D007396:Internship and Residency / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D008953:Models, Anatomic; D011446:Prospective Studies; D016037:Single-Blind Method; D013043:Specialties, Surgical / Q000193:education*