title: Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial.
abstract: OBJECTIVE
  : To develop and validate an ex vivo comprehensive curriculum for a basic laparoscopic procedure.
  
  
  BACKGROUND
  : Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Moreover, neither the effect of ex vivo training on learning curves in the operating room (OR), nor the effect on nontechnical proficiency has been investigated.
  
  
  METHODS
  : This randomized single-blinded prospective trial allocated 20 surgical trainees to a structured training and assessment curriculum (STAC) group or conventional residency training. The STAC consisted of case-based learning, proficiency-based virtual reality training, laparoscopic box training, and OR participation. After completion of the intervention, all participants performed 5 sequential laparoscopic cholecystectomies in the OR. The primary outcome measure was the difference in technical performance between the 2 groups during the first laparoscopic cholecystectomy. Secondary outcome measures included differences with respect to learning curves in the OR, technical proficiency of each sequential laparoscopic cholecystectomy, and nontechnical skills.
  
  
  RESULTS
  : Residents in the STAC group outperformed residents in the conventional group in the first (P = 0.004), second (P = 0.036), third (P = 0.021), and fourth (P = 0.023) laparoscopic cholecystectomies. The conventional group demonstrated a significant learning curve in the OR (P = 0.015) in contrast to the STAC group (P = 0.032). Residents in the STAC group also had significantly higher nontechnical skills (P = 0.027).
  
  
  CONCLUSIONS
  : Participating in the STAC shifted the learning curve for a basic laparoscopic procedure from the operating room into the simulation laboratory. STAC-trained residents had superior technical proficiency in the OR and nontechnical skills compared with conventionally trained residents. (The study registration ID is NCT01560494.).
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada. vanessa.palter@utoronto.ca
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Palter
authors.forename: Neil
authors.initials: N
authors.lastname: Orzech
authors.forename: Richard K
authors.initials: RK
authors.lastname: Reznick
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000193:education; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method