title: Multimedia-based training on Internet platforms improves surgical performance: a randomized controlled trial.
abstract: BACKGROUND
  Surgical procedures are complex motion sequences that require a high level of preparation, training, and concentration. In recent years, Internet platforms providing surgical content have been established. Used as a surgical training method, the effect of multimedia-based training on practical surgical skills has not yet been evaluated. This study aimed to evaluate the effect of multimedia-based training on surgical performance.
  
  
  METHODS
  A 2 × 2 factorial, randomized controlled trial with a pre- and posttest design was used to test the effect of multimedia-based training in addition to or without practical training on 70 participants in four groups defined by the intervention used: multimedia-based training, practical training, and combination training (multimedia-based training + practical training) or no training (control group). The pre- and posttest consisted of a laparoscopic cholecystectomy in a Pelvi-Trainer and was video recorded, encoded, and saved on DVDs. These were evaluated by blinded raters using a modified objective structured assessment of technical skills (OSATS). The main evaluation criterion was the difference in OSATS score between the pre- and posttest (ΔOSATS) results in terms of a task-specific checklist (procedural steps scored as correct or incorrect).
  
  
  RESULTS
  The groups were homogeneous in terms of demographic parameters, surgical experience, and pretest OSATS scores. The ΔOSATS results were highest in the multimedia-based training group (4.7 ± 3.3; p < 0.001). The practical training group achieved 2.5 ± 4.3 (p = 0.028), whereas the combination training group achieved 4.6 ± 3.5 (p < 0.001), and the control group achieved 0.8 ± 2.9 (p = 0.294).
  
  
  CONCLUSIONS
  Multimedia-based training improved surgical performance significantly and thus could be considered a reasonable tool for inclusion in surgical curricula.
authors.affiliation: Department for Abdominal, Vascular, and Transplant Surgery, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimerstrasse 200, 51109 Köln (Cologne), Germany. carolinapape@gmx.de
authors.forename: Carolina
authors.initials: C
authors.lastname: Pape-Koehler
authors.forename: Marc
authors.initials: M
authors.lastname: Immenroth
authors.forename: Stefan
authors.initials: S
authors.lastname: Sauerland
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lindlohr
authors.forename: Jens
authors.initials: J
authors.lastname: Toaspern
authors.forename: Markus
authors.initials: M
authors.lastname: Heiss
mesh_terms: D000328:Adult; D057189:Checklist; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D004521:Educational Measurement; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D019212:Multimedia; D010820:Physicians; D011214:Practice, Psychological; D011597:Psychomotor Performance; D016037:Single-Blind Method; D013337:Students, Medical; D014741:Video Recording