title: Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve.
abstract: BACKGROUND
  Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum.
  
  
  METHODS
  Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed.
  
  
  RESULTS
  By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement.
  
  
  CONCLUSIONS
  This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.
authors.affiliation: Sao Paulo University Medical School - CEPEC Vicky Safra - Department of Urology, Sao Paulo, Brazil.
authors.forename: Ricardo Jordão
authors.initials: RJ
authors.lastname: Duarte
authors.forename: José
authors.initials: J
authors.lastname: Cury
authors.forename: Luis Carlos Neves
authors.initials: LC
authors.lastname: Oliveira
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D016009:Chi-Square Distribution; D002983:Clinical Competence; D003198:Computer Simulation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D013337:Students, Medical; D013647:Task Performance and Analysis; D013997:Time Factors; D014584:User-Computer Interface