title: Laparoscopic skills maintenance: a randomized trial of virtual reality and box trainer simulators.
abstract: OBJECTIVE
  A number of simulators have been developed to teach surgical trainees the basic skills required to effectively perform laparoscopic surgery; however, consideration needs to be given to how well the skills taught by these simulators are maintained over time. This study compared the maintenance of laparoscopic skills learned using box trainer and virtual reality simulators.
  
  
  METHODS
  Participants were randomly allocated to be trained and assessed using either the Society of American Gastrointestinal Endoscopic Surgeons Fundamentals of Laparoscopic Surgery (FLS) simulator or the Surgical Science virtual reality simulator. Once participants achieved a predetermined level of proficiency, they were assessed 1, 3, and 6 months later. At each assessment, participants were given 2 practice attempts and assessed on their third attempt.
  
  
  METHODS
  The study was conducted through the Simulated Surgical Skills Program that was held at the Royal Australasian College of Surgeons, Adelaide, Australia.
  
  
  RESULTS
  Overall, 26 participants (13 per group) completed the training and all follow-up assessments. There were no significant differences between simulation-trained cohorts for age, gender, training level, and the number of surgeries previously performed, observed, or assisted. Scores for the FLS-trained participants did not significantly change over the follow-up period. Scores for LapSim-trained participants significantly deteriorated at the first 2 follow-up points (1 and 3 months) (p < 0.050), but returned to be near initial levels by the final follow-up (6 months).
  
  
  CONCLUSIONS
  This research showed that basic laparoscopic skills learned using the FLS simulator were maintained more consistently than those learned on the LapSim simulator. However, by the final follow-up, both simulator-trained cohorts had skill levels that were not significantly different to those at proficiency after the initial training period.
authors.affiliation: University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Montaha W
authors.initials: MW
authors.lastname: Khan
authors.affiliation: University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Diwei
authors.initials: D
authors.lastname: Lin
authors.affiliation: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Marlow
authors.affiliation: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia.
authors.forename: Meryl
authors.initials: M
authors.lastname: Altree
authors.affiliation: University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Babidge
authors.affiliation: John Field Consulting Pty Ltd, Adelaide, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Field
authors.affiliation: University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hewett
authors.affiliation: University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia. Electronic address: guy.maddern@adelaide.edu.au.
authors.forename: Guy
authors.initials: G
authors.lastname: Maddern
mesh_terms: D000328:Adult; D003198:Computer Simulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D017063:Outcome Assessment, Health Care; D014584:User-Computer Interface
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; education; laparoscopy