title: Manual laparoscopic skills development using a low-cost trainer box in Tanzania.
abstract: OBJECTIVE
  To explore the feasibility and effectiveness of guided practice using a low-cost laparoscopic trainer on the development of laparoscopic skills by surgeons in a resource-poor setting.
  
  
  METHODS
  This was a prospective trial involving a pretest/posttest single-sample design. Study participants completed a background survey and pretest on the 5 McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) tasks using a simulator developed and validated by researchers from the University of California, San Francisco. On completion of a 3-month guided practice course, participants were again tested on the MISTELS tasks and completed an exit survey.
  
  
  METHODS
  The Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania.
  
  
  METHODS
  Fourteen Tanzanian surgery residents and specialists completed the study.
  
  
  RESULTS
  Most of the subjects were surgical residents (64.3%). Only 2 participants (14.2%) had previous laparoscopic training, and baseline laparoscopic surgical experience was limited to intraoperative observation only. Study subjects practiced the MISTELS tasks for an average of 8.67 hours (range: 4.75-15.25) over the 3-month course. On the posttest, participants improved significantly in performance of each of the MISTELS tasks (p < 0.001). Total scores on the tasks increased from 24 ± 44 on the pretest to 384 ± 49 on the posttest (p < 0.001). All study participants were satisfied with the course, found the training personally valuable, and felt that their laparoscopic skills had improved on completion of the training.
  
  
  CONCLUSIONS
  We have demonstrated the feasibility and effectiveness of training with a low-cost laparoscopic trainer box in Tanzania. Study participants achieved impressive posttest scores on the 5 MISTELS tasks with minimal baseline laparoscopic exposure. We feel that guided training by an expert was key in ensuring correct technique during practice sessions.
authors.affiliation: Department of Surgery, University of California, San Francisco, California. Electronic address: jessica.beard@ucsfmedctr.org.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Beard
authors.affiliation: Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Larry
authors.initials: L
authors.lastname: Akoko
authors.affiliation: Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Ally
authors.initials: A
authors.lastname: Mwanga
authors.affiliation: Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Charles
authors.initials: C
authors.lastname: Mkony
authors.affiliation: Department of Medicine, University of California, San Francisco, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013636:Tanzania; D013664:Teaching Materials
keywords: Africa; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; laparoscopy; simulation; surgical education; training