Simulator training and non-technical factors improve laparoscopic performance among OBGYN trainees.
OBJECTIVE
To investigate how simulator training and non-technical factors affect laparoscopic performance among residents in obstetrics and gynecology.


METHODS
In this prospective study, trainees were randomized into three groups. The first group was allocated to proficiency-based training in the LapSimGyn(®) virtual reality simulator. The second group received additional structured mentorship during subsequent laparoscopies. The third group served as control group. At baseline an operation was performed and visuospatial ability, flow and self-efficacy were assessed. All groups subsequently performed three tubal occlusions. Self-efficacy and flow were assessed before and/or after each operation.


METHODS
Simulator training was conducted at the Center for Advanced Medical Simulation and Training, Karolinska University Hospital. Sterilizations were performed at each trainee's home clinic.


METHODS
Twenty-eight trainees/residents from 21 hospitals in Sweden were included.
Visuospatial ability was tested by the Mental Rotation Test-A. Flow and self-efficacy were assessed by validated scales and questionnaires. Laparoscopic performance was measured as the duration of surgery. Visuospatial ability, self-efficacy and flow were correlated to the laparoscopic performance using Spearman's correlations. Differences between groups were analyzed by the Mann-Whitney U-test.


RESULTS
No differences across groups were detected at baseline. Self-efficacy scores before and flow scores after the third operation were significantly higher in the trained groups. Duration of surgery was significantly shorter in the trained groups. Flow and self-efficacy correlate positively with laparoscopic performance.


CONCLUSIONS
Simulator training and non-technical factors appear to improve the laparoscopic performance among trainees/residents in obstetrics and gynecology.
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden; Department of Obstetrics and Gynecology, Södertälje Hospital, Södertälje, Sweden; Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
Liv
L
Ahlborg
Leif
L
Hedman
Henry
H
Nisell
Li
L
Felländer-Tsai
Lars
L
Enochsson
D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008611:Mentors; D008875:Middle Aged; D009774:Obstetrics / Q000193:education*; D061646:Operative Time; D011446:Prospective Studies; D011597:Psychomotor Performance; D020377:Self Efficacy; D013548:Sweden; D014584:User-Computer Interface
Laparoscopic surgery; flow; obstetrics and gynecology; residents; self-efficacy; simulator training; visuospatial ability