Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study.
OBJECTIVE
Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills.


METHODS
A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values.


RESULTS
Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course.


CONCLUSIONS
Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: jan-maarten.luursema@radboudumc.nl.
Jan-Maarten
JM
Luursema
Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Epidemiology, Biostatistics & HTA, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Maroeska M
MM
Rovers
Department of Technical Medicine, University of Twente, Enschede, The Netherlands.
Marleen
M
Groenier
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Harry
H
van Goor
D000328:Adult; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D014584:User-Computer Interface; D055815:Young Adult
Practice-Based Learning and Improvement; VR simulator training; damage control; laparoscopy; performance assessment