title: Mastering instruments before operating on a patient: the role of simulation training in tool use skills.
abstract: BACKGROUND
  We examined the impact of tool complexity on surgeons' performance and evaluated the value of using a simulation-based program for reducing training cost.
  
  
  METHODS
  Three pairs of surgical graspers with increasing mechanical complexity, which were designed for open, laparoscopic, and endoscopic procedures, were used in performing a simple object transportation task. Task times and mental workload of 17 surgeons were compared using all 3 variations of the graspers to test the impact of tool complexity on surgical performance. Subsequently, 4 of these surgeons decided to enter a 3-week training phase and practiced with these 3 surgical instruments on a daily basis. Learning curves were plotted to examine the value of using simulation for proficiency training with these tools.
  
  
  RESULTS
  Task time was significantly prolonged as tool complexity increased. Practice in a simulated environment shortened the task time significantly and moderately reduced mental workloads. However, the difference in task time varied among the 3 types of tools. Between days 1 and 9, task times for each types of grasper were reduced by 55% (endoscopic), 42% (open), and 22% (laparoscopic).
  
  
  CONCLUSIONS
  Tool complexity may degrade a surgeon's performance. Extensive simulation training programs are important for surgeons to gain proficiency in handling a tool before they practice on patients.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada bin.zheng@ualberta.ca.
authors.forename: Bin
authors.initials: B
authors.lastname: Zheng
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Bo
authors.initials: B
authors.lastname: Fu
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Thamer A
authors.initials: TA
authors.lastname: Al-Tayeb
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Yi Fan
authors.initials: YF
authors.lastname: Hao
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: A Karim
authors.initials: AK
authors.lastname: Qayumi
mesh_terms: D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D057605:Natural Orifice Endoscopic Surgery / Q000193:education*; D066231:Surgeons / Q000193:education*; D013997:Time Factors
keywords: NOTES; laparoscopy; learning curve; simulation; surgical education; tool complexity