title: Perceptions, training experiences, and preferences of surgical residents toward laparoscopic simulation training: a resident survey.
abstract: BACKGROUND
  Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents' curriculum is essential to enhance participation in the simulation laboratory.
  
  
  METHODS
  A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study.
  
  
  RESULTS
  Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The simulation laboratory was most commonly used during work hours; lack of free time during work hours was most commonly cited as a reason for underutilization. Factors influencing use of the simulation laboratory in order of importance were the need for skill development, an interest in minimally invasive surgery, mandatory/protected time in a simulation environment as part of the residency program curriculum, a recommendation by an attending surgeon, and proximity of the simulation center. The most preferred simulation tool was the live animal model followed by cadaveric tissue. Virtual reality simulators were among the least-preferred (25%) simulation tools. Most residents (91.0%) felt that mandatory/protected time in a simulation environment should be introduced into resident training protocols.
  
  
  CONCLUSIONS
  Mandatory and protected time in a simulation environment as part of the resident training curriculum may improve participation in simulation training. A comprehensive curriculum, which includes the use of live animals, cadaveric tissue, and virtual reality simulators, may enhance the laparoscopic training experience and interest level of surgical trainees.
authors.affiliation: The Stanley J. Dudrick Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut. Electronic address: shohan_shetty@hotmail.com.
authors.forename: Shohan
authors.initials: S
authors.lastname: Shetty
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Boris
authors.initials: B
authors.lastname: Zevin
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
mesh_terms: D000328:Adult; D001290:Attitude; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D008297:Male; D013337:Students, Medical / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; curriculum; laparoscopic skills training; resident participation; simulation; surgical education