title: Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance.
abstract: BACKGROUND
  This study investigated whether deliberate practice leads to an increase in surgical quality in virtual reality (VR) laparoscopic cholecystectomies (LC). Previous research has suggested that sustained DP is effective in surgical training.
  
  
  METHODS
  Fourteen residents were randomized into deliberate practice (n = 7) or control training (n = 7). Both groups performed ten sessions of two VR LCs. Each session, the DP group was assigned 30 min of DP activities in between LCs while the control group viewed educational videos or read journal articles. Performance was assessed on speed and dexterity; quality was rated with global (GRS) and procedure-specific (PSRS) rating scales. All participants then performed five porcine LCs.
  
  
  RESULTS
  Both groups improved over 20 VR LCs in time, dexterity, and global rating scales (all p < 0.05). After 20 LCs, there were no differences in speed or dexterity between groups. The DP group achieved higher quality of VR surgical performance than control for GRS (26 vs. 20, p = 0.001) and PSRS (18 vs. 15, p = 0.001). For VR cases, DP subjects plateaued at GRS = 25 after ten cases and control group at GRS = 20 after five cases. At completion of VR training, 100 % of the DP group reached target quality of performance (GRS ≥ 21) compared with 30 % in the control group. There were no significant differences for improvements in time or dexterity over five porcine LCs.
  
  
  CONCLUSIONS
  This study suggests that DP leads to higher quality performance in VR LC than standard training alone. Standard training may leave individuals in a state of "arrested development" compared with DP.
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK. dahashimoto@partners.org.|Department of Surgery, Massachusetts General Hospital, Boston, USA. dahashimoto@partners.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hashimoto
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Pramudith
authors.initials: P
authors.lastname: Sirimanna
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Ernest D
authors.initials: ED
authors.lastname: Gomez
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.affiliation: Department of Psychology, Florida State University, Tallahassee, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Ericsson
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada. rajesh.aggarwal@mcgill.ca.|Faculty of Medicine, Arnold & Blema Steinberg Medical Simulation Centre, McGill University, 3575 Parc Ave, Suite 5640, Montreal, QC, H2X 3P9, Canada. rajesh.aggarwal@mcgill.ca.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D013552:Swine; D013647:Task Performance and Analysis; D014584:User-Computer Interface
keywords: Cholecystectomy; Education; Imaging & VR