title: Simulator training in fetoscopic laser surgery for twin-twin transfusion syndrome: a pilot randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of a newly developed training curriculum on the performance of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS) using an advanced high-fidelity simulator model.
  
  
  METHODS
  Ten novices were randomized to receive verbal instructions and either skills training using the simulator (study group; n = 5) or no training (control group; n = 5). Both groups were evaluated with a pre-training and post-training test on the simulator. Performance was assessed by two independent observers and comprised a 52-item checklist for surgical performance (SP) score, measurement of procedure time and number of anastomoses missed. Eleven experts set the benchmark level of performance. Face validity and educational value of the simulator were assessed using a questionnaire.
  
  
  RESULTS
  Both groups showed an improvement in SP score at the post-training test compared with the pre-training test. The simulator-trained group significantly outperformed the control group, with a median SP score of 28 (54%) in the pre-test and 46 (88%) in the post-test vs 25 (48%) and 36 (69%), respectively (P = 0.008). Procedure time decreased by 11 min (from 44 to 33 min) in the study group vs 1 min (from 39 to 38 min) in the control group (P = 0.69). There was no significant difference in the number of missed anastomoses at the post-training test between the two groups (1 vs 0). Subsequent feedback provided by the participants indicated that training on the simulator was perceived as a useful educational activity.
  
  
  CONCLUSIONS
  Proficiency-based simulator training improves performance, indicated by SP score, for fetoscopic laser therapy. Despite the small sample size of this study, practice on a simulator is recommended before trainees carry out laser therapy for TTTS in pregnant women.
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: S H P
authors.identifier: http://orcid.org/0000-0002-2274-8357
authors.initials: SH
authors.lastname: Peeters
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Akkermans
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Slaghekke
authors.affiliation: PLATO, Center for Research and Development in Education and Training, Faculty of Social Sciences, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bustraan
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Haak
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.affiliation: Department of Obstetrics and Gynecology, Division of Fetal Medicine, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Lewi
authors.affiliation: Department of Obstetrics and Gynecology, Division of Fetal Medicine, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Devlieger
authors.affiliation: Department of Obstetrics and Gynecology, Division of Fetal Medicine, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: De Catte
authors.affiliation: Department of Obstetrics and Gynecology, Division of Fetal Medicine, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Deprest
authors.affiliation: Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Ek
authors.affiliation: Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Kublickas
authors.affiliation: Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Lindgren
authors.affiliation: Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Tiblad
authors.affiliation: Department of Obstetrics, Division of Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000328:Adult; D001530:Belgium; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000193:education* / Q000379:methods; D006176:Gynecology / Q000193:education*; D006801:Humans; D017075:Laser Coagulation / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009774:Obstetrics / Q000193:education*; D010865:Pilot Projects; D011247:Pregnancy; D015203:Reproducibility of Results; D000066908:Simulation Training; D013548:Sweden
keywords: laser therapy; monochorionic twins; randomized controlled trial; simulator; teaching; training; twin-twin transfusion syndrome