title: A Randomized Controlled Trial to Assess the Effects of Competition on the Development of Laparoscopic Surgical Skills.
abstract: BACKGROUND
  Serious games have demonstrated efficacy in improving participation in surgical training activities, but studies have not yet demonstrated the effect of serious gaming on performance. This study investigated whether competitive training (CT) affects laparoscopic surgical performance.
  
  
  METHODS
  A total of 20 novices were recruited, and 18 (2 dropouts) were randomized into control or CT groups to perform 10 virtual reality laparoscopic cholecystectomies (LCs). Competitiveness of each participant was assessed. The CT group members were informed they were competing to outperform one another for a prize; performance ranking was shown before each session. The control group did not compete. Performance was assessed on time, movements, and instrument path length. Quality of performance was assessed with a global rating scale score.
  
  
  RESULTS
  There were no significant intergroup differences in baseline skill or measured competitiveness. Time and global rating scale score, at final LC, were not significantly different between groups; however, the CT group was significantly more dexterous than control and had significantly lower variance in number of movements and instrument path length at the final LC (p = 0.019). Contentiousness was inversely related to time in the CT group.
  
  
  CONCLUSIONS
  This was the first randomized controlled trial to investigate if CT can enhance performance in laparoscopic surgery. CT may lead to improved dexterity in laparoscopic surgery but yields otherwise similar performance to that of standard training in novices. Competition may have different effects on novices vs experienced surgeons, and subsequent research should investigate CT in experienced surgeons as well.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biosurgery and Surgical Technology, St. Mary׳s Hospital, Imperial College London, London, United Kingdom. Electronic address: dahashimoto@partners.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hashimoto
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ernest D
authors.initials: ED
authors.lastname: Gomez
authors.affiliation: Center for Surgical Teaching and Research (CERC), Université de la Méditerranée, Marseille, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.affiliation: Department of Biosurgery and Surgical Technology, St. Mary׳s Hospital, Imperial College London, London, United Kingdom.
authors.forename: Ankur
authors.initials: A
authors.lastname: Khajuria
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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, United Kingdom.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Arnold and Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000193:education; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D010988:Play and Playthings
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; competitive training; minimally invasive; student education; surgical education; virtual reality simulation