title: Optimizing training cost-effectiveness of simulation-based laparoscopic inguinal hernia repairs.
abstract: BACKGROUND
  Motor learning theory suggests that highly complex tasks are probably best trained under conditions of part task (PT), as opposed to whole-task (WT) training. Within PT, random practice of tasks has been shown to lead to improved skill retention and transfer.
  
  
  METHODS
  General surgery residents were equally randomized to PT vs WT, mastery learning type, and simulation-based training of laparoscopic inguinal hernia repair. Training time and resources used to reach mastery (skill acquisition), performance at 1-month testing (skill retention), and intraoperative time and performance scores (skill transfer) were compared.
  
  
  RESULTS
  Forty-four general surgery trainees were randomized. All residents achieved mastery benchmarks. Trainees in the PT group achieved mastery on average 17 minutes faster (60.2 ± 23.8 vs 77.1 ± 24.8 minutes, P = .02, saving 6.2 instructor hours), used fewer material resources (curricular cost savings of $2,380 or $121 per learner), and were more likely to retain mastery level performance at 1-month retention testing (59% vs 22.7% P = .03). No differences in intraoperative performance were encountered.
  
  
  CONCLUSIONS
  For laparoscopic inguinal hernia repair, random PT simulation-based training seems to be more cost-effective, compared with WT training.
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernández-Irizarry
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
authors.forename: Shahzad M
authors.initials: SM
authors.lastname: Ali
authors.affiliation: Department of Surgery, College of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. Electronic address: farley.david@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D005260:Female; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D010535:Laparoscopy / Q000193:education*; D008297:Male; D009048:Motor Skills; D011214:Practice, Psychological; D012153:Retention, Psychology; D000066908:Simulation Training / Q000191:economics* / Q000379:methods; D014163:Transfer, Psychology
keywords: Contextual interference; Inguinal hernia repairs; Laparoscopy; Motor learning theory; Retention; Simulation-based training