title: Off-site training of laparoscopic skills, a scoping review using a thematic analysis.
abstract: The focus of research in simulation-based laparoscopic training has changed from examining whether simulation training works to examining how best to implement it. In laparoscopic skills training, portable and affordable box trainers allow for off-site training. Training outside simulation centers and hospitals can increase access to training, but also poses new challenges to implementation. This review aims to guide implementation of off-site training of laparoscopic skills by critically reviewing the existing literature.
  
  
  
  An iterative systematic search was carried out in MEDLINE, EMBASE, ERIC, Scopus, and PsychINFO, following a scoping review methodology. The included literature was analyzed iteratively using a thematic analysis approach. The study was reported in accordance with the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement.
  
  
  
  From the search, 22 records were identified and included for analysis. A thematic analysis revealed the themes: access to training, protected training time, distribution of training, goal setting and testing, task design, and unsupervised training. The identified themes were based on learning theories including proficiency-based learning, deliberate practice, and self-regulated learning.
  
  
  
  Methods of instructional design vary widely in off-site training of laparoscopic skills. Implementation can be facilitated by organizing courses and training curricula following sound education theories such as proficiency-based learning and deliberate practice. Directed self-regulated learning has the potential to improve off-site laparoscopic skills training; however, further studies are needed to demonstrate the effect of this type of instructional design.
authors.affiliation: Department of Surgery, Zealand University Hospital, Koege, Denmark. ebbe.thinggaard@gmail.com.|Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Blegdamsvej 9, Copenhagen, 2300, Denmark. ebbe.thinggaard@gmail.com.
authors.forename: Ebbe
authors.identifier: 0000-0002-4218-1212
authors.initials: E
authors.lastname: Thinggaard
authors.affiliation: Department of Surgery, Hilleroed Hospital, Hilleroed, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Kleif
authors.affiliation: Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bjerrum
authors.affiliation: Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jeanett
authors.initials: J
authors.lastname: Strandbygaard
authors.affiliation: Department of Surgery, Zealand University Hospital, Koege, Denmark.
authors.forename: Ismail
authors.initials: I
authors.lastname: Gögenur
authors.affiliation: Department of Surgery and NCR Simulation Consortium, Uniformed Services University / Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: E
authors.initials: E
authors.lastname: Matthew Ritter
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Blegdamsvej 9, Copenhagen, 2300, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D007858:Learning; D000066908:Simulation Training
keywords: Box trainer; Laparoscopy; Medical education; Off-site; Simulation; Technical skills