title: Sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying-a randomized controlled trial "The Shoebox Study" DRKS00008668.
abstract: OBJECTIVE
  Learning curves for minimally invasive surgery are prolonged since psychomotor skills and visuospatial orientation differ from open surgery and must be learned. This study explored potential advantages of sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying compared to simultaneous learning.
  
  
  METHODS
  Laparoscopy-naïve medical students were randomized into a sequential learning group (SEQ) or a simultaneous learning group (SIM). SEQ (n = 28) trained on a shoebox with direct 3D view before proceeding on a box trainer with 2D laparoscopic view. SIM (n = 25) trained solely on a box trainer with 2D laparoscopic view. Training time and number of attempts needed were recorded until a clearly defined proficiency level was reached.
  
  
  RESULTS
  Groups were not different in total training time (SEQ 5868.7 ± 2857.2 s; SIM 5647.1 ± 2244.8 s; p = 0.754) and number of attempts to achieve proficiency in their training (SEQ 44.0 ± 17.7; SIM 36.8 ± 15.6; p = 0.123). SEQ needed less training time on the box trainer with 2D laparoscopic view than did SIM (SEQ 4170.9 ± 2350.8 s; SIM 5647.1 ± 2244.8 s; p = 0.024), while the number of attempts here was not different (SEQ 29.9 ± 14.1; SIM 36.8 ± 15.6; p = 0.097). SEQ was faster in the first attempts on the shoebox (281.9 ± 113.1 s) and box trainer (270.4 ± 133.1 s) compared to the first attempt of SIM on the box trainer (579.4 ± 323.8 s) (p < 0.001).
  
  
  CONCLUSIONS
  In the present study, SEQ was faster than SIM at the beginning of the learning curve. SEQ did not reduce the total training time needed to reach an ambitious proficiency level. However, SEQ needed less training on the box trainer; thus, laparoscopic experience can be gained to a certain extent with a simple shoebox.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Nickel
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Hendrie
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Kowalewski
authors.affiliation: Institute for Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Carly R
authors.initials: CR
authors.lastname: Garrow
authors.affiliation: Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Maisha
authors.initials: M
authors.lastname: Mantel
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Hannes G
authors.initials: HG
authors.lastname: Kenngott
authors.affiliation: Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Romero
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. beat.mueller@med.uni-heidelberg.de.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
mesh_terms: D002983:Clinical Competence; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008953:Models, Anatomic; D011446:Prospective Studies; D011597:Psychomotor Performance; D000066908:Simulation Training; D065855:Spatial Processing; D013536:Suture Techniques / Q000193:education*
keywords: Education; Laparoscopy; Minimally invasive surgery; Suturing and knot tying; Training