title: A Virtual Reality Training Curriculum for Laparoscopic Colorectal Surgery.
abstract: OBJECTIVE
  Training within a competency-based curriculum (CBC) outside the operating room enhances performance during real basic surgical procedures. This study aimed to design and validate a virtual reality CBC for an advanced laparoscopic procedure: sigmoid colectomy.
  
  
  METHODS
  This was a multicenter randomized study. Novice (surgeons who had performed <5 laparoscopic colorectal resections as primary operator), intermediate (between 10 and 20), and experienced surgeons (>50) were enrolled. Validity evidence for the metrics given by the virtual reality simulator, the LAP Mentor, was based on the second attempt of each task in between groups. The tasks assessed were 3 modules of a laparoscopic sigmoid colectomy (medial dissection [MD], lateral dissection [LD], and anastomosis) and a full procedure (FP). Novice surgeons were randomized to 1 of 2 groups to perform 8 further attempts of all 3 modules or FP, for learning curve analysis.
  
  
  METHODS
  Two academic tertiary care centers-division of surgery of St. Mary's campus, Imperial College Healthcare NHS Trust, London and Nord Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, were involved.
  
  
  METHODS
  Novice surgeons were residents in digestive surgery at St. Mary's and Nord Hospitals. Intermediate and experienced surgeons were board-certified academic surgeons.
  
  
  RESULTS
  A total of 20 novice surgeons, 7 intermediate surgeons, and 6 experienced surgeons were enrolled. Evidence for validity based on experience was identified in MD, LD, and FP for time (p = 0.005, p = 0.003, and p = 0.001, respectively), number of movements (p = 0.013, p = 0.005, and p = 0.001, respectively), and path length (p = 0.03, p = 0.017, and p = 0.001, respectively), and only for time (p = 0.03) and path length (p = 0.013) in the anastomosis module. Novice surgeons' performance significantly improved through repetition for time, movements, and path length in MD, LD, and FP. Experienced surgeons' benchmark criteria were defined for all construct metrics showing validity evidence.
  
  
  CONCLUSIONS
  A CBC in laparoscopic colorectal surgery has been designed. Such training may reduce the learning curve during real colorectal resections in the operating room.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, United Kingdom; Centre for Surgical Teaching and Research (CERC), Aix-Marseille Université, Marseille, France. Electronic address: laura.beyer@ap-hm.fr.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.affiliation: Centre for Surgical Teaching and Research (CERC), Aix-Marseille Université, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hashimoto
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Arnold & Blema Steinberg Medical Simulation Centre, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003107:Colorectal Surgery / Q000193:education*; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D006113:United Kingdom; D014584:User-Computer Interface
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; advanced surgery; colorectal; education; laparoscopy; simulation