title: An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events.
abstract: BACKGROUND
  Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions.
  
  
  METHODS
  In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue).
  
  
  RESULTS
  The odds of adverse events were 4.5 (95% confidence interval 1.3-15.3) and 3.9 (95% confidence interval 1.5-9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees.
  
  
  CONCLUSIONS
  Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events.
authors: Department of Urology, Antwerp University Hospital; Faculty of Health Sciences, University of Antwerp, Antwerp.
authors: Gunter
authors: G
authors: De Win
authors: Department of Urology, University Hospitals of KU Leuven; Centre for Surgical Technologies, KU Leuven, Leuven, Belgium.
authors: Siska
authors: S
authors: Van Bruwaene
authors: Kulkarni Endo Surgery Institute, Pune, India.
authors: Jyotsna
authors: J
authors: Kulkarni
authors: Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
authors: Ben
authors: B
authors: Van Calster
authors: Department of Surgery, Faculty of Medicine; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors: Rajesh
authors: R
authors: Aggarwal
authors: School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
authors: Christopher
authors: C
authors: Allen
authors: Centre for Surgical Technologies, KU Leuven, Leuven, Belgium.
authors: Ann
authors: A
authors: Lissens
authors: Department of Urology, University Hospitals of KU Leuven.
authors: Dirk
authors: D
authors: De Ridder
authors: Centre for Surgical Technologies, KU Leuven, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors: Marc
authors: M
authors: Miserez
keywords: laparoscopy; learning curve; simulation; transfer of skills