title: Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves.
abstract: OBJECTIVE
  Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training.
  
  
  METHODS
  After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups.
  
  
  METHODS
  Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands.
  
  
  METHODS
  Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course.
  
  
  RESULTS
  In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group.
  
  
  CONCLUSIONS
  No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand.
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands. Electronic address: t_broekema88@hotmail.com.
authors.forename: Theo H
authors.initials: TH
authors.lastname: Broekema
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Aaldert K
authors.initials: AK
authors.lastname: Talsma
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Wevers
authors.affiliation: Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Postgraduate School of Medicine, University Medical Center Groningen, Groningen, The Netherlands; University Groningen, Groningen, The Netherlands.
authors.forename: Jean-Pierre E N
authors.initials: JEN
authors.lastname: Pierie
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D009426:Netherlands; D011300:Preoperative Care / Q000379:methods; D000066908:Simulation Training / Q000379:methods; D018709:Statistics, Nonparametric; D013337:Students, Medical; D014741:Video Recording / Q000379:methods*; D055815:Young Adult
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; instructional video; laparoscopy; learning curve; skills training