Training on an inexpensive tablet-based device is equally effective as on a standard laparoscopic box trainer: A randomized controlled trial.
BACKGROUND
The aim of the study was to assess whether an inexpensive tablet-based box trainer (TBT) is at least equally effective compared with a standard box trainer (SBT) to learn basic laparoscopic skills (BLS). BLS training outside the operating room has been shown to be beneficial for surgical residency. However, simulation trainers are expensive and are not consistently available in all training centers. Therefore, TBT and other homemade box trainers were developed.


METHODS
Medical students were randomized to either a TBT or an SBT and trained 4 fundamentals of laparoscopic surgery (FLS) tasks for 1 hour twice a week for 4 weeks. A baseline test before the training period and a posttraining test were performed. All students then completed a questionnaire to assess their assigned box trainer. The primary outcome measure was the improvement in total test scores. Improvement in the scores for the 4 individual FLS tasks was chosen as a secondary outcome measure.


RESULTS
Thirty-two medical students were recruited. Baseline test scores did not differ significantly between the groups. BLS improved significantly in both groups for the total score and for all 4 tasks separately. Participants in the TBT group showed a greater improvement of total scores than those in the SBT group, although this did not reach statistical significance; noninferiority of the TBT compared with the SBT concerning the improvement of total scores could be demonstrated. Regarding the individual FLS tasks, noninferiority of the TBT could be shown for the pattern cutting and the suturing with intracorporeal knot-tying task. The acceptance of the TBT by the trainees was very good.


CONCLUSIONS
Learning BLS on a homemade TBT is at least equally effective as on an SBT, with the advantage of being very cost saving. Therefore, this readily available box trainer may be used as an effective, flexible training device outside the operating room to improve accessibility to simulation training.
aDepartment of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria bDepartment of Surgery, University of Toronto, Toronto, Canada.
Eliana
E
Montanari
Richard
R
Schwameis
Marisa
M
Louridas
Christian
C
Göbl
Lorenz
L
Kuessel
Stephan
S
Polterauer
Heinrich
H
Husslein
D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D034201:Computers, Handheld; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D010535:Laparoscopy / Q000193:education*; D008297:Male; D000066908:Simulation Training / Q000191:economics / Q000379:methods*; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D055815:Young Adult
Br J Surg. 2014 Aug;101(9):1063-76
24827930
Am J Surg. 1998 Jun;175(6):482-7
9645777
Br J Surg. 2004 Dec;91(12):1549-58
15547882
JSLS. 2014 Jul-Sep;18(3):null
25392668
ANZ J Surg. 2004 Aug;74(8):691-3
15315575
Br J Surg. 2004 Feb;91(2):146-50
14760660
Adv Med Educ Pract. 2015 Jan 30;6:55-63
25674032
Ann Surg. 2002 Oct;236(4):458-63; discussion 463-4
12368674
Ann Surg. 2013 Feb;257(2):224-30
23013806
BJU Int. 2005 Sep;96(4):679-82
16104931
Surg Endosc. 2016 Feb;30(2):512-20
26091982
BJU Int. 2013 Dec;112(8):1223-8
24053711
Clin Teach. 2011 Jun;8(2):118-21
21585673
Urology. 2014 Jan;83(1):116-20
24246314
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):380-6
25337161
Surg Endosc. 2008 Aug;22(8):1887-93
18270774
Arch Dis Child Educ Pract Ed. 2015 Oct;100(5):244-51
26033788
J Minim Access Surg. 2010 Jan;6(1):3-5
20585486
Eur Urol. 2006 Dec;50(6):1285-90; 1290-1
16860459
Ann Surg. 2006 Sep;244(3):400-9
16926566
Surg Endosc. 2005 Nov;19(11):1498-502
16206008
BMJ. 2009 May 14;338:b1802
19443914
J Urol. 2005 Jan;173(1):180-3
15592070
CMAJ. 2010 Aug 10;182(11):1191-6
20351120
Surg Endosc. 2010 Jan;24(1):152-60
19517182
Med J Aust. 1995 Nov 20;163(10):527-30
8538523
Surg Endosc. 2016 Feb;30(2):593-602
26091987
J Endourol. 2005 Jul-Aug;19(6):748-52
16053370
J Endourol. 2012 Jan;26(1):67-72
21999424
Urology. 2005 Jul;66(1):50-4
15992878
Acta Chir Belg. 2013 Mar-Apr;113(2):77-95
23741926
J Med Syst. 2013 Feb;37(1):9903
23321961
BMC Med Educ. 2011 Jun 13;11:32
21668984
Am J Surg. 2010 Jan;199(1):115-20
20103076