title: Changing the Learning Curve in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program.
abstract: OBJECTIVE
  A major challenge in laparoscopic surgery is the lack of depth perception. With the development and continued improvement of 3D video technology, the potential benefit of restoring 3D vision to laparoscopy has received substantial attention from the surgical community. Despite this, procedures conducted under 2D vision remain the standard of care, and trainees must become proficient in 2D laparoscopy. This study aims to determine whether incorporating 3D vision into a 2D laparoscopic simulation curriculum accelerates skill acquisition in novices.
  
  
  METHODS
  Postgraduate year-1 surgical specialty residents (n = 15) at the Schulich School of Medicine and Dentistry, at Western University were randomized into 1 of 2 groups. The control group practiced the Fundamentals of Laparoscopic Surgery peg-transfer task to proficiency exclusively under standard 2D laparoscopy conditions. The experimental group first practiced peg transfer under 3D direct visualization, with direct visualization of the working field. Upon reaching proficiency, this group underwent a perceptual switch, changing to standard 2D laparoscopy conditions, and once again trained to proficiency.
  
  
  RESULTS
  Incorporating 3D direct visualization before training under standard 2D conditions significantly (p < 0.0.5) reduced the total training time to proficiency by 10.9 minutes or 32.4%. There was no difference in total number of repetitions to proficiency. Data were also used to generate learning curves for each respective training protocol.
  
  
  CONCLUSIONS
  An adaptive learning approach, which incorporates 3D direct visualization into a 2D laparoscopic simulation curriculum, accelerates skill acquisition. This is in contrast to previous work, possibly owing to the proficiency-based methodology employed, and has implications for resource savings in surgical training.
authors.affiliation: Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Anatomy and Cell Biology, Corps for Research of Instructional and Perceptual Technologies, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dawidek
authors.affiliation: Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Roach
authors.affiliation: Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ott
authors.affiliation: Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Anatomy and Cell Biology, Corps for Research of Instructional and Perceptual Technologies, The University of Western Ontario, London, Ontario, Canada. Electronic address: tim.wilson@uwo.ca.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Wilson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D003867:Depth Perception; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D009864:Ontario; D066330:Printing, Three-Dimensional; D000066908:Simulation Training / Q000379:methods*; D055815:Young Adult
keywords: 3D visualization; FLS; Medical Knowledge; Practice-Based Learning and Improvement; adaptive training; laparoscopy; skill acquisition