Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance.
OBJECTIVE
To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis.


METHODS
A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external).


RESULTS
Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time.


CONCLUSIONS
Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.
Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
Hannah
H
Gostlow
Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
Nicholas
N
Marlow
Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
Wendy
W
Babidge
Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia. Electronic address: guy.maddern@adelaide.edu.au.
Guy
G
Maddern
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D010535:Laparoscopy / Q000193:education*; D008297:Male; D009042:Motivation; D016032:Randomized Controlled Trials as Topic; D000066908:Simulation Training; D066231:Surgeons / Q000523:psychology / Q000706:statistics & numerical data*
Medical knowledge; Motivation; Practice-based learning and improvement; laparoscopy; self-directed learning; simulation-based education; surgical education; voluntary training